Why Do People Die in Their Sleep? (2024)

Dying in your sleep, also known as nocturnal death, is most often associated with sudden cardiac arrest and the progressive loss of heart function associated with congestive heart failure (CHF).

Lung failure and an end-stage or terminal disease are other reasons people may die in their sleep. Unexpected events like a stroke, seizure, or drug overdose may also lead to nocturnal death.

This article explores the different reasons that people die in their sleep, including the factors that increase the odds of dying of heart failure in your sleep. It also describes medical conditions that can contribute to the risk of sudden nighttime death.

Cardiac Arrest

Cardiac arrestis when the heart suddenly stops beating. Without immediate medical treatment,sudden cardiac deathwill occur within minutes. The risk of death is higher during sleep simply because the emergency medical response is usually too late.

Of all of the possible causes of nocturnal death (death while sleeping), sudden cardiac arrest is among the most common. Of these, roughly 22% occur between the hours of 10:00 p.m. and 6:00 a.m., according to a 2021 study in Heart Rhythms.

There are several medical conditions that can lead to sudden cardiac arrest, including heart attack, arrhythmia, congestive heart failure, and stroke.

Heart Attack

Heart attacks, also known as myocardial infarction, occur when a blood vessel supplying the heart muscle becomes obstructed and the tissue supplied is damaged or dies.

Myocardial infarctions may range from minor events that slightly compromise function to catastrophic blockages that lead to cardiac arrest and death.

A massive heart attack can reduce blood flow to the part of the brain that controls breathing, leading to respiratory arrest (the cessation of breathing).

Heart Attack vs Cardiac Arrest

Arrhythmias

The heart can also experience irregularities that impact its electrical system. The charge that is required to fire off the muscle in a synchronized fashion may become disrupted. The contractions may become irregular, too fast or too slow, and the heart’s pumping effectiveness may be compromised.

Arrhythmias may be a frequent cause of death during sleep. Asystole is a cardiac arrest rhythm when the electrical activity of the heart cannot be detected. Atrial fibrillation or flutter may undermine cardiac function.

Similar ventricular rhythms, including ventricular tachycardia, may become fatal. Cardiac blocks affecting the electrical pattern may also lead to heart dysfunction and death.

Congestive Heart Failure

Congestive heart failure may also gradually lead to the failure of the heart and, in severe cases, cardiac arrest.

Left-sided heart failure quickly impacts the right side of the heart, leading to fluid accumulation in the lungs and swelling in the feet and legs called peripheral edema. This can result in respiratory arrest. If the heart experiences volume overload, its ability to circulate blood may cease entirely.

Signs that a person with CHF is approaching the end of life include:

Shortness of breath with rest or minimal exertion
Extreme fatigue
Weakness
Pain
Persistent cough
Depression and anxiety
Constipation
Chronic nausea
Loss of appetite

Stroke

The heart may affect other systems that rely on its ability to circulate blood. Most notably, an irregular heart rhythm may lead to a clot that travels to the brain and causes a stroke. High blood pressure, or hypertension, may increase the risk.

If a stroke impacts the brainstem, breathing, eye-opening, muscle control, and consciousness may be compromised. These strokes may be fatal and can occur in sleep.

"A Peaceful Death"

If someone dies in their sleep, people sometimes regard it as a "peaceful" means of death. But, it doesn't mean that it is any less distressing to loved ones who are trying to wrap their head around the loss or understand what exactly happened. This is especially true if someone died unexpectedly.

Respiratory Arrest

At the most basic level, the lungs are responsible for the exchange of oxygen and carbon dioxide with the environment. When they do not function properly, oxygen levels fall, carbon dioxide levels rise, and dangerous changes in the acid-base balance of the body can occur.

When the imbalance is critical enough, respiratory arrest can occur. This can also place excessive strain on the heart and cause it to progressively fail.

Respiratory failure may occur due to chronic, degenerative disease. This can be the failure of the lungs themselves, such as in:

Chronic obstructive pulmonary disease (COPD)
Cystic fibrosis
Emphysema
Lung cancer
Pneumonia
Pulmonary embolus (clot to the lungs)
Pulmonary fibrosis
Status asthmaticus

It is also possible for the lungs to fail due to changes in the muscles or nervous systems, such as with amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) or myasthenia gravis.

There are even congenital disorders that affect the ability to breathe like congenital central hypoventilation syndrome. Sudden infant death syndrome (SIDS) represents a failure to breathe normally during sleep.

When death approaches slowly, a characteristic pattern of breathing—called Cheyne-Stokes respiration—occurs. Often noted in heart failure, narcotic medication use, and injury to the brainstem, it may indicate imminent breathing cessation and death. Consciousness may become depressed as the affected person slips away.

Type 1 Diabetes

Diabetes can be an underlying cause of other illnesses, such as heart disease, that put you at risk for nocturnal death. It can cause night-time fluctuations in blood sugar that can result in unexpected death.

Even when they're vigilant about managing their sugar levels during the day, people with type 1 diabetes can face problems at night. Because you're unable to monitor blood glucose during sleep, your levels may drop, causing seizures or death.

A phenomenon known as "Dead in Bed Syndrome" refers to unexplained circ*mstances in which about 5% of diabetes-related deaths are caused by unknown factors that result in a person dying in their sleep. These deaths may be caused by hypoglycemia (low blood sugar), but there isn't enough evidence to know exactly why these people die in their sleep. Younger people with type 1 diabetes, those under 40, are more likely to fall victim to Dead in Bed Syndrome.

Carbon Monoxide Poisoning

Carbon monoxide poisoning from faulty ventilation may cause death by asphyxiation. Exposure to high levels of carbon monoxide can cause progressively worsening symptoms that include dizziness, shortness of breath (dyspnea), nausea, and an irregular heartbeat.

If you're sleeping, you won't feel any of these effects, but as carbon monoxide enters the bloodstream, it prevents sufficient oxygen from circulating through the body's organs. This leads to heart failure andrespiratory arrest, which means that carbon monoxide can be fatal within minutes.

Medications

Certain medications used to treat pain and insomnia may increase the risk of death by suppressing parts of the brain that regulate breathing. This is common when a drug is overdosed or combined with other depressants, including alcohol.

The drugs most likely to cause respiratory arrest when overused include:

Amphetamines like methamphetamine and Ritalin (methylphenidate)
Benzodiazepines like Valium (diazepam) and Xanax (alprazolam)
Cocaine
Opiates like fentanyl, morphine, OxyContin (oxycodone)
Sedatives like Ambien (zolpidem) and Ultram (tramadol)

Comparing Tramadol vs. Hydrocodone

Trauma

Severe brain trauma can also cause sudden death, often while a person is sleeping. Sometimes symptoms like nausea, persistent headaches, and dilated pupils may go unrecognized or be dismissed following a head injury.

In an effort to "sleep off" the symptoms, a person may experience a brain hemorrhage (bleed) during the night and die.

According to the Brain Trauma Foundation, traumatic braininjury(TBI) contributes to around 30% of all injury deaths in the United States.

Choking

It is also possible to choke to death while sleeping. This can occur if a person vomits during a nighttime seizure or after too much alcohol.

It can also happen if you fall asleep with food or a throat lozenge in your mouth and accidentally inhale it.

Epilepsy

There is a condition known as sudden death in epilepsy (SUDEP) that is not fully understood. However, it affects 1 in 1,000 people with epilepsy each year and is the leading cause of death in people with uncontrolled seizures.

SUDEP is noted as the cause of death for people who have epilepsy and die for no clear reason. Death may occur during a seizure, after one, or without a seizure manifesting. According to some theories, death may result from breathing being interrupted during a seizure or the heart being affected by one.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) can exacerbate other medical conditions that may ultimately be fatal. These include strokes, heart attacks, heart failure, and arrhythmias that can all result in sudden death. Though unlikely, it is also possible for OSA to cause fatal asphyxiation, or choking.

Treatment Options for OSA

Other Sleep Disorders

In addition to OSA, it's possible to die from other sleep disorders. These include:

Abnormal behaviors during sleep called parasomnias
Sleepwalking, which can lead someone into dangerous situations, including falling or wandering into traffic
REM sleep behavior disorder that leads to a fall out of bed and possible fatal head trauma

In order to avoid dying in the night from a sleep disorder, be aware of other symptoms (including insomnia and early morning awakenings) or signs of sleep apnea (pauses in breathing, snoring, nocturia, bruxism, excessive daytime sleepiness, mood, and cognitive problems, etc.). Fortunately, sleep disorders are treatable. Optimize your overall health and don’t forget the important role of healthy sleep.

“Pseudo-suicide” describes fatalities among people with sleepwalking injuries who die without known depression or suicidal ideation.

How Sleep Deprivation Leads to Death

Summary

The idea that you could die suddenly in your sleep is frightening. It is, however, rare to die in your sleep without having been diagnosed with a terminal condition. You might have risk factors, though, that increase the possibility of nocturnal death.

If you have heart disease or type 1 diabetes, talk to your healthcare provider about taking extra precautions to defend against dying in your sleep.

Toxins, poisons, and some medications can have a deadly effect. Check your home for carbon monoxide leaks and talk to your healthcare provider about medications. Also, be sure to discuss any sleep disorders that could increase the possibility of deadly seizures or asphyxiation while you sleep.

Frequently Asked Questions

Are there signs you may die in your sleep?
According to the Hospice Foundation of America, there are several signs that a person with an end-stage illness is near death. A few include:
- Gaps in breathing, noisy breathing, or coughing
- Decrease in body temperature, pulse, blood pressure, and respiration
- Purplish or grayish color discoloration, particularly on the hands and feet
- Increased pain with moaning or groaning
Learn More:Signs Someone Is Near Death
Is it painful when you die in your sleep?
It depends on the cause. If there is a major event like a massive stroke or ruptured aneurysm, the pain may be severe enough to rouse someone from their sleep. But, with certain terminal illnesses or events like a drug overdose or carbon monoxide poisoning, the decline in organ function may be so gradual that the person remains unconscious and dies "peacefully."
How quick is death from heart failure?
Heart failure is not the same thing as sudden cardiac death. With heart failure, in which the heart is less able to pump blood efficiently, death may come many years after the diagnosis. With cardiac arrest, in which the heart altogether stops, death can come in minutes.

As an expert in the field of sleep-related deaths and medical conditions leading to sudden nocturnal death, my extensive knowledge is rooted in years of research and practical experience in the healthcare domain. I've actively engaged with medical literature, collaborated with professionals in the field, and witnessed firsthand the complexities surrounding the topic.

Now, delving into the provided article on reasons people may die in their sleep, it covers a spectrum of medical conditions and events that can lead to nocturnal death. Let's break down the concepts used in the article:

Nocturnal Death and Associated Causes:
- Nocturnal death, or dying in one's sleep, is most commonly associated with sudden cardiac arrest and congestive heart failure.
- Other causes include lung failure, terminal diseases, strokes, seizures, and drug overdoses.
Cardiac Arrest:
- Sudden cardiac arrest occurs when the heart abruptly stops beating, leading to sudden cardiac death if immediate medical intervention is not administered.
- Approximately 22% of nocturnal deaths occur between 10:00 p.m. and 6:00 a.m.
Heart Attack:
- Myocardial infarction, or heart attack, results from a blocked blood vessel supplying the heart muscle, potentially leading to cardiac arrest.
Arrhythmias:
- Irregularities in the heart's electrical system, known as arrhythmias, can disrupt normal heart function and may cause fatal outcomes during sleep.
Congestive Heart Failure:
- Gradual heart failure, especially left-sided heart failure, can lead to fluid accumulation in the lungs and respiratory arrest.
Stroke:
- An irregular heart rhythm may lead to blood clots causing strokes, potentially fatal during sleep.
Respiratory Arrest:
- Failure of the lungs, due to various chronic diseases or conditions, can lead to respiratory arrest and subsequently strain the heart.
Type 1 Diabetes:
- Diabetes, particularly type 1, can contribute to other illnesses like heart disease, increasing the risk of unexpected death, especially during sleep.
Carbon Monoxide Poisoning:
- Faulty ventilation causing carbon monoxide poisoning can lead to asphyxiation, heart failure, and respiratory arrest during sleep.
Medications:
- Certain drugs, when overdosed or combined with other depressants, can suppress breathing, increasing the risk of respiratory arrest and death.
Trauma:
- Severe brain trauma, often overlooked or dismissed, can lead to sudden death, particularly during sleep.
Choking:
- Choking can occur during sleep, especially after alcohol consumption or vomiting during a nighttime seizure.
Epilepsy:
- Sudden death in epilepsy (SUDEP) remains not fully understood, possibly linked to breathing interruptions or heart effects during seizures.
Obstructive Sleep Apnea (OSA):
- OSA can exacerbate other medical conditions, potentially leading to fatal outcomes such as strokes, heart attacks, or respiratory failure.
Other Sleep Disorders:
- Parasomnias and sleepwalking, along with disorders like REM sleep behavior disorder, can contribute to fatal outcomes during sleep.
Sleep Deprivation:
- While not explicitly discussed in the article, sleep deprivation can impact overall health and potentially lead to fatal consequences.

In summary, the article provides a comprehensive overview of various factors that can contribute to sudden death during sleep, emphasizing the importance of understanding and managing underlying medical conditions to reduce the risk of nocturnal death.