If you’re told an acquaintance has died in his or her sleep, it might mean the cause of death is unclear — or the family just wants to maintain privacy. But when somebody close to you is found dead in bed for no apparent reason — especially a younger adult who was considered healthy — it’s important to find answers.
For grieving survivors, certainty about why someone died helps bring closure. And for family members, being aware of a genetic cause can potentially lead them to lifesaving treatment. Below, experts describe the chain of events that follow a sudden, unexplained death.
[See: 17 Ways Heart Health Varies in Women and Men.]
“Anybody who dies at home, unwitnessed, is going to be reported to the medical examiner’s office,” says Dr. Candace Schoppe, a forensic pathologist and medical examiner for Dallas County. “Whether or not we take jurisdiction depends on how much medical history the person has and what the circumstances are.”
The age of the deceased is an important consideration, Schoppe says. The younger a person is, the more likely there will be an autopsy. If it’s an adult in his or her mid- to late 50s or older with a known medical condition, who’s found in bed with nothing remarkable at the scene, an autopsy is unlikely.
A suspicious death with the possibility of homicide is different. “Someone that’s dead in bed — if there’s something amiss with the scene, or there’s something in the history or the person’s real young and has no history — I would always keep that in the back of my mind,” Schoppe says.
Accidental overdose is another possibility to consider, she says, with the “skyrocketing” number of people misusing or abusing prescription painkillers, usually opioids.
Household Tragedies
Every year brings tragic sudden deaths from carbon monoxide poisoning, says Dr. Patrick Lantz, a professor of pathology at Wake Forest University School of Medicine and a regional forensic pathologist and medical examiner in North Carolina. A malfunctioning furnace could emit carbon monoxide throughout the home. “People can die in their sleep from that very easily,” he says.
Or, people with an enclosed garage in the house may turn on the car to warm it up, leaving the garage door closed. “It can build up carbon monoxide pretty quickly,” Lantz says. With silent engines, a person might leave the motor running without realizing it.
Strange cases happen: Someone could get electrocuted from a faulty wire in an appliance like a hairdryer. “They could have touched that in the bathroom, and their irregular heartbeat may not start right away,” Lantz says. “It may give them enough time to lie down on the bed and fall asleep or fall down on the bed. They might not be found right next to the device that caused the electrocution.”
[See: Was That a Seizure?]
If you ever find somebody who has died in bed, the next course of action depends on the circumstances, Lantz says: “If it’s someone who had known disease like cancer or long-term heart disease, probably the best thing to do is to call the individual’s physician.”
However, if death was unexpected, it’s essential to call 911, Lantz says. “Not only will law enforcement arrive, but probably a rescue squad will arrive, just to make sure the person is really dead,” he says. “Because they could just not be breathing very much and have a pulse that you couldn’t detect. So it’s really important to have a professional to assess if a person has died in his or her sleep.”
Starts at the Heart
Adult cases of natural death that go to autopsy tend to be people between 20 and 55 who had very little reported medical history, Schoppe says. “They may just have a history of slightly high blood pressure, or maybe just diabetes, or maybe just obesity,” she says. “And in the vast majority of [cases], what we’ve been finding is undiagnosed cardiovascular disease.”
Cases where a person suddenly drops dead, whether at night or during the day, are more likely due to a heart arrhythmia, Schoppe says. With these abnormal heart rhythms, the electrical supply of the heart is disrupted. Autopsy of the heart may reveal old scarring, she says, “or a person’s heart has become really large, either because they consumed a lot of alcohol or they’re obese.” The heart could also be enlarged due to congenital heart conditions.
Undetected Disease in the Family
Understanding the reason for a loved one’s sudden death is important, Lantz says. “Number one, it helps the family with closure to give an explanation why this individual actually died,” he says. “Especially if there’s any genetic component.”
Genetic conditions that can lead to sudden death include “channelopathies.” This group of diseases involves disruption in the flow of ions such as potassium, sodium and calcium across cells. Channelopathies are responsible for some fatal heart arrhythmias in younger people, Schoppe says. Certain channelopathies are associated with death occurring during sleep.
Brugada syndrome, for example, may cause abnormal rhythms in the lower chambers of the heart. Sometimes inherited, Brugada syndrome occurs more frequently in Asians. Because it can be present without symptoms, people may not realize they have the potentially fatal condition.
Lifesaving Treatment
Autopsy results can steer family members to medical screening to catch serious genetic conditions and spur treatment, which might be observation or medication. When certain arrhythmias are found, Lantz says, patients may need to have an implantable defibrillator placed around their heart.
Diseases of the wall of the aorta — the large, central artery that carries blood from the heart to the body — can lead to tears, rupture and sudden death. Risk for aortic aneurysms can run in families. “The family members can actually be screened with echocardiograms and CTs or MRIs, and when they see the aortas start to dilate, they can go have preventive surgery,” Lantz says. “And that will prevent sudden , unexpected death of those people.”
Schoppe says when inheritable conditions are the suspected cause of sudden death, her office alerts family members. “I make a point to actually speak, at least over the phone, to the next of kin and explain to them,” she says. “And I also note in the autopsy report that this is likely a genetic mutation that is inherited and recommend that immediate family members — usually parents, siblings and children — seek the advice of their physicians regarding the need for individual testing.”
Mental Health Questions
Taking mental health into account is part of the process to differentiate between natural and unnatural death. “That really falls back on the medical examiner or coroner service to make sure a thorough investigation is done, in talking to the family,” Lantz says. “Has someone been depressed? Were there any drugs available? Had the person had any suicidal ideation?”
If so, that affects decision-making. “If we had any information like that, that this person had been depressed and had suicidal ideation, I think any examiner, no matter what the person’s age, would probably bring them in to do an autopsy, just to rule [suicide] out,” he says.
[See: 9 Things to Do or Say When a Loved One Talks About Taking Their Life.]
How Common Really?
Brain conditions linked to sudden, unexpected death include massive stroke or massive bleeding from a brain aneurysm, Lantz says. Although infections such as meningitis and encephalitis can be fatal, he says, people have symptoms leading up to their death.
“Epilepsy is notorious for causing death during sleep,” Schoppe says. That’s probably due to reduced oxygen level to the brain inducing a seizure. Usually, she says, the person has had a prior history of seizures.
How often seemingly healthy people die suddenly in bed depends on what people perceive as “healthy,” Schoppe says. Obesity is a significant factor in sudden death, she says: “The number of people now that I’m seeing with really bad coronary artery disease, or clogging of their arteries — it just seems to get younger and younger and younger.” In some cases, she says, a person with poor access to health care may die without any medical history whatsover — because he or she hasn’t seen a doctor in the past 15 years.
“It’s very uncommon for people to die in their sleep suddenly and unexpectedly,” Lantz says. “But it can happen. In most cases when it is truly unexpected, the vast majority of medical examiners will investigate those thoroughly. And hopefully, most of the time an autopsy will be done to give more information to the families.”
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What Does It Mean to Die in Your Sleep? originally appeared on usnews.com
