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Sudden Unexplained Nocturnal Death Syndrome, a.k.a. Bangungot

I knew something was badly wrong the moment the planchadora walked past the gate. Her wrinkled leathery face looked sad and horribly weary. Her shoulders were hunched forward as though laden with an invisible load.

“May patay pô kami!” she blurted the moment she saw me. My eyebrows shot straight up. “Sino?” I asked.

“One of my sons,” she told me in Tagalog. “The one who got married just last year.” Then, after looking at me with a gaze that really swept past me and into an imagined distance, she added, “It’s his birthday today!”

I could only shake my head in sympathy. “How old was he?” I asked.

“25,” she replied. “Cardiac arrest daw pô… His wife was awakened by his moaning in the middle of the night. When he would not wake, we all scrambled to take him to the hospital.”

At the hospital, all they saw on the electrocardiogram machine was… She gestured with her pointer finger. “Flat lines,” I supplied the word. She nodded.

The clerk who issued the death certificate suggested to her that the doctor could have been more specific about the cause of death. Cardiac arrest is the consequence of an ailment; but it is not the ailment itself.

“Did he show signs of heart ailment before?” I asked. “Walâ pô,” she answered. “He even played basketball every once and a while. He was perfectly healthy.”

It then belatedly dawned upon me why the doctor could not have been more specific, assuming that no autopsy was undertaken. “Bakâ bangungot?” I suggested.

“Iyon na ngâ pô,” she agreed, for some reason reluctant to tell me from the beginning.

In the late seventies, I came across a Reader’s Digest article about what was then called the Asian Nocturnal Death Syndrome. The article talked about something we Filipinos have always known all about but was only then beginning to catch the attention of western medical practitioners. This was the often inexplicable death in the middle of the night of apparently healthy individuals. At that time – or so I recall from the article – it was thought to be something that happened only to East or Southeast Asians.

These days, the phenomenon is referred to in the medical profession as the Sudden Unexplained Nocturnal Death Syndrome or SUNDS. Although a lot more studies have been conducted of the syndrome, nothing really definitive and conclusive has been arrived at. I would imagine that this is because the syndrome arrives stealthily like a thief in the middle of the night; and cases are brought to the attention of doctors after the fact of actual death.

It first came to the attention of Western doctors when statistics in the United States started to rack up of unexplained deaths among immigrant Hmongs, an ethnic group of people who live in the mountain regions of Laos, Thailand, Vietnam and southern China. The initial suspicion was that the syndrome was stress-related. These immigrants spoke no English, were in a strange environment and could not find work in their adopted country.

Of course, subsequently, it had been discovered that the syndrome was observable not only among the immigrant Hmongs but also in East and Southeast Asian countries among the natives as well. Mostly, victims were found to be in apparent good health, male and between the ages of 25 and 44.

It has been found that most of the cases of SUNDS were caused by a disease called the Brugada Syndrome, a genetic disorder that makes natives studied in Thailand and Laos susceptible to sudden cardiac arrest. It goes without saying that other cases of SUNDS have not been attributed to something definitive.

In the Philippines, it is believed that SUNDS or bangungot strikes 43 of 100,000 Filipinos. Most of the victims are young males.

The syndrome is the subject of countless street-acquired and unsubstantiated supposed wisdom. Most common is the admonishment – which I heard God knows frequently enough from my own Mom – never to go to sleep right after a heavy meal. Some say it is just the heavy carbohydrates – i.e. from the rice – that should be avoided.

There have also been medical practitioners in the country who have conjectured about SUNDS being caused by acute inflammation in the pancreas. This conjecture, however, came about from results of autopsies conducted on SUNDS victims. The cause of that sudden inflammation of the pancreas in the victims is still to be established.

In my life – particularly when I was younger – I can recall a few times when what seemed like a dream turned gory because it just felt as though an unseen hand was pushing hard on my chest and preventing me from breathing. Each time, I would suddenly just snap out of it. I would bolt upright as though I just escaped the hidden hand and find my heart pounding unbelievably hard against my chest.

This was by no means unique. Naturally, I had discussed the matter with friends and contemporaries; and just about everyone had had similar experiences. Who knows? Maybe these were just ordinary nightmares – albeit, there was nothing ordinary about the feeling of being strangled.

It is said that the best way to rouse somebody who is being beset by SUNDS is to hold the toes and wiggle the legs of the person. I would not know why; and this is just another of the superstitions that cloud the phenomenon. Even if it works, the assumption is still that somebody will get to the victim before that thief in the night we simply call bangungot.

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