December 6, 2022

Bangungot (or bangungut) is a cause of sudden unexplained death syndrome or SUNDS.
The term is from the words “bangon at ungol” or rise and moan. It was first reported in world medical literature in 1917 in the journal of the Philippine Medical Association and since then the condition has been the focus of research by pathologists and other medical fields like cardiology.
In 1960, Dr. Sta. Cruz, SJ, published a summary of findings in his study of cases that occurred in the Philippines from 1915 to 1938: Bangungot had a preponderance of males, ages 25 to 40 years old, apparently in good health, and died suddenly at night, often with history of heavy meal or jovial disposition the night before.
Autopsies showed usual postmortem (after death) structural findings in the heart, lungs, blood vessels in the abdomen, and coatings of the lungs and abdomen (pleura and peritoneum). In cases who had history of abdominal pain before their death, there were findings of acute hemorrhagic pancreatitis (bleeding in the pancreas).
Sta. Cruz, in his study early on, suspected that nightmare, abnormality in the heart with or without Vitamin B1 deficiency (beri-beri) could be a cause. Subsequent studies by other authors showed similar findings, with high incidence of sudden death during sleep or rest and victims were in apparent good health before death.
The victim is usually described as unresponsive and difficult to rouse from sleep, with loud groans and difficulty in breathing before becoming rigid.
In Philippine folklore, bangungot is also linked to batibat, a vengeful hag-like mythical creature responsible for the mysterious death in a person’s sleep by sitting on their chest until they run out of breath.
Similar conditions are called Lai Tai in Thailand and Pokkuri in Japan. The characteristics of Lai Tai are similar to bangungot and the condition has been recognized in the northeastern part of Thailand for many years. Elderly people in the region have described victims as making loud groans and showing signs of difficulty in breathing or labored respiration, who become rigid and die.
What are medical or scientific explanations for bangungot? Unfortunately, there is a lack of conclusive studies regarding this condition, leading medical scientists to tag it as a cause of SUNDS. When it comes to the heart as the possible culprit, sudden cardiac death (SCD) like the Brugada syndrome has features similar to bangungot.
It is characterized by disturbance in the heart rhythm (arrhythmia). In studies of heart models developed in laboratories, gene mutations that alter certain body proteins involved in the production of normal electrical activity in the heart are offered as an explanation. In some studies, autopsy of cases showed dilatation of certain heart chambers. Hereditary predisposition could also play a role. SCD is a cause of sudden death in infants.
Another possible cause of bangungot or SUNDS is hemorrhagic pancreatitis, a type of sudden inflammation of the pancreas associated with rupture of blood vessels and bleeding in the organ. The pancreas is an organ near the stomach, liver, and gall bladder. Acute hemorrhagic pancreatitis often occurs suddenly and quickly, and in some cases, it could be fatal. It can result in necrosis or tissue death and even cause multi-organ failure due to sepsis.
The most common causes of pancreatitis, both acute and chronic, are gallstones, heavy alcohol use, genetic disorders of the pancreas, and some medicines. Yet 10 percent of all acute pancreatitis reported are labeled idiopathic, with causes unknown.
In a journal published in 2007, a study was done from 1991 to 2001 to review 3,305 autopsies at Turkey’s Council of Forensic Medicine. Of these, only 12 cases (0.36 percent) involved sudden death due to acute hemorrhagic pancreatitis without symptoms, which led the researchers to advise forensic pathologists that deal with sudden deaths without symptoms to consider examining the pancreatic region and pay close attention to pancreatitis-related complications.
Can we prevent bangungot? The answer is difficult because the exact cause has not been conclusively established yet. But based on common findings seen in autopsies of victims, it is practical to consider observing usual changes in our lifestyle or habits like the following: avoid large evening meals, heavy alcohol intake, fatty food, and on a regular basis observe measures to take care of our body as a whole.
Avoid, reduce, or stop smoking because studies have shown that it causes pathological (abnormal) and functional changes in the pancreas, like disturbances in pancreatic blood flow.


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