What is this thing called ‘bangungot’?

Reports say that it was the cause of the sudden death of actor Rico Yan, only 27, last Good Friday. Before Rico, actor Miguel Rodriguez, only in his 30s, reportedly died of it on May 14, 1997. Both Rico and Miguel were said to have been drinking on the night before their death.

We call it "bangungot" while Americans refer to it as the nocturnal death syndrome because it usually happens at night while we’re sleeping.

"It’s common among young males, aged 20 to 30," says Dr. Erdie Fadreguilan of the UP-PGH cardiovascular unit. "There has been neither medical explanation nor evidence why this is so. It’s actually a rare condition."

According to local medical literature, the first reported case of death due to bangungot was in 1960. "The victim was an American war veteran who had been staying in Manila," Dr. Erdie relates.

This enigma called bangungot appears to be common among people in Southeast Asia, and not in Western countries. In Japan, it’s called tokkuri and in Laos, it’s called nonlaltal. In 1983, there were reports of cases among Laos refugees.

Dr. Erdie explains: "There is suggestion but no definite proof that it is related to diet."

For one, there’s the ingestion of alcohol the night before. It’s not so much how much alcohol was taken in as what was in the alcohol. Some people have a low tolerance for alcohol, according to Dr. Erdie.

Time and again, old folks warn young people against sleeping on a full stomach. "Baka mabangungot ka," they grimly admonish. Of course, most of us don’t believe it and simply laugh it off.

"A high carbo diet the night before appears to trigger it," Dr. Erdie points out. "Asians eat a lot of rice, it’s our staple food. And when we drink, we also eat a lot. It’s a cultural thing with us."

A 1960 study of an autopsy done on a bangungot victim revealed a condition called hemorrhagic pancreatitis.

There are two types of pancreatitis: chronic and acute. Both are inflammations of the pancreas (the large gland that produces digestive enzymes which the body uses to metabolize carbohydrates and fats as well as the hormone insulin).

Acute pancreatitis, which is cited as the cause of Rico Yan’s death, is associated with excessive alcohol drinking and gallstones (in about 80 percent of cases in the US) with the rest as a result of viral and bacterial infections, drugs, blockage of the pancreatic duct, trauma or surgery to the abdomen, elevated calcium levels or extremely high triglyceride levels (the fat that circulates in the blood).

On the other hand, chronic pancreatitis occurs after a history of recurrent attacks of acute pancreatitis. It may lead one to lose the ability to secrete the enzymes the body needs to digest food. This results in a condition called pancreatic insufficiency. Among its symptoms are either gradual or sudden weight loss and foul-smelling stools or diarrhea.

These factors seem to encourage pancreatic digestive enzymes to act on the pancreas itself, causing swelling, hemorrhage, and damage to the blood vessels in the pancreas.

More than half of those who develop chronic pancreatitis are heavy drinkers (heavy alcohol consumption is the most frequent cause of pancreatic insufficiency in adults).

"There’s abdominal pain in massive pancreatitis," says Dr. Erdie. "But in eight out of 10 cases, we brush it aside as ulcers. "In pancreatitis, the pancreas, which digests our food, dissolves – it can actually digest itself. It can cause massive bleeding in every part of the body, inside and outside."

Himself shocked when he heard about Rico Yan’s death from another doctor, Dr. Erdie recalls, "I thought they said Rico Puno."

He adds, "It takes a few minutes for the pancreas to bleed. When Rico Yan was heard groaning, he was probably already going through some abdominal pain."

The good doctor, who’s dealt with more cases of sudden death than he remembers, tells us: "Sleeping is a dynamic activity. It’s much similar to a waking stage, so sleep studies will tell you."

There are different sleep stages. There’s the dream stage – some may have bad dreams or nightmares that appear so real.

Eighty to 90 percent of sudden death cases are caused by cardiac problems. "It’s fatal arrhythmia, something happens to the rhythm of the heart, which could be part of the whole bangungot picture."

Snoring, the doctor notes, can suggest a cardiac problem.

Dr. Erdie warns that smoking and prohibited drugs can trigger heart problems.

Other doctors say that the most prone to pancreatitis are those who drink a lot and those with gall bladder stones. They dispute the common notion that only males can die of bangungot.

"It’s not something a lot of Filipino doctors are interested in or would like to know more about," Dr. Erdie asserts.

Maybe it’s about time doctors woke up and devoted more time to studying the matter.