“We are here to debunk some beliefs and pinpoint what is fact and what is myth.”

— PHA Director I Dr. Luigi Segundo

Short link: https://wp.me/paaccn-OE1

Guest author:

• GYNNA P. GAGELONIA, PHA Communications/Media Relations Officer

MANILA — For generations, Filipinos have feared “bangungut” — a sudden, silent death during sleep, often blamed on bad dreams or evil spirits.

Bangungut mainly affects Filipinos, including those in Hawaii, the Pacific Islands, and the United States. A 2007 health survey in the Philippines found 43 cases of Sudden Unexplained Nocturnal Death Syndrome (SUNDS) for every 100,000 people each year. Based on the 2008 population, that means over 39,000 deaths annually — mostly males aged 15 to 64.

The Philippine Heart Association (PHA) has since shed light on the mystery, warning that what was once feared as a nightmare could actually be caused by a hidden heart rhythm problem.

In the PHA’s Usapang Puso sa Puso (UPP) titled “Bangungut: Not Just a Bad Dream But A Detectable Heart Disease”, electrophysiologist and Primary Investigator of the Philippine Bangungut and Brugada Projects Dr. Giselle Gervacio clarified some beliefs on the nature, causes, and risks of Bangungut.

“Totoo na sikat na sikat ang bangungut, especially pagdating sa Filipino culture, in fact, sa pag-ikot namin, walang Filipino na hindi nakakaalam kung ano ‘yung bangungut, however, tama ka dahil kailangan natin itama iyong mga fake news na iba para mas maging scientific naman ang pagkakaintindi natin dito,” Gervacio points out.

PHA Director I Dr. Luigi Segundo, also an electrophysiologist, said that Bangungut has been documented in the Philippines for over a century as a local folklore.

“We are here to debunk some beliefs and pinpoint what is fact and what is myth,” Segundo says.

Tales, fake beliefs

“Bangungut” comes from the Bisaya words bangun (to wake up) and ungul (to moan or grimace).

In the early 19th century, people believed it was caused by an evil spirit –often described as a large, angry woman with long black hair called the Batibat. She was said to sit on sleeping men and stop them from breathing. This may be why many believed bangungut mostly affected men.

“May colloquial term kasi na binangungut ibig sabihin ay nanaginip nang masama pero ‘yung totoong seryosong bangungut ay nakakamatay. Usually, hindi nagigising ‘yung biktima not unless madala siya sa ospital at ma-revive doon,” Gervacio explains.

Moreover, Gervacio clarified that while bangungut may resemble sleep apnea due to the sounds of snoring or gasping often reported before sudden death, the two conditions are not the same — and sleep apnea is not considered fatal on its own.

“Sleep apnea lowers oxygen levels and can lead to complications such as atrial fibrillation, an irregular heartbeat,” says Gervacio. “But it does not directly cause sudden death, unlike bangungut.

She added that while people often associate bangungut with having eaten or consumed alcohol before sleeping, these are not direct causes either. However, they may act as potential triggers for bangungut episodes.

“We understand why this belief persists,” she says, “but what the findings show is that heavy meals or alcohol may trigger an event — they’re not the root cause.”

The Philippine Bangungut Program

In 2023, Dr. Gervacio launched the Philippine Bangungut Program — a nationwide effort to better understand and respond to sudden unexplained deaths, which may be linked to Brugada Syndrome.

Led by UP-PGH (University of the Philippines-Philippine General Hospital), the program works with several government agencies, including the Department of Health (DOH), Philippine Heart Center (PHC), Philippine National Police (PNP), East Avenue Medical Center (EAMC), and local governments.

Quezon City is being eyed as a model city for the program. The goal is to improve medical response and provide support to families affected by suspected bangungut cases.

The program’s research side includes two key studies: the Bangungut Project and the Brugada Project. Funded by the DOST-PCHRD(Department of Science-Philippine Council on Health Research and Development), they aimed at finding genetic mutations linked to bangungut and Brugada Syndrome in Filipinos.

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“Once we determine the specific genetic variants prevalent among Filipinos, we can develop a genetic screening kit tailored to our population,” says Gervacio. “This will allow families of sudden death victims to be screened, and those diagnosed with Brugada Syndrome can be managed accordingly.”

Families of suspected bangungut victims can join the program through referrals. Blood samples should be taken soon after the incident, either in the ER (Emergency Room) or at the barangay level. The program offers genetic counseling before and after testing to help families understand the process.

Those found at high risk may be referred to PGH or the Philippine Heart Center for further care, which may include an Implantable Cardioverter-Defibrillator (ICD).

For Brugada Syndrome, patients need a confirmed ECG diagnosis before joining the Brugada Project for genetic screening.

Details and contact info, including a QR code, are available on the Philippine Bangungut Program’s official Facebook page.

Arrythmia based on researches, investigations

Early researchers noticed that some victims had a pinkish pancreas, leading them to suspect pancreatitis.

In 2014, Dr. Gervacio and her team at UP-PGH, along with members of the Philippine Heart Association (PHA), decided to take a closer look and investigate the findings further.

“Noong inaral ito sa UP College of Medicine under the microscope, wala namang pancreatitis, hence, definitively noong 2014, na-prove na natin na hindi pancreatitis,” Gervacio emphasizes.

By process of elimination, one possibility stood out: arrhythmia. It is an electrical disturbance in the heart that can cause it to beat irregularly — or stop altogether.

“Naglead iyon sa conclusion na baka arrythmia kasi ‘yung arrythmia ay abnormal na tibok ng puso na pwedeng nakakamatay kasi masyadong biglaan eh,” Gervacio explains.

“Isipin niyo majority ng victims ay healthy, mga bata, tapos matutulog at hindi na magigising. Ganoon kabiglaan, kaya ang unang-unang tinitingnan is of course ‘yung puso, specifically ‘yung electrical system ng puso,” she adds.

Brugada, bangungut, and cardiac death

Dr. Gervacio urged the public to learn about Brugada Syndrome — a serious but treatable heart condition possibly linked to sudden unexplained deaths often mistaken for bangungut.

First identified in 1992 by Spanish brothers Pedro, Josep, and Ramon Brugada, the syndrome can cause sudden cardiac death. Unlike bangungut, it can be detected through a distinct ECG pattern, offering a chance for early treatment.

An ECG test costs around Php600 at PGH.

“Kung mayroon ka nang warning symptom katulad ng pagba-blackout, o pagkakaroon ng kombulsyon na mabilisan lang, or palpitation, tapos nakitang may ECG pattern ka, ‘yun na ang hudyat para malagyan ng Implantable Cardioverter Defibrillator (ICD). At itong ICD na ito ay lifesaving kasi sa pamamagitan nito, napipick-up kung nagkakaroon ng arrhythmia or irregular heartbeat na delikado sa pasyente, at nagde-deliver ito ng lifesaving shock,” she says.

ICDs are critical in preventing cardiac arrest among people who have certain heart-rhythm abnormalities that put them at high risk for it.

Segundo also acknowledged that while Brugada Syndrome may sound alarming, advancements in the Philippines such as access to ICDs helps improve patient outcomes.

“Ang maganda rito ay mayroon na tayong ginagawa na paraan para makatulong sa mga kababayan natin para ma-link natin sa possible treatment na ginagawa naman sa Pilipinas,” he says.

Gervacio also called on the public to pay attention to warning signs and adopt simple but critical lifestyle precautions to reduce the risk of sudden cardiac death from Brugada Syndrome.

“Brugada Syndrome is not caused by lifestyle habits like poor diet or lack of exercise, but there are things patients can do to reduce their risk,” she says.

One of the most important precautions: avoid high fevers. Research had shown that elevated body temperatures can trigger dangerous heart rhythms in people with Brugada Syndrome.

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“When someone with Brugada gets a fever, the risk of arrhythmia increases significantly. They need to manage their temperature right away,” Gervacio warns.

Dr. Gervacio advised the public to watch for warning signs like frequent fainting, sudden blackouts, or brief convulsions, which are sometimes misdiagnosed as epilepsy. She also stressed the need for genetic counseling, especially in families with a history of sudden deaths.

Dr. Segundo added that while Brugada Syndrome is a specific genetic and electrical heart condition, overall heart health remains just as important.

“Tama rin po ‘yung PHA PUSO MUNA,” Segundo said, referring to the PHA’s advocacy for cardiovascular prevention. “Ayaw mo na dagdagan ‘yung sakit mo, ano? So, kailangan pa rin yung prevention. Kaya ugaliin niyo pong ireview yung sinasabi naming PHA PUSO MUNA,” he adds.

PHA PUSO MUNA which means, Pagkain na malusog, Huwag manigarilyo, Aktibong pamumuhay, Presyon ay kontrolin, Uminom ng maintenance, Obesity ay iwasan, Matulog nang kumpleto, Umiwas sa stress, No to alcohol, and Ayaw sa cholesterol, promotes a heart-healthy lifestyle.

History

Gervacio said that in the 1950s, the U.S. Centers for Disease Control (CDC) noticed sudden spike in mysterious deaths among migrant workers from Southeast Asia particularly those from Laos.

The victims were young, healthy, mostly male, and breadwinners for their families. “They went to bed one night, and never woke up,” she says.

CDC launched an investigation, but the autopsies said that the results were normal — no sign of trauma, no clear illness, nothing that could explain the deaths.

The same puzzling pattern was later observed in the Philippines, and the autopsy studies mirrored the U.S. findings — “victims died suddenly, without any warning, and their bodies did not show any obvious cause.” (®)