A young wife in Nepal cries as she leans on the coffin of her 26 year-old husband, a migrant worker who died in his sleep in Qatar. (AP Photo/Niranjan Shrestha) Source.

In December, an AP reporter named Martha Mendoza called me to ask about a blogpost I’d written about a phenomenon called SUDS (Sudden Unexplained Death During Sleep) that occurred in Southeast Asian refugees. Apparently, the story was published in December, but I didn’t know it until a Nepali official in Saudi Arabia contacted me about it, as he was concerned about young migrant workers in Saudi Arabia and other Gulf States who were dying in fairly high numbers there.

I originally wrote “Killer Ghosts & Broken Hearts: The Mystery of Sudden Unexplained Death in Sleep in Asian Men” way back in 2010, and it’s been one of the more widely read posts on this site. I think the reason for that is because it’s hard to find accessible information on SUDS, and because there are still many people in Asia who are worried about it (particularly, it seems, in the Philippines). 

My interests in the topic started simply from having Hmong, Lao, and Khmer friends in college who told me they had been attacked by ghosts at nighttime. By the time I got to graduate school, I ended up looking at the culture and biology of this in Andrea Wiley’s class on Medical Anthropology, and whether it was connected to SUDS. I almost pursued the topic for my dissertation, but was advised that it would probably be a dead-end because there weren’t as many fatal cases by that time. 

In any case, I don’t know much about Nepali migrant workers beyond the AP story, but it seems clear that they do not have an easy life. Many come from extreme poverty only to take jobs overseas where many die from several causes. Injuries are common, but others seem to be dying from SUDS — they are young, seemingly healthy men in the prime of their lives who go to bed and never wake up. 

The biology an epidemiology of SUDS is complex. Why are ~90% of victims men? Why young? (The average age is about 30-35). Why (mostly) Asian? Why during sleep? Is it connected to sleep paralysis? Though there were many hypotheses as to what caused SUDS in Asian refugees in the 1980s, no single cause was ever isolated before the cases in the U.S. decreased. To me, the fact that rates decreased over time and place strongly suggested an environmental component. Though it was never proven, there was one study by Ron Munger, who is also quoted in the AP story, that hinted that a vitamin deficiency (thiamin, or vitamin B-1) could have been involved in SUDS in refugee camps in Thailand. Perhaps an improved diet or improved overall environment after refugees were resettled abroad could help explain why cases of SUDS decreased.

Unfortunately, it sounds like the conditions are ripe for an outbreak of SUDS among Nepali migrant workers. All the risk factors are there — young Asian men, working hard and living in somewhat stressful conditions with less than optimal diets (the story says that a common diet for workers in Gulf States is whole meal flour flatbread with some pickle or a vegetable, and once a day they have chicken). As poor, foreign, migrant workers, I imagine there is a temptation on the part of employers to see them as expendable (maybe that’s an unfair criticism, but history suggests to me that not all lives are equally valued). I think it would not hurt to improve their living and working conditions, perhaps including their diets.