Groundbreaking SIDS Discovery | Sudden Unexpected Deaths

Diaphragm Cramp-Contracture (DCC) in SIDS

Diaphragm cramp respiratory arrest in SIDS flow diagram by D. Gebien MD 2024.
Diaphragm cramp respiratory arrest in SIDS
Diaphragm fatigue combined with a ventilatory workload surge is proposed to cause diaphragm cramp-contracture (DCC) in SIDS and other sudden unexpected deaths in all ages.

SIDS Discovery 2024 – Inadvertently made by a practicing community physician in Toronto, Ontario on Friday October 28th, 2022. It all started with a 7-year-old boy who recounted, 45 years after the fact, recurrent life-threatening breathing emergencies that had awakened him from sleep sporadically throughout his childhood and youth. In medical terms, we have described this as “paroxysmal bearhug pain apnea”. How he survived it is simply fascinating, essentially learning to breathe out to breathe in, “like a pilot breathing in a centrifuge” (see below).

The story is astounding. It continues to unfold at its own pace. It will take time to experimentally prove this killer mechanism: novel diaphragm cramp-contracture (DCC). After two years of full-time research, we can confidently hypothesize DCC is responsible for most non-cardiac sudden unexpected deaths in infants (SIDS), sudden unexplained deaths in childhood (SUDC) and those in adults (sudden “cardiac” deaths). If you have experienced similar symptoms then please let us know.

Adverse childhood experiences (ACEs) and grief need to be explored in all children and adults. It can present in seemingly unrelated ways like delayed speech or language problems. The sooner the better. Even greater things await, beyond this SIDS discovery!

Learn the rescue breath technique now. Dr. Gebien demonstrates the patient’s rescue breath technique below. It is used to reverse the painful bearhug and inspiratory arrest of diaphragm cramp. Most people would never have experienced this unusual painful condition, however, it should be learned just in case.

Dr. Gebien demonstrates the case patient’s rescue breaths. Turn up the volume to hear it. He first exhales then takes in three rapid, short-burst inhalations pressing and releasing his tongue on the hard palate to interrupt airflow.

Diaphragm cramp is exceptionally rare but strikes most often during sleep because of worsening diaphragm fatigue and inflammation. To prevent DCC at any age, avoid sleeping on the stomach. If ill with a cold or flu, drink plenty of fluids and take Ibuprofen or another anti-inflammatory before sleep. Ensure good airflow in the bedroom with a gentle fan or open window to prevent rebreathing of exhaled gases. Pacifiers (dummies) and thumb-sucking should be encouraged (at any age for that matter)!

Diaphragm Spasms, Flutter, Cramps and Paralysis

Diaphragm cramp-contracture (DCC) appears to occupy a spectrum of diaphragm contraction disorders. The higher the frequency, the more severe are symptoms and worse is prognosis. The disorders start with benign diaphragm spasms which can cause hiccups, shortness of breath (dyspnea), breathing pauses (apneas) and pain. If the apnea is prolonged, blood oxygen levels will drop (called hypoxemic episodes, which happen often in premature babies). Diaphragm and respiratory flutter are not well known but indeed have been reported in all ages including very young infants. Existing examples of sudden respiratory paralysis from sustained diaphragm contractions (tetany) include nicotine overdoses, neuromuscular blocker medications and some electrocutions. Interestingly, tobacco smoke exposure is a well-known SIDS risk factor. It causes diaphragm fatigue and is hereby proposed to lower the threshold for DCC respiratory arrest.

Diaphragm Fatigue and Excitation

Table: Diaphragm fatigue and increased workload factors contributing to neuromuscular excitation in the form of diaphragm spasms, diaphragm flutter and diaphragm cramps (DCC). Many overlap with SIDS risk factors. Citations available as a separate PDF download. August 2024. Dov Gebien MD.
Table: Diaphragm fatigue and increased workload factors contributing to neuromuscular excitation in the form of diaphragm spasms, diaphragm flutter and diaphragm cramps (DCC). Many overlap with SIDS risk factors. Citation list is available as a separate PDF download.
Diaphragm Fatigue 2 CITATIONSDownload

Diaphragm Paralysis from DCC

Sudden diaphragm paralysis is not always fatal, primarily because respiratory accessory muscles (RAM) can take over the work of breathing. However, this happens only under certain conditions, like if the diaphragm is weakened (paretic) but not fully paralyzed, or if one-half of the diaphragm is paralyzed. Young infants have under-developed, immature RAM. We believe these try to take over respirations in sudden DCC paralysis but are unable to expand the lungs. Instead, an airway obstruction develops where the immobilized diaphragm resists RAM contractions. This leaves some evidence at autopsy including intrathoracic petechiae (Tardieu spots) and wet and heavy lungs full of fluid. Sadly, most SIDS autopsies do not include diaphragm assessment under the microscope (histology) to discover these abnormalities.

Hypothetical sequence in a SIDS death from diaphragm cramp

Here’s the comprehensive manuscript PDF, outlining this major medical discovery in-process.

DCC Gebien and Eisenhut 2024 12Download

Why DCC, a Novel SIDS Mechanism, is Unknown to Medicine

  • DCC is silent, as the victim is unable to breathe in and cry for help.
  • DCC comes on suddenly, spontaneously and unpredictably making it difficult to observe scientifically.
  • Specialized tests are needed to reveal it (e.g. fluoroscopy, ultrasound, electromyography).
  • The diaphragm is internal. No ability to visually confirm diaphragm spasms or cramps.
  • It induces respiratory arrest which masquerades as a seizure, choking episode or cardiac arrest.
  • Sudden respiratory arrest is actually quite difficult to recognize, even by a medical professional.
  • Most apnea alarms (at home and hospital) monitor respiratory movements but not airflow. They will miss the initial respiratory arrest of DCC because the victim’s chest continues to move and expand a bit.

  • Few signs remain at autopsy. However, disrupted diaphragm myofibers and contraction band necrosis have been documented in systematic diaphragm histological studies.
  • Autopsies in sudden unexpected deaths do not routinely assess the diaphragm. This includes SIDS, SUDC (sudden unexplained deaths in childhood) and SCD (sudden cardiac deaths in adults).
  • Inexplicably and despite compelling evidence, modern medicine has cast a blind eye to the diaphragm as being responsible for causing serious disease.
DCC Why Unknown GEBIENDownload

Why Diaphragm Spasms are Unknown to Medicine

  • Coming soon

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