Groundbreaking SIDS Discovery | Sudden Unexpected Deaths

Diaphragm Cramp-Contracture (DCC) in SIDS

SIDS breakhthrough flow diagram. It involves spontaneous diaphragm cramp-contracture (DCC) causing respiratory arrest and novel airway obstruction created by RAM contractions to breathe against diaphragm immobilized and inactivated by the cramp. Supported by autopsy evidence including contraction band necrosis which occurs under terminal anoxia in SIDS [Kariks 1989, Silver 1992].
SIDS breakthrough 2025 flow diagram. Novel diaphragm cramp-contracture (DCC) in vulnerable infants with critical diaphragm fatigue is no different than a leg cramp, except it causes respiratory arrest. It also creates a novel airway obstruction where the hypercontracted diaphragm resists efforts to breathe by the accessory inspiratory (intercostal) muscles.
Explosion diagram with "diaphragm fatigue" written in the center, surrounded by over a dozen causes. Some major ones include young, premature and male infants (weaker diaphragms), viral infections (diaphragm myositis), overheating (diaphragm myopathy) and rebreathing exhaled gases (hypoxia and hypercapnia weaken the diaphragm).
Diaphragm fatigue in infants is caused by a variety of factors that are believed to act synergistically, contributing to a critical level whereby cramp may occur. Like a limb cramp, DCC is triggered by a workload surge (e.g. REM sleep, airway obstruction or prone positioning). Numbers refer to supporting citations provided here….
Diaphragm fatigue factors largely overlap with SIDS risk factors. Citations are provided here, so readers can fact-check us.

Emerging SIDS Discovery 2025 – Inadvertently made by a practicing community physician in Toronto, Ontario. 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 fascinating, essentially breathing out to breathe in, “like a pilot 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, it is becoming clear that DCC is responsible for many non-cardiac sudden unexpected deaths in infants (SIDS) as well as 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, social or language problems. The sooner the better. Even greater things await, beyond this SIDS discovery!

Please support our GoFundMe campaign. Proceeds will be used to cover publication costs, 3D diaphragm anatomical imaging and more. Dr. Gebien has committed his own funds and his time to this important breakthrough. The sooner DCC is confirmed in laboratory, the sooner will young lives be saved from SIDS and other breathing problems in vulnerable infants. Thank you.

Diaphragm cramp is exceptionally rare but strikes most often during sleep because of added work of breathing from prone positioning (face-down), obstructive sleep apnea (OSA) and/or REM sleep shutdown of the accessory respiratory muscles by the central nervous system. The added workload worsens diaphragm fatigue and may push it past the cramp threshold of DCC.

It occurs more often in young, premature and male infants because of higher ventilatory workloads and weaker respiratory muscles. Their diaphragms are more vulnerable to fatigue and cramp.

Diaphragm inflammation (myositis) and damage (myopathy) from viral or bacterial infections also fatigue the diaphragm. This explains why SIDS is more common when respiratory infections were present [Southall 1990].

Nicotine is exceptionally dangerous in young children when ingested or absorbed by second-hand tobacco smoke. In overdose, it paralyzes the diaphragm by contracture. In sub-toxic doses, like babies sleeping upstairs in a heated home in winter, nicotine reduces the diaphragm cramp threshold (diaphragm fatigue).

To prevent sleep-related DCC at any age, drink some fluids and avoid sleeping face-down (prone). If ill with a cold or flu, drink plenty of fluids and take Ibuprofen or Tylenol before sleep. For infants, give medications and fluids BEFORE naps and sleeps. Ensure body ventilation can occur (no over bundling or polar fleece fabrics). Do not nap with the baby on your chest at any time (avoids rebreathing and an added diaphragm workload). Ensure good ventilation in the bedroom with a gentle fan or open window (prevents rebreathing).

Pacifiers (dummies) and thumb-sucking should be encouraged, as they are SIDS-preventative (at any age for that matter)!

Our new SIDS prevention measures can be downloaded here. This solitary document will save babies from succumbing to SIDS. It also is the best baby shower gift ever. Please remember our GoFundMe.

Public Alert on SIDS v3 GEBIEN GREYDownload
New SIDS prevention measures. How to avoid sudden infant death syndrome.
New SIDS Prevention Measures (2025): Based on avoiding diaphragm excitation. As opposed to the above PDF, this is a JPG.

Learn the rescue breath technique. 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.

Diaphragm Spasms, Flutter, Cramps and Paralysis

This new SIDS hypothesis, respiratory arrest by diaphragm cramp, is thought to represent just one along a spectrum of contractile disorders where the diaphragm contracts with automaticity (on its own). It is like diaphragm paralysis caused by succinylcholine or neuromuscular blockers like curare, tetanus, botulism and nicotine. It is the cause of death in nicotine poisoning (by oral ingestion). There is overlap here too with sepsis and malignant hyperthermia, thte latter causing muscle rigidity, spasms and cramps of the limbs. Death in that condition is thought due to DCC respiratory arrest. Experimental endotoxins, emulating severe sepsis in dogs, caused diaphragm fatigue and sudden failure (likely by DCC).
Respiratory arrest by diaphragm cramp is thought to represent just one along a spectrum of contractile disorders (diaphragm hyperexcitability), where the diaphragm contracts with automaticity (on its own). Others include hiccups, diaphragm spasms, diaphragm tremor, flutter and fibrillation, each with its unique set of symptoms.

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

The formal version of this peer-reviewed publication on diaphragm cramp in infants can be accessed by clicking here.

Here’s the plain-English version for all readers. It’s a bullet point summary explaining the diaphragm fatigue problem in young infants.

Plain English Companion Guide for ALL READERS – Diaphragm Cramp in Sudden Unexpected Infant Deaths – Gebien 2025Download

Why Diaphragm Cramp-Contracture — a novel SIDS mechanism — is unknown to medicine:

  • Tragically, DCC is near-silent, where the victim is unable to breathe in and cry out for help.
  • DCC is triggered suddenly, spontaneously and unpredictably, making it difficult to observe or measure scientifically.
  • Specialized tests are needed to reveal it (e.g. fluoroscopy, ultrasound, RIP, electromyography).
  • The diaphragm is internal, thus, unable to visualize 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.
Table 3 – Why DCC Unknown to Medicine GEBIEN v3Download

What are Diaphragm Spasms?

  • Coming soon. For now though…
  • The plain-English version of our groundbreaking research paper in SIDS above (in PDF) can also be accessed online…

Companion Guide — Opinion: Uncovering diaphragm cramp in SIDS and other sudden unexpected deaths by Dov Jordan Gebien MD, MSc

A plain-English summary of an emerging medical discovery in sudden infant death syndrome (SIDS)

Read on Substack

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