Once one organ system starts to fail, without powerful medical intervention it starts to drag the rest down with it. When someone actually passes away “in their sleep” it usually means either the lungs failed or the heart did (oftentimes they both kind of fail at the same time in people who are old and ready to die). The part of your brain that controls those two organs is so low in the brain stem that barring a massive stroke, those usually fail on their own for any of a long list of reasons before the brain itself shuts them down
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