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The medical folklorist Shelley Adler postulates that a supernormal nocturnal experience that is part of Hmong traditional beliefs can trigger the fatal syndrome. The experience is referred to as a "night-mare," not in the modern sense of a bad dream, but rather in its original denotation as the nocturnal visit of an evil being that threatens to press the very life out of its terrified victim. Hmong refugees in the United States experience a culture-specific manifestation of the universal nightmare phenomenon. The Hmong Nightmare (known as dab tsog) causes cataclysmic psychological stress, which can trigger sudden death. Although the Dab Tsog attack in Laos is related to the worldwide nightmare tradition, the peculiar stresses of Hmong refugee experience transformed its outcome. The power of traditional belief in the nightmare—in the context of the trauma of war, migration, rapid acculturation, and inability to practice traditional healing and ritual—causes cataclysmic psychological stress to male Hmong refugees that can result in SUNDS.