By Alan Duke, CNN updated 3:04 PM EDT, Fri June 21, 2013
Doctor: Jackson had no REM sleep
STORY HIGHLIGHTS
- NEW: Expert says Jackson could've died within days even without overdose
- Jackson may be the only human ever to go two months without REM sleep, expert says
- Lab rats die after five weeks of no REM sleep, expert says
- Propofol deprives patient of vital REM sleep, Dr. Charles Czeisler testifies
Jackson may be the only
human ever to go two months without REM -- rapid eye movement -- sleep,
which is vital to keep the brain and body alive. The 60 nights of
propofol infusions Dr. Conrad Murray said he gave Jackson to treat his insomnia is something a sleep expert says no one had ever undergone.
"The symptoms that Mr.
Jackson was exhibiting were consistent with what someone might expect to
see of someone suffering from total sleep deprivation over a chronic
period," Dr. Charles Czeisler, a Harvard Medical School sleep expert,
testified Friday at the wrongful-death trial of concert promoter AEG
LIve.
The symptoms documented
by e-mails among show producers and testimony from his chef, hairstylist
and choreographers included his inability to do standard dances or
remember words to songs he sang for decades, paranoia, talking to
himself and hearing voices, and severe weight loss, Czeisler said.
"I believe that that
constellation of symptoms was more probably than not induced by total
sleep deprivation over a chronic period," he testified.
Propofol disrupts the
normal sleep cycle and offers no REM sleep, yet it leaves a patient
feeling refreshed as if they had experienced genuine sleep, according to
Czeisler.
If the singer had not
died on June 25, 2009, of an overdose of the surgical anesthetic, the
lack of REM sleep may have taken his life within days anyway, according
Czeisler's testimony Friday.
Lab rats die after five
weeks of getting no REM sleep, he said. It was never tried on a human
until Murray gave Jackson nightly propofol infusions for two months.
Translating that to a
human, Czeisler estimated, Jackson would have died before his 80th day
of propofol infusions. Murray told police he had given it to him for 60
nights before trying to wean him off it on June 22, 2009 -- three days
before his death.
Czeisler -- who serves
as a sleep consultant to NASA, the CIA and the Rolling Stones --
testified Thursday that the "drug-induced coma" induced by propofol
leaves a patient with the same refreshed feeling of a good sleep but
without the benefits that genuine sleep delivers in repairing brain
cells and the body.
"It would be like eating
some sort of cellulose pellets instead of dinner," he said. "Your
stomach would be full, and you would not be hungry, but it would be zero
calories and not fulfill any of your nutrition needs."
Depriving someone of REM
sleep for a long period of time makes them paranoid, anxiety-filled,
depressed, unable to learn, distracted and sloppy, Czeisler testified.
They lose their balance and appetite while their physical reflexes get
10 times slower and their emotional responses 10 times stronger, he
said.
Those symptoms are
strikingly similar to descriptions of Jackson in his last weeks, as
described in e-mails from show producers and testimony by witnesses in
the trial.
Jackson's mother and
children are suing AEG Live, contending that the company is liable in
his death because it hired, retained or supervised Murray, who was
convicted of involuntary manslaughter. They argue that the promoter
pressured Murray to get Jackson to rehearsals while failing to get
Jackson help despite numerous red flags warning that he was in trouble.
AEG Live lawyers contend
that it was Jackson who chose, hired and supervised Murray, and their
executives had no way of knowing about the dangerous propofol treatments
administered in the privacy of Jackson's rented mansion.
A very long question
Czeisler was back on the
witness stand Friday to answer a question that was asked just as court
ended Thursday. Jackson lawyer Michael Koskoff asked his expert what may
also be a record-breaker in a trial: a 15-minute-long hypothetical
question.
He was asked to render
an opinion based on a long list of circumstances presented so far in the
trial about Jackson's condition and behavior, including:
• That Murray administered propofol to Jackson 60 consecutive nights before June 22, 2009.
• That Murray began to wean Jackson from propofol on June 22, 2009, and gave him none of the drug on June 23.
• That a paramedic who tried to revive him the day he died initially assumed he was a hospice patient.
• That show producers reported Jackson became progressively thinner and paranoid and was talking to himself in his final weeks.
• That the production
manager warned that Jackson had deteriorated over eight weeks, was "a
basket case" who he feared might hurt himself on stage and could not do
the multiple 360-degree spins that he was known for.
• That show director
Kenny Ortega wrote that Jackson was having trouble "grasping the work"
at rehearsals and needed psychiatric help.
• That Jackson needed a teleprompter to remember the words to songs he had sung many times before over several decades.
• That show workers reported the singer was talking to himself and repeatedly saying that "God is talking to me."
• That Jackson was suffering severe chills on a summer day in Los Angeles and his skin was cold as ice to the touch.
Jackson lawyers revised
the question Friday morning after AEG Live lawyers objected to the
information about Murray's nightly propofol treatments, since it was
derived only from the doctor's statement to police after Jackson's
death. The judge previously ruled that statement inadmissible.
Instead, they brought up
evidence that Murray ordered more than four gallons of propofol between
April and June, which Czeisler said equaled 155,000 milliliters of the
drug. An anesthesiologist uses between 20 and 30 milliliters to induce a
coma for surgery, he said.
The expert testified
that his review of Jackson's medical records convinced him that the
singer suffered a chronic sleep disorder that "was greatly exaggerated"
while he was on tour or preparing for a tour.
Jackson died just two
weeks before he would have traveled to London for the premiere of his
"This Is It" comeback concerts, produced and promoted by AEG Live.
A lecture on sleep
Jurors appeared quite
interested as Czeisler lectured them Thursday on his sleep research,
including an explanation of circadian rhythm: the internal clock in the
brain that controls the timing of when we sleep and wake and the timing
of the release of hormones
"That's why we sleep at night and are awake in the day," he said.
Your brain needs sleep to repair and maintain its neurons every night, he said.
Blood cells cycle out every few weeks, but brain cells are for a lifetime, he said.
"Like a computer, the
brain has to go offline to maintain cells that we keep for life, since
we don't make more," he said. "Sleep is the repair and maintenance of
the brain cells."
An adult should get seven to eight hours of sleep each night to allow for enough sleep cycles, he said.
You "prune out"
unimportant neuron connections and consolidate important ones during
your "slow-eyed sleep" each night, he said. Those connections -- which
is the information you have acquired during the day -- are consolidated
by the REM sleep cycle. Your eyes actually dart back and forth rapidly
during REM sleep.
"In REM, we are
integrating the memories that we have stored during slow-eyed sleep,
integrating memories with previous life experiences," he said. "We are
able to make sense of things that we may not have understood while
awake."
Learning and memory
happen when you are asleep, he said. A laboratory mouse rehearses a path
through a maze to get to a piece of cheese while asleep.
The area of a basketball
player's brain that is used to shoot a ball will have much greater
slow-eyed sleep period since there is more for it to store, he said.
Players shoot better after sleep.
The Portland
Trailblazers consulted with him after they lost a series of East Coast
basketball games, he said. He was able to give their players strategies
for being sharper when traveling across time zones.
He's worked with the
Rolling Stones on their sleep problems, he said. Musicians are
vulnerable since they are often traveling across time zones and usually
"all keyed up" to perform at night, he said.
Czeisler developed a
program for NASA to help astronauts deal with sleep issues in orbit,
where they have a sunrise and sunset every 90 minutes.
Other clients include
major industries that are concerned about night shift workers falling
asleep on the job, the CIA, the Secret Service and the U.S. Air Force,
he said.
Jackson lawyers argue that AEG Live should have consulted a sleep expert like Czeisler for Jackson instead of hiring Murray -- a cardiologist -- for $150,000 to treat the artist.
The trial ends its eighth week in a Los Angeles courtroom Friday. Lawyers estimate that the case will conclude in early August.
No comments:
Post a Comment