Did an undiagnosed and untreated sleep disorder kill Michael Jackson?

by CynthiaYockey on July 2, 2009

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Today Michael Jackson’s nurse practitioner and nutritionist — she is licensed in both fields — Cherilynn Lee, told reporters that five days before his death, Michael Jackson begged her to order a drug that is ONLY for use in hospitals for anesthesia — where patients are intubated to keep their airway open and on a ventilator that breathes for them — or in intensive care — ditto on the intubation and ventilator. (Nurse practitioners are allowed to prescribe drugs.)

The generic name of the drug Jackson sought is propofol and its brand name is Diprivan. It is given intravenously and burns, so the local anesthetic Lidocaine is usually given with it. (I assume the Lidocaine is either given as a topical spray to numb the IV site, or as a sub-cutaneous or intramuscular injection near the IV site.) Lidocaine was found near Jackson’s body when his breathing stopped.

While propofol could have stopped Jackson’s breathing and killed him because those are two of its side effects, the secondary cause of his death has to be his undiagnosed and untreated sleep disorders — at the least, he had insomnia. Yet I’ve heard nothing about Jackson being referred to a sleep specialist for evaluation, diagnosis and treatment. If he couldn’t sleep, he had a sleep disorder. He went to other specialists for particular problems. But for a sleep problem, Jackson was not referred to a sleep specialist and did not consult with one on his own.

Dr. Sanjay Gupta blathered on CNN about how he’d consulted anesthesiologists to get them to explain to him the use of propofol. Yet Dr. Gupta said nothing about how Jackson was desperately seeking medical help for a sleep problem AND YET NO ONE SENT HIM TO A SLEEP SPECIALIST. The thought that Jackson should have been under the care of a sleep specialist was not a cloud on Dr. Gupta’s horizon.

Instead, because Jackson has had so many surgeries and therefore had anesthesia so often — which put him to sleep — when he could not sleep he sought treatment with an anesthetic and an anesthesiologist. That is, he went after the drug and medical specialty he associated with SLEEP. He was not trying to get high. He just wanted to sleep, according to the statement of Ms. Lee, who strikes me as ethical and on-the-ball. But she only knew enough to refuse to order propofol for Jackson, or find him an anesthesiologist. But she did NOT know enough to round up a sleep specialist for Jackson and get a sleep study done on him stat.

Let me say this again. Jackson clearly had a sleep disorder that was tormenting him out of his mind — as sleep disorders do. YET NO ONE INSISTED HE CONSULT A SLEEP SPECIALIST — the doctor who has the expertise that could have helped him get the good night’s sleep he craved.

Really, gentle readers, sometimes I think it’s like the journals that print sleep research are published with ink and pixels visible only to other sleep researchers.

Here are a few of the specialties that should know enough about sleep research to refer patients to a sleep specialist:

Cardiologist: because sleep disorders can cause atrial fibrillation, intractable high blood pressure and idiopathic congestive heart failure. The cardiologist can treat those conditions, but will have greater success when the underlying sleep disorder causing all the trouble is treated, too.

Endocrinologist: because half of people who have hypothyroidism have obstructive sleep apnea, too, but blame their fatigue on the titration of their thyroid dose or the thyroid hormones prescribed. Also because endocrinologists treate people with diabetes — the sleep disorder frequently precedes the weight gain.

Psychiatrist: because they diagnose depression without ruling out hypothyroidism and obstructive sleep apnea and bipolar disorder without ruling out restless leg syndrome.

Neurologist: because people with multiple sclerosis very often have insomnia. (Note to regular gentle readers: my late life partner, Margaret, had MS and insomnia and for our first few years together felt so delicate about her sleep that we slept in separate bedrooms. Then an abusive member of her family visited and I gave up my room and had to sleep in the same room with Margaret. She felt so safe and slept so well that she insisted we sleep in the same room after that. So we did. She never had insomnia again.)

Rheumatologist: OK, on this one the only research I know about is that alpha waves during deep sleep are associated with fibromyalgia. Plus, my personal experience that I had agonizing joint and muscle pain that almost completely vanished after I began CPAP therapy.

Oh, and family practioners and internists should be referring people to sleep doctors, too, when patients complain of poor sleep or daytime sleepiness.

Whatcha wanna bet that NONE of the cable news channels or major networks or major newspapers or blogs have the slightest glimmer of awareness that Jackson is dead because he had a SLEEP disorder and did not seek care from a SLEEP SPECIALIST.  And yet I expect they will go over again and again that he had sleep problems.

Make the connection, people! Make the connection!

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  • Ms. Yockey, why do you know MJ did not get referred to a sleep specialist? The confidentiality rules prevent us from knowing if he was or wasn’t.

    Jackson was a celeb. He had the usual batch of hangers on, including some Doc. How many of those hangers on were more interested in their cash cow than on his well being? Death by being a celeb is pretty common, common enough that I’m glad I spent my life working in an ordinary job, retiring to a poor but comfortable life with the dogs, a too-rare visit with the grandkids and playing with the dogs. We’d planned on travelling some but we didn’t plan on what the idiots in Congress did with our money. So it’s a big day when we go to the supermarket .
    Anyway, back to Jackson. He spent more money paying families of young boys to settle out of court than most people will ever see. Sooner or later he would have been hauled before a jury that wasn’t from California. So he died before the degradtion of going to the slam as a baby raper. There were lots of people dying right around then that may not advance your sleep specialist cause but certainly deserve more in print.
    Farrah Fawcett who spent a lot of her own money to help battered women. Ed McMahon, Marine pilot. He rose to Colonel in the Marine Corps Reserve and flew scads of missions during the Korean War in an unarmed Cessna Bird Dog, low and slow over the battlefield , within range of everything more powerful than a slingshot.
    Not to mention the heros slaughtered in Iran, trying for democracy. Funny, that’s just what George Bush said would happen, too bad the new President doesn’t believe in supporting freedom.

    Oh well, here I am, writing a book on your site while ignoring mine. Lucky thing nobody ever accused me of being too smart.
    .-= Peter´s last blog ..The Unpaid Dell Software Mechanic =-.

  • It’s amazing how many life-altering diseases are out there that no one ever tests for.

    My husband used to drink 2 pots of coffee a day. Finally he referred himself to a sleep specialist and found out that his oxygen level was sometimes under 80% at night. (The sleep doctor rushed a CPAP to him.)

    I suffered with all sorts of sinus infections, headaches, exhaustion, and IBS for over a decade. One day I stopped eaten gluten. Three days later I felt better than I had in over 10 years. My life was hell. I was too tired to clean, my head was always burning pain. I was probably destroying my liver with non-stop advil.

    Crazy.
    .-= silvermine´s last blog ..Voting By Shopping =-.

  • West

    Yeah, a sleep study would have saved his life. Sure.

    I went to a sleep center and despite the fact that my blood oxygen never fell below 90%, I was diagnosed with Hypopnea. That’s Apnea Lite, or down-defined apnea for the purpose of moving more CPAP machines. I never even met the doctor. The machine was useless, despite 3 months of concentrated attempts to use it, several masks, yadda yadda.
    I do have a sleep problem, but is seemingly to obscure for a ‘sleep specialist’ to diagnose, since prescribing a machine has such a nice profit margin (I was sold a $750 machine for $2200) and is much easier for everyone involved – except me. No one had any explanation of my complete lack of stage 4 sleep.

    Sleep centers are nothing more than apnea mills existing solely for the purpose of moving CPAP machines.

    • West,

      The attitude that people are only out to cheat you means that you will only consider evidence supporting your pre-conceived conclusion that you will always be cheated.

      Also, what’s up with not seeing the sleep specialist to discuss your sleep study results? Start Googling about the Stage 4 sleep problem to educate yourself, then see the doctor who has the sleep study results — the DOCTOR. It sounds like you didn’t get properly diagnosed, which is not surprising since you did not get to go over the test results with the sleep specialist. The way our medical system works, it is up to you to keep trying until you are correctly diagnosed and treated. Until around the 1980’s, doctors would push on your behalf because they were not restricted about making referrals. Now it’s all on you. This sucks because you have to advocate for yourself when you don’t feel well and find your way to the right doctors when you don’t understand the system. But that’s how it works now.

      Sleep doctors and sleep centers, as far as I know, are financially separate from the durable medical equipment providers who sell respirators and masks. So sleep centers do not exist to sell CPAP machines.

      Keep trying and good luck.

      Cynthia

  • Travis

    West,
    Unfortunately, CPAP machines are the only known way to treat obstructive sleep apnea/hypopnea. If you have this condition, then OF COURSE they would sell you one. It’s the only known treatment modality, other than having your spouse kick you awake every time you stop breathing(the oldest known treatment) Just because you couldn’t make it work for you, does NOT mean it’s a hoax, or some sort of con-job. I deal with sleep apnea patients every day(I’m an anesthesiologist) and many people report having to try literally dozens of different masks to find one that will work for them, which is why we always tell sleep apnea patients to bring their own equipement with them when they are to have surgery. Sleep apnea patients are often so sleep deprived that even a small amount of sedative has a very strong effect, and they may still be obstructing hours after the anesthetics should have worn off. Keep trying different masks. there are hundreds of styles to choose from. You’ll eventually find one, and when you do, you’ll be glad you did.

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