Did Michael Jackson die of obstructive sleep apnea?

Because it takes six-to-eight weeks for toxicology reports to be completed, it may be that long before we have a definitive answer on the cause of Michael Jackson’s death. But there is one likely cause that I believe cannot be detected by autopsy: obstructive sleep apnea. And I think the combination of sedating drugs and obstructive sleep apnea (OSA) may turn out to be the cause of Jackson’s death — although I doubt that the complicating factor of undiagnosed OSA will even be considered by the coroner.

This is a shame because I think the combination of sedating drugs and OSA is what really caused the deaths of Heath Ledger, Anna Nicole Smith, John Belushi,  Judy Garland and Marilyn Monroe.

In obstructive sleep apnea, the throat collapses totally and seals the airway so that no air gets through to the lungs. People who witness this hear silence instead of the sound of breathing, then usually look to see if the sleeper has motions of breathing. When they see motions of breathing, they assume the sleeper is OK. Actually, they are watching the sleeper beginning to die. However, usually as the oxygen level in the blood falls, the brain sends a sharp signal to wake up, which causes the sleeper’s body to jerk and the airway to open. The opening of the airway is usually accompanied by the sound of a snore.

What happens when the sleeper with OSA is in very advanced stages of the illness, or has taken sedating drugs or alcohol, is that the apneas become so long or so frequent that the body’s feedback system based on the balance between the levels of oxygen and carbon dioxide in the blood causes the brain NOT to send signals to breathe. In effect, the brain has a procedure for shutting down the body in a sequence that ends in death. Apneas caused by the failure of the brain to send the signal to breathe are called central apneas. (BiPAP ST respirators can detect central apneas and prompt breathing, but there is no other treatment for central apneas.)

I would source everything I’m saying, but I’m late for an appointment and I know all of this because I have OSA and it nearly killed me and also my father. It’s been a long road back.

Obstructive sleep apnea is one of the top under-diagnosed conditions because it was only discovered in the late 1970’s in the course of research on sudden infant death syndrome. The treatment of a CPAP respirator was not developed until the 1980’s. And sleep research in general is still a very young field and the specialists whose fields treat conditions that may have their source in OSA or another sleep disorder do not read sleep medicine journals.

This is particularly a problem when it comes to the relationship between cardiology and sleep medicine. For example, the first research connecting OSA as the cause of idiopathic congestive heart failure was published in 1996. My father has this condition and I’ve gotten him an extra six years of productive life by getting his OSA treated with a CPAP, and later, BiPAP, respirator, plus a pacemaker in December 2008 at the age of 92.

Other heart conditions that research shows are caused by OSA are atrial fibrillation and intractable high blood pressure. If you’re wondering about the connection, imagine the strain on your heart when you continue to go through the motions of breathing when your airway has collapsed and is sealed shut. (I was going to ask you to try to breathe while holding your hand over your mouth, but it is possible that some people could die trying that experiment, so just use your imagination.)

Other conditions that go along with untreated OSA are migraines and a ferocious amount of joint and generalized body pain. (I don’t have research for the second one, just my personal experience. However, fibromyalgia may be caused by a sleep disorder associated with alpha waves occurring during deep sleep when they shouldn’t.)

The bottom line is that OSA can cause depression and a lot of pain, and doctors may treat those symptoms with drugs that depress the breathing center. In Michael Jackson’s case, he is reported to have had the painful condition of lupus and a variety of other aches and pains that required Demerol. If Jackson had undiagnosed OSA, then it is far more likely that ordinary doses of pain medications could have led to his death, especially if he was exceptionally tired for any reason, such as rehearsing for his comeback tour. (By the way, if Jackson slept alone that was another factor dooming him, because there was no one to notice his symptoms or complain about his snoring and haul him to a sleep specialist.)

The foundation for my speculation is that just before my own diagnosis of OSA, I was in some of the worst pain of my life. I took one Percocet and woke up after such a long apneic episode with so many symptoms of cardiac distress that I had to call 911. I spent three days in the hospital getting heart tests and an angiogram before heart disease was ruled out. The cardiologist was stumped. The answer came two weeks later during my sleep study when my symptoms of OSA were so severe the tech got permission to switch to titrating the pressure for my respirator the first minute he could.

I hope my readers with symptoms like heart arrhythmias, chronic migraines, atrial fibrillation, intractable high blood pressure, idiopathic congestive heart failure, depression and hypothyroidism (yes! research suggests half of people with hypothyroidism also have OSA) will consider discussing their symptoms with a sleep specialist, especially if they also have trouble sleeping and/or daytime sleepiness.

Update, 6/29/09: The British tabloid The Sun has published a story based on leaked info about Michael Jackson’s autopsy results. He was 5’10” tall but weighed only 112 lbs., 1 oz., at death. His stomach contained only half-digested pills. His body was covered with needle marks from being injected with pain medication three times a day for many years. It is reported he  had been barely eating for months. I now think the most likely cause of his death was failure to thrive, or inanition, due to his use of painkillers and assorted health problems.