Jacksons vs AEG - Day 34 – June 20 2013 – Summary
Katherine Jackson is in court.
Dr. Charles Czeisler Testimony , Jackson's retained Sleeping Disorder Specialist.
Jackson direct
Jackson's attorney Michael Koskoff doing direct examination. (ABC7)
Dr. Czeisler lives in the Boston area, Massachusetts, grew up in Chicago. He detailed his extensive background in the medical field. Dr. Czeisler graduated from Harvard and went to Stanford Medical School. He became a professor at Harvard medical school. (ABC7)
The doctor said our internal clock regulates the timing we are awake and asleep. Dr. Czeisler began studying the internal clock in the brain that controls our sleep while in undergraduate school. After lunch time, the drive from the internal clock to stay awake becomes stronger and stronger, Dr. Czeisler said. Light is the most synchronizing sleep pattern, Dr. Czeisler explained. When it's light out, it's time to stay awake. Dark, time to sleep. Changes in the regular sleeping pattern sends confusing signals to the brain, which suppresses the release of hormones, Dr. Czeisler said. People who work night shift have difficulty going to sleep right away when they get home, since they are still wired up. (ABC7)
The first sports team Dr. Czeisler worked with was NBA Portland Trail Blazers. They contacted him to help the teamed just through time zones. The doctor also worked with the Minnesota Timberwolves and Boston Celtics, the Bruins and now the Red Sox. Dr. Czeisler said musicians can also have sleeping problems when they are traveling through time zones. Musicians on tour have altered schedule, Dr. Czeisler said. They perform late, are on a different country with different time zones. Dr Czeisler has worked with The Rolling Stones and Shaquille O'Neal. Shaq allowed doctor to videotape exam to evaluate if he had sleep apnea.The doctor said Shaq wanted help educate the public about sleeping problems. They published entire film of episode of him going through exam. Dr. Czeisler worked with astronauts for 25 years to help them adjust their sleep while in space. They trained the astronauts how to set up the recording system so they could see different stages of sleep they were in while in space. (ABC7)
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 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, Secret Service and the U.S. Air Force, he said. (CNN)
Dr. Czeisler said there are about 800,000 physicians in the US. He was elected one of the members of the Institute of Medicine. Dr. Czeisler belongs to several professional societies. He testified before Congress in a panel of shift workers discussion. Dr. Czeisler published over 120 original reports in peer review journals, which are all new researches. The doctor works with industries that typically work around the clock and workers who have problems sleeping during the day/work at night.Dr. Czeisler has worked with nuclear power plants workers, police forces, firefighters, federal air marshals, CIA, secret service, others. He worked with pilots in the operation desert storm, where most flights were at night. (ABC7)
Dr. Czeisler has served as expert witness before, testified in less than a dozen cases. Dr. Czeisler is being paid $950 an hour. He's one of Jackson's retained experts. (ABC7)
"Sleep is a very active process, but it's characterized by, and fulfills basically biological needs," Dr. Czeisler explained. Sleep is controlled by the brain, Dr. Czeisler said. Signs of sleep: Reduced activity Posture Eyes closed Reduction in sensitivity, but not a complete loss Reversible loss of conscious. Dr. Czeisler created slides showing how the brain works to help the jury understand how sleep happens. "There's a lot going on in the brain while we sleep," Dr. Czeisler said, explaining it's the time for repair/maintenance of the brain cells. "The average person should obtain 7-8 hours asleep every night," Dr. Czeisler said. Sleep cycle takes about an hour and a half to two hours, Dr. Czeisler explained. You go through a progression between sleeping stages. "Sleep has an architecture to it" Dr Czeisler said. We keep brain cells for life, the brain has to go through offline maintenance process. Dr. Czeisler: That period of repair and maintenance is called sleep. The brain uses 20% of glucose (energy) a day, Dr. Czeisler said. At night, we purge things that are not important and keep the ones that are. Dr. Czeisler explained sleep is essential to consolidate the memory of what we learned during the day in our brain. "We sleep in order to fulfill a series of basic biological needs," Dr. Czeisler explained. Dr. Czeisler: We keep our brain cells for life, we need to repair and maintain the connections because we don't have enough room. Doc: While we sleep, we consolidate our memory, integrate learning, refuel the tank, store energy in cells, which requires brain to be off. The doctor said it was believed that sleep was just necessary for the brain, but it was learned sleep is also necessary for the body. "Regulation of metabolism doesn't go well if we are sleep deprived," Dr. Czeisler said. "If we don't get enough sleep, we are hungrier." The doctor said if we sleep only 4-5 hours a night we use more energy, but because we are awake longer, we eat more and gain weight. "Even fat cells need sleep to metabolize properly," Dr. Czeisler said. Dr. Czeisler said lack of sleep increases appetite, among other things. "Sleep is necessary for life, just like the same way eating or drinking fluid is necessary for life," the expert said. (ABC7)
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 7-8 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.
A basketball player's area of the 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. They shoot better after sleep. (CNN)
It takes 17 days before an animal dies if deprived of food, Dr. Czeisler said. Study shows that rats sleep deprived became scrawny, disheveled, unable to maintain body temperature, Dr. Czeisler testified. Rats deprived of all sleep died on 21 days, rats selectively deprived of sleep died in 37 days. Recovery occurred in 1-3 days in those rats. If deprived, animal is no longer able to maintain body temperature, Dr. Czeisler explained. (ABC7)
Rapid eye movement sleep (REM) is necessary, Dr. Czeisler said. Its deprivation affects cognitive function, ability to consolidate memory. Adverse impact of sleep deficiency on cognition: Slowed reaction time; slowed reflexes, Impaired balance, Increased distractibility, Impaired judgement, Impaired memory, Impaired creativity, Increased risk of lapses of attention. Increased risk of automatic behavior, Increased risk of falling asleep, Fast and sloppy (speed/accuracy trade off). (ABC7)
250,000 people a day fall asleep at the wheel, Dr. Czeisler said. "People take chances they would not take when sleep deprived," Dr. Czeisler explained. Dr. Czeisler said even if someone has taken a shower and put on make up, we can recognize lack of sleep by looking at their picture. (ABc7)
Adverse impact of sleep deficiency on mood: Increased emotional volatility, difficult focusing sustained attention, increased risk of burnout, depression and suicidal ideation, euphoria/slap-happy, somatic complaints, anxiety, paranoia. "You may not be able to hold your emotions in check," Dr. Czeisler explained. Dr. Czeisler described the brain and what each area does. (ABC7)
"They will make 10 times as many mistakes if they are sleep deprived," Dr. Czeisler said. "When we are sleeping, were going through and replaying the events," Dr. Czeisler explained. "We are actually practicing what we learned." You need to sleep the night after you learned a task in order to absorb it, Dr. Czeisler said. (ABC7)
Dr. Czeisler testified sleep deprivation is used as a method of torture to get confessions. "It's so exhaustive and so painful to be sleep deprived," Dr. Czeisler explained. Some say it is by far the worse type of torture. Koskoff: Sleep deprived people look for ways to get sleep? Dr. Czeisler: Yes (ABC7)
"Insomnia is a complaint of difficulty of sleep in either falling asleep, staying asleep or waking up too early," Dr. Czeisler explained. "They may have negative associations with bedroom or sleep that may prevent them from sleeping," Dr. Czeisler explained about insomniac. Dr. Czeisler said there are 3 billion hours a week of video game playing, which affects the sleep because of over activity in the brain. If irregular sleeping, it's necessary to look into sleep hygiene: Poor sleeping environment, caffeine usage (16 hour half life), darkness. 70% of parents put TVs in children's room to help them asleep but it actually interfere with sleep, Dr. Czeisler said. (ABC7)
Insomnia could be secondary to medicine use or substance abuse. Dr. Czeisler: Once you're taking sleeping pills for a series of nights, now you can't sleep without them. Your sleep is actually worse. Dr. Czeisler said cognitive behavior therapy is used to treat insomnia, where a psychologist identifies the problem. The expert said this is a multi-week therapy with personalized approached. It's proven effective, even more than drugs, Dr. Czeisler said. If it is secondary to anxiety, doctor might consider give some anxiolytics, Dr. Czeisler explained. In order to treat insomnia, the first step is to figure out what the disorder is, Dr Czeisler said; sleeping disorder is a treatable disease. (ABC7)
"Propofol is not sleep medicine," Dr. Czeisler said. "It is an anesthetic." "Even thought it's the brain they are anesthetizing, they have not been monitoring the brain," Dr. Czeisler said about anesthesia. Dr. Czeisler: There are a series of experiments to understand the extend from which its similar or different from sleep. "Propofol appears to dissipate the drive for sleep," Dr. Czeisler testified. AEG atty said there's no reference in Dr. Czeisler's 78 pages resume of Propofol study, asked judge to not allow his testimony. Attorneys discussed extensively about Dr. Czeisler's competence to testify on Propofol vs sleep. Judge admitted his opinion conditionally. (ABC7)
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. 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 Dr. Charles Czeisler, a Harvard Medical School sleep expert testifying at the wrongful death trial of concert promoter AEG LIve. If the singer had not died on June 25, 2009, of an overdose of the surgical anesthetic, the lack of REM sleep may have soon taken his life anyway, according to an opinion by Czeisler. (CNN)
Genuine sleep: Actively generated by the brain; Fulfills biological needs; Readily reversible reduction in sensation;,Readily reversible loss of conscious awareness, Can be easily awakened, Cycles between two behavioral states: REM and non-REM sleep, Sensitive to pain.(ABC7)
Propofol anesthesia: Drug-induced coma, Doesn't fulfill needs, Profound unresponsiveness, No consciousness, Cannot be awakened until gone, No REM sleep, NREM sleep abnormal, Isoelectric EEG in deep, Insensitive to pain, Dissipates the sleep drive without fulfilling the sleep need. (ABC7)
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. (CNN)
"When you go under anesthesia, you are going into induced coma," Dr. Czeisler said. "There's no FDA approved reversal to Propofol, you need to metabolize it in order to wake up," Dr. Czeisler explained. (ABC7)
"If you didn't get REM sleep yesterday, you'll have REM rebound tonight, you might fall directly into sleep," Dr. Czeisler said. Dr. Murray: Ironically, Propofol anesthesia in sleep deprived animals, they don't have rebound, it destroys the drive for sleep. "They wake up feelings refreshed, it has dissipated their sleep drive, but not their sleep need," Dr. Czeisler said about Propofol. "They feel like they had a great night, but they haven't had any sleep at all," the expert said. Genuine sleep fulfills biological needs, but Propofol sleep dissipate the sleep drive, the doctor explained. (ABC7)
Dr. Czeisler said there are no intravenous medication approved to treat insomnia. Dr. Czeisler: Demerol is an opioid and it increases sleep propensity. It's not the same as anesthetic. "The sleep that you are getting is generated by the brain, not by the drug," Dr. Czeisler explained. Demerol is a sedative, normally used in association with surgical procedure to address pain. Demerol dissipates some of your biological drive for sleep, if slept for hours during the day it will be more difficult to sleep at night. Withdrawal of Demerol is a secondary type of insomnia. "It can increase insomnia," Dr. Czeisler explained. (ABC7)
Koskoff gave a very long hypothetical using all the examples that happened with MJ. Defendant's objected, judge held another long sidebar. (ABC7)
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, paranoid and was talking to himself in his final weeks.
-- That the production manager warned 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 spins that he was known for.
-- That show director Kenny Ortega wrote 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.
AEG Live lawyers objected to the question because the information about Murray's nightly propofol treatments was derived only from the doctor's statement to police after Jackson's death. The judge previously ruled that statement was inadmissible. It was a ruling made earlier in the trial when Jackson lawyers objected to AEG's use of Murray's statement that he believed he was Jackson's employee, not AEG Live's.
The statement could be used if Murray, who is serving a prison term, is brought into testify. But that is unlikely since the doctor has said he would impose his constitutional protections against self-incrimination as long as the appeal of his conviction is pending.
Jackson lawyers could clear the way for use of the statement by withdrawing their objection, something they are now considering.
Koskoff told the judge that his expert would testify that Jackson's symptoms perfectly matched what he would expect from someone who had been given long-term propofol treatments. (CNN)