Wednesday, October 12, 2011

Is Propofol Safe for Sleep?

Is propofol safe for sleep? Simply put, the answer is no. However, there is a study that was published online in November 2010 entitled "Propofol-Induced Sleep: Efficacy and Safety in Patients with Refractory Chronic Primary Insomnia".

Here is a link to the study so you can read it yourself and I urge everyone to read it carefully as it does contain some great insight into insomnia and how it is conventionally treated (and how many conventional treatments fail):

The study was done in China on patients who were considered to have "refractory chronic primary insomnia". This means these patients do not have any underlying causes for their insomnia (ex. sleep apnea or bad habits), they have it continuously and conventional treatments have failed them. A friend of mine who is a nurse told me there is no listing for "refractory chronic primary insomnia" in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) so I am not sure if people can be diagnosed as having such or if this type of insomnia was coined specifically for this study. Regardless, the study states 30-40% of adults suffer from insomnia and that is a considerable sum of people who suffer from this ailment.

For the clinical trial there were 103 participants--64 received propofol and 39 received saline. I am not sure how much (milligrams) each patient received but the study states the 64 who received propofol received propofol at a concentration of 3 g/L. This seems to indicate propofol was diluted as it is typically in a concentration of 10 mg/mL which is also equal to 10 g/L. The study states, concerning administration, "the protocol for propofol administration was based on our earlier study according to some clinical parameters such as age, weight, liver function, renal function, etc." I have not been able to locate this study yet (the name is included in the study as a source) and have attempted to email the professor who did this study to see just exactly how much propofol was received by these patients as I am very curious to know. Anyhow, those who received propofol received a 2 hour infusion at rate based on the guidelines from a previous study, starting at 10:00 pm each night, for 5 nights.

The patients had their brainwaves monitored and also filled out questionnaires that were used to determine if the propofol had made any improvements in sleep on the first morning after the last treatment and 6 months later as well.

According to the questionnaire that patients took part in, those who received propofol were more likely to report improvements in how long it took them to fall asleep, their quality of sleep, their ability to wake up after sleeping and what waking up in a better mood. These improvements were still evident 6 months later as well. Individuals who received propofol also reported longer sleep times, faster times at falling asleep and fewer awakenings during the night.

There are four stages of non-REM (NREM) sleep and then there is REM sleep, which is the deepest state of sleep and the most restorative. According to this study, Stage I NREM was shortened with propofol, Stage II NREM was unchanged, and there was an increase in NREM Stage III, IV sleep as well as REM sleep. Stage I NREM is the lightest level of sleep while Stage IV is heavier.

For those who received propofol, there were few reported adverse events. Four said they experienced somnolence during the morning after treatment, two reported being dizzy and two had mild nausea. There were no reported issues 6 months later.

The researchers who conducted this study state they believe that propofol may be able to restore sleep homeostatis after sleep deprivation. This would seem likely given positive results even 6 months later.

The study closes with the following paragraph:

Future studies on the efficacy and safety of propofol induced
insomnia should be aimed at confirming these findings in a multi-center cohort study. Since our study participants did not suffer from an ongoing psychiatric or medical condition, it would be useful to know whether propofol-induced sleep would be therapeutically beneficial in such patients who also suffer from insomnia. Lastly, the results of this study also calls for further investigation on the mechanism of propofol action on the attenuation of the sleep debt in patients with refractory chronic primary insomnia.

The article also mentions that they believe they are the first to demonstrate propofol-induced sleep is a safe and effective alternative treatment for patients with this kind of insomnia.

Now--with all that being said, I think it is important to distinguish how this study does NOT relate to anything Conrad Murray did to Michael Jackson.

1. This study was the first of its kind--this means there were NO studies for Conrad Murray to base his "treatment" on for Michael. This study was published almost 18 months after Michael was killed. Murray is not an anesthesiologist, neurologist or a sleep specialist. He is nothing as far as I am concerned.

2. Though we do not know exactly what Murray did to Michael as far as what all he administered, how he administered it and when he administered it, in this particular study propofol was only used for 5 days from 10:00 p.m. until midnight. That is a total of 10 hours of propofol use for the entire treatment. Whatever Murray was doing lasted far more than 10 hours and Michael was obviously having adverse effects that were lingering into his rehearsals.

3. This clinical study took place in a clinic--not a home setting.

4. Propofol was administered continuously with a micro-infusion pump--not a gravity-drip device with a roller clamp, as Murray had ordered supposedly for rehydration.

5. Blood pressure was continuously monitored.

6. An EKG, or the heart rhythm, was constantly monitored.

7. Oxygen saturation was constantly monitored.

We can gather from this study that someday, with more research, propofol may be useful to those who are healthy and have insomnia that is not successfully treated with conventional methods. Does this mean that Murray was right in what he did? No. Does it mean propofol can now safely be used for insomnia? No. Does it mean it will ever be safe to use for insomnia? No. There is too much that needs to be learned before such a leap is made. There are still no excuses for what Murray did and absolutely no justification in his actions, be it administering propofol or simply refusing to administer appropriate aid to his patient. Murray's actions continue to baffle even the most seasoned of medical professionals. No one can put a direct finger on what exactly he did to Michael--but as Dr. Alon Steinburg said today in court--Michael Jackson was savable. He should have been saved but for whatever reasons, he was allowed to die. Many of you reading this hurt from Michael's death and though we may see Murray found guilty there is still a huge knife in our hearts because we do not know why he had to die or how he died. Yes, we have a cause of death but we do not know how it came about and that for me is painful, especially knowing that the man who sits in court everyday looking like a clown yet not shedding a tear (except for the first day when the discussion was focusing on him) knows what happened and why but is not talking and will never talk if he has it his way. Well, he will talk but it will not be the truth.

The following articles remind us of why propofol is not currently used for sleep and why it would never be used for sleep in a home-setting:

Though the following study does not promote or detest the use of anesthetics for sleep it is a fascinating read that discusses how general anesthesia is basically synthetic brain-stem death rather than sleep:

We can gather in the propofol for insomnia study that propofol was not used like it is for general anesthesia--a key indication of this is the lack of intubation in those patients who received propofol. However, it is important to remember that there is a fine line between the different stages of sedation (from consciously sedated to general anesthesia), especially when using propofol. Because of that, precautions will always need to be put in place, just in case. As the Boy Scout motto says--"be prepared".


  1. This is very good blog GG thank you,
    CM did not treat mj like a caring doctor. He treat him like a street drug dealer who base goal is getting paid,
    A caring good doctor would take the opportunity to make a difference to mj look into history and make sure the patient safety is #1 keeping dangerous drug out of the patient reach make sure patient is being monitored at all time while you are giving him drug,
    I am still in shock that Murray did not have a code blue plan knowing how dangerous those drug are,
    Knowing he did not have a rescues plan he should have call 911 even before he start telling them he is a doctor and he have a patient down.
    Murray found MJ at 12 and did not call 911 for 20 minutes?
    For that alone he should heve his license revoke.
    He knew that he gave MJ drug that can stop him from breathing and he Had no backup equipment call 911,
    Doctor muarray clean up the crime sight put away drugs and call mj personal assistance to send security to him but no mention call "911 I need" help Know.
    He his a doctor so him call for help are going to make the situation more serious 20 minutes for help this is tough.

  2. This may be a little off topic, but I think the prosecution's biggest hurdle here is that many people have a fundamental misunderstanding of what the definition of criminally negligent involuntary manslaughter is.

    The defense keeps hammering home that Murray did not give Michael the fatal dose of propofol.
    That does not mean that he is not guilty of criminally negligent involuntary manslaughter.

    A failure to act when there is a duty to do so that results in a death is enough to have committed criminally negligent involuntary manslaughter.

    As MJ's doctor Murray had a duty to act. He failed. By his own admission he delayed calling 9-1-1. By his own admission he left the room. He is guilty.

    It is not simply what one "does" that makes this act criminal.. It is more significantly what one "does not".

    I thing Walgren should give the jury a copy of the definition of Criminally negligent involuntary manslaughter, along with Murray's actions and lack there of and then ask for a verdict. By the law. The defense is trying to confuse the jury as to what the law states.. That is the only thing that can get Murray off.