Re: Jacksons vs AEG - Day 34 - June 20 2013 - News Only (no discussion)
ABC7 Court News ?@ABC7Courts 3m
That wraps Day 34 of testimony. We hope to see you tomorrow. For all the latest, watch @ABC7 and
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Judge adjourned session until tomorrow 9:15 am PT. Dr. Czeisler resumes testifying tomorrow. Karen Faye won't return until next Friday.
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Koskoff gave a very long hypothetical using all the examples that happened with MJ. Defendant's objected, judge held another long sidebar.
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Withdrawal of Demerol is a secondary type of insomnia. "It can increase insomnia," Dr. Czeisler explained.
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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.
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Demerol is a sedative, normally used in association with surgical procedure to address pain.
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"The sleep that you are getting is generated by the brain, not by the drug," Dr. Czeisler explained.
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Dr. Czeisler: Demerol is an opioid and it increases sleep propensity. It's not the same as anesthetic.
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Dr. Czeisler said there are no intravenous medication approved to treat insomnia.
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Genuine sleep fulfills biological needs, but Propofol sleep dissipate the sleep drive, the doctor explained.
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"They feel like they had a great night, but they haven't had any sleep at all," the expert said.
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"They wake up feelings refreshed, it has dissipated their sleep drive, but not their sleep need," Dr. Czeisler said about Propofol.
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Dr. Murray: Ironically, Propofol anesthesia in sleep deprived animals, they don't have rebound, it destroys the drive for sleep.
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"If you didn't get REM sleep yesterday, you'll have REM rebound tonight, you might fall directly into sleep," Dr. Czeisler said.
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"There's no FDA approved reversal to Propofol, you need to metabolize it in order to wake up," Dr. Czeisler explained.
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"When you go under anesthesia, you are going into induced coma," Dr. Czeisler said.
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Propofol anesthesia: Dissipates the sleep drive without fulfilling the sleep need
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Propofol anesthesia: No REM sleep, NREM sleep abnormal, Isoelectric EEG in deep, Insensitive to pain
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Propofol anesthesia: Drug-induced coma, Doesn't fulfill needs, Profound unresponsiveness, No consciousness, Cannot be awakened until gone
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Genuine sleep: Cycles between two behavioral states: REM and non-REM sleep, Sensitive to pain
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Genuine sleep: Readily reversible loss of conscious awareness, Can be easily awakened
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Genuine sleep: Actively generated by the brain; Fulfills biological needs; Readily reversible reduction in sensation;
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Attorneys discussed extensively about Dr. Czeisler's competence to testify on Propofol vs sleep. Judge admitted his opinion conditionally.
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AEG atty said there's no reference in Dr. Czeisler's 78 pages resume of Propofol study, asked judge to not allow his testimony.
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"Propofol appears to dissipate the drive for sleep," Dr. Czeisler testified.
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Dr. Czeisler: There are a series of experiments to understand the extend from which its similar or different from sleep.
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"Even thought it's the brain they are anesthetizing, they have not been monitoring the brain," Dr. Czeisler said about anesthesia.
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"Propofol is not sleep medicine," Dr. Czeisler said. "It is an anesthetic."
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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
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If it is secondary to anxiety, doctor might consider give some anxiolytics, Dr. Czeisler explained.
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The expert said this is a multi-week therapy with personalized approached. It's proven effective, even more than drugs, Dr. Czeisler said.
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Dr. Czeisler said cognitive behavior therapy is used to treat insomnia, where a psychologist identifies the problem.
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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
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Insomnia could be secondary to medicine use or substance abuse.
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70% of parents put TVs in children's room to help them asleep but it actually interfere with sleep, Dr. Czeisler said.
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If irregular sleeping, it's necessary to look into sleep hygiene: Poor sleeping environment, caffeine usage (16 hour half life), darkness
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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.
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"They may have negative associations with bedroom or sleep that may prevent them from sleeping," Dr. Czeisler explained about insomniac.
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"Insomnia is a complaint of difficulty of sleep in either falling asleep, staying asleep or waking up too early," Dr. Czeisler explained.
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Koskoff: Sleep deprived people look for ways to get sleep?
Dr. Czeisler: Yes
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"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.
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Dr. Czeisler testified sleep deprivation is used as a method of torture to get confessions.
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You need to sleep the night after you learned a task in order to absorb it, Dr. Czeisler said.
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"When we are sleeping, were going through and replaying the events," Dr. Czeisler explained. "We are actually practicing what we learned."
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"They will make 10 times as many mistakes if they are sleep deprived," Dr. Czeisler said.
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"You may not be able to hold your emotions in check," Dr. Czeisler explained.
Dr. Czeisler described the brain and what each area does.
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Impact on mood: increased risk of burnout, depression and suicidal ideation, euphoria/slap-happy, somatic complaints, anxiety, paranoia.
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Adverse impact of sleep deficiency on mood:
Increased emotional volatility, difficult focusing sustained attention
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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.
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"People take chances they would not take when sleep deprived," Dr. Czeisler explained.
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250,000 people a day fall asleep at the wheel, Dr. Czeisler said.
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More impact: Increased risk of automatic behavior, Increased risk of falling asleep, Fast and sloppy (speed/accuracy trade off).
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More impact: Increased distractibility, Impaired judgement, Impaired memory, Impaired creativity, Increased risk of lapses of attention
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Adverse impact of sleep deficiency on cognition:
Slowed reaction time; slowed reflexes, Impaired balance
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Rapid eye movement sleep (REM) is necessary, Dr. Czeisler said. Its deprivation affects cognitive function, ability to consolidate memory
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If deprived, animal is no longer able to maintain body temperature, Dr. Czeisler explained.
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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.
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Study shows that rats sleep deprived became scrawny, disheveled, unable to maintain body temperature, Dr. Czeisler testified.
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It takes 17 days before an animal dies if deprived of food, Dr. Czeisler said.
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"Sleep is necessary for life, just like the same way eating or drinking fluid is necessary for life," the expert said.
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Dr. Czeisler said lack of sleep increases appetite, among other things.
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"Even fat cells need sleep to metabolize properly," Dr. Czeisler said.
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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.
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"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."
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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.
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Doc: While we sleep, we consolidate our memory, integrate learning, refuel the tank, store energy in cells, which requires brain to be off
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Dr. Czeisler: We keep our brain cells for life, we need to repair and maintain the connections because we don't have enough room
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"We sleep in order to fulfill a series of basic biological needs," Dr. Czeisler explained.
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Dr. Czeisler explained sleep is essential to consolidate the memory of what we learned during the day in our brain.
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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
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Dr. Czeisler: That period of repair and maintenance is called sleep.
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"Sleep has an architecture to it" Dr Czeisler said. We keep brain cells for life, the brain has to go through offline maintenance process.
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Sleep cycle takes about an hour and a half to two hours, Dr. Czeisler explained. You go through a progression between sleeping stages.
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"The average person should obtain 7-8 hours asleep every night," Dr. Czeisler said.
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"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.
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Dr. Czeisler created slides showing how the brain works to help the jury understand how sleep happens.
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Signs of sleep:
Reduced activity
Posture
Eyes closed
Reduction in sensitivity, but not a complete loss
Reversible loss of conscious
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Sleep is controlled by the brain, Dr. Czeisler said.
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"Sleep is a very active process, but it's characterized by, and fulfills basically biological needs," Dr. Czeisler explained.
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Dr. Czeisler is being paid $950 an hour. He's one of Jackson's retained experts.
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Dr. Czeisler has served as expert witness before, testified in less than a dozen cases.
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He worked with pilots in the operation desert storm, where most flights were at night.
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Dr. Czeisler has worked with nuclear power plants workers, police forces, firefighters, federal air marshals, CIA, secret service, others.
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The doctor works with industries that typically work around the clock and workers who have problems sleeping during the day/work at night
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Dr. Czeisler published over 120 original reports in peer review journals, which are all new researches.
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Dr. Czeisler belongs to several professional societies. He testified before Congress in a panel of shift workers discussion.
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Dr. Czeisler said there are about 800,000 physicians in the US. He was elected one of the members of the Institute of Medicine.
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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.
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Dr. Czeisler worked with astronauts for 25 years to help them adjust their sleep while in space.
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The doctor said Shaq wanted help educate the public about sleeping problems. They published entire film of episode of him going through exam
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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
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Musicians on tour have altered schedule, Dr. Czeisler said. They perform late, are on a different country with different time zones.
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Dr. Czeisler said musicians can also have sleeping problems when they are traveling through time zones.
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The doctor also worked with the Minnesota Timberwolves and Boston Celtics, the Bruins and now the Red Sox.
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The first sports team Dr. Czeisler worked with was NBA Portland Trail Blazers. They contacted him to help the teamed just through time zones
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People who work night shift have difficulty going to sleep right away when they get home, since they are still wired up.
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Changes in the regular sleeping pattern sends confusing signals to the brain, which suppresses the release of hormones, Dr. Czeisler said.
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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.
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After lunch time, the drive from the internal clock to stay awake becomes stronger and stronger, Dr. Czeisler said.
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Dr. Czeisler began studying the internal clock in the brain that controls our sleep while in undergraduate school.
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The doctor said our internal clock regulates the timing we are awake and asleep.
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Dr. Czeisler graduated from Harvard and went to Stanford Medical School. He became a professor at Harvard medical school.
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Dr. Czeisler lives in the Boston area, Massachusetts, grew up in Chicago. He detailed his extensive background in the medical field.
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Jackson's attorney Michael Koskoff doing direct examination.
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New witness on the stand: Dr. Charles Czeisler, plaintiff's retained Sleeping Disorder Specialist.
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Judge said alternate juror 6 has been excused, since he moved. Judge said with the move came financial hardship. Thus, she let him go.
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Katherine Jackson is in court today wearing a black and white floral long jacket.
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Attorneys spent the last 20 minutes discussing with the judge boundaries for testimony of upcoming sleeping disorder expert.
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Hello from the courthouse in downtown LA. Day 34 of Jackson family vs AEG trial is underway. Jurors are not in the courtroom yet.