Michael Jackson died while preparing to set a world record for the most successful concert run, but he unknowingly set another record that led to his death.
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.
"The symptoms that Mr. Jackson was exhibiting were consistent with what someone might expect to see of someone suffering from total sleep deprivation over a chronic period," Dr. Charles Czeisler, a Harvard Medical School sleep expert, testified Friday at the wrongful-death trial of concert promoter AEG LIve.
The symptoms documented by e-mails among show producers and testimony from his chef, hairstylist and choreographers included his inability to do standard dances or remember words to songs he sang for decades, paranoia, talking to himself and hearing voices, and severe weight loss, Czeisler said.
"I believe that that constellation of symptoms was more probably than not induced by total sleep deprivation over a chronic period," he testified.
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 Czeisler.
If the singer had not died on June 25, 2009, of an overdose of the surgical anesthetic, the lack of REM sleep may have taken his life within days anyway, according Czeisler's testimony Friday.
Lab rats die after five weeks of getting no REM sleep, he said. It was never tried on a human until Murray gave Jackson nightly propofol infusions for two months.
Translating that to a human, Czeisler estimated, Jackson would have died before his 80th day of propofol infusions. Murray told police he had given it to him for 60 nights before trying to wean him off it on June 22, 2009 -- three days before his death.
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.
Those symptoms are strikingly similar to descriptions of Jackson in his last weeks, as described in e-mails from show producers and testimony by witnesses in the trial.
Jackson's mother and children are suing AEG Live, contending that the company is liable in his death because it hired, retained or supervised Murray, who was convicted of involuntary manslaughter. They argue that the promoter pressured Murray to get Jackson to rehearsals while failing to get Jackson help despite numerous red flags warning that he was in trouble.
AEG Live lawyers contend that it was Jackson who chose, hired and supervised Murray, and their executives had no way of knowing about the dangerous propofol treatments administered in the privacy of Jackson's rented mansion.
A very long question
Czeisler was back on the witness stand Friday to answer a question that was asked just as court ended Thursday. 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 and paranoid and was talking to himself in his final weeks.
• That the production manager warned that 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-degree spins that he was known for.
• That show director Kenny Ortega wrote that 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.