Author’s Note: The following is the Opinion of the author and does not necessarily reflect the opinions of DailyStrength.

Do you breathe more through your nose or your mouth? The correct answer is that you should breathe through your nose. Our lungs are an incredible machines designed to take the air that you breathe in, and transfer that into oxygen molecules bound to red blood cells which deliver the oxygen to our tissues. The temperature and moisture of the oxygen that is inspired into the lungs, are two of the most important factors that affect the EFFICIENCY with which the lungs oxygenate our bodies. When you breathe through your nose, the nasal tissues moisten and warm the air, the exact amount necessary for efficient oxygenation. When you breathe through your mouth, the air that goes into your lungs is neither warmed nor moistened. For a given amount of oxygen brought into the lungs, less will get to your tissues if it is breathed through your mouth then if the exact same amount of oxygen were breathed through your nose. Which brings us to the very sad story of Michael Jackson.

In the British documentary “Living with Michael Jackson,” which aired on ABC in February of 2003, Michael told Martin Bashir that when he was a small boy, his father used to repeatedly make fun of him because he had a wide “black” nose. I believe this had a negative affect on his self esteem and eventually led to the numerous plastic surgeries he had on his nose. Over the years, his nose appearance got smaller and more narrow. A prominent New York Plastic Surgeon, Dr. Pamela Lipkin, who had never met Jackson, was given pictures of him from age 5 to 40 years old and said that he appeared to be a “Nasal Cripple” which is the name that plastic surgeons give to people who have had so many surgeries on their nose that it becomes almost impossible to breathe through.

If this is true, and Michael Jackson could not breathe through his nose, then he had to breathe through his mouth. At night when he tried to sleep, his mouth breathing would significantly increase the chances that his tongue could go to the back of his throat blocking off his airway, causing Obstructive Sleep Apnea (OSA.) This lack of oxygenation at night would give him chronic fatigue; and could affect his cognitive functions, which might explain his sometime bizarre behavior in public. Patients with Obstructive Sleep also often exhibit insomnia; because the unconscious brain does not want the body to fall asleep, it does not want there to be decreased oxygenation of the heart and brain when the tongue goes to the back of the throat and clogs off the airway.

UNCONSCIOUS DOES NOT EQUAL ASLEEP

Michael Jackson suffered such extreme insomnia, that he craved a good night’s sleep. The most significant fact in this tragic story is that Michael Jackson discovered a drug called Propofol, which is a drug that is used by anesthesiologists during surgical procedures. Propofol is a hypnotic agent which makes the patient unconscious. There is however, a significant difference between being unconscious and being asleep.

Getting a good night’s sleep is a complex process that has 4 different stages and two different categories, REM and NON-REM. When you sleep, you should cycle between REM and NON-REM sleep. REM sleep in adult humans typically occupies 20–25% of a total night’s sleep. During a normal night of sleep, humans usually experience about four or five periods of REM sleep; they are quite short at the beginning of the night and longer toward the end. REM is the stage of deep sleep where you dream; your muscles relax and is necessary for you to wake up feeling refreshed. If you do not get enough REM sleep you will wake up after a night of sleeping and be exhausted.

If Michael Jackson had OSA, because he could not breathe through his nose, he would never be able to get into REM sleep and his REM deprivation could lead to his profound insomnia. In his search for a good nights sleep he found a physician who would administer Propofol thinking that being unconscious was the same as getting a good night’s sleep. The tragedy of the situation was that even though a patient like Jackson would not be expected to know better, a physician should know the difference between being unconscious and being asleep. A drug like Propofol would actually prevent you from going through the normal stages required to get a good nights sleep.

Instead of illegally and unethically giving Michael Jackson Propofol, his doctor should have referred him to a qualified Sleep Physician. The Sleep MD could have performed a sleep study, called a Polysomnograph (PSG,) diagnosed his Sleep Disordered Breathing problem and prescribed a machine called CPAP, or given him a dental appliance to help him breathe at night and get a good night's sleep.

It was Jackson’s doctor, who failed to make the proper diagnosis and referral, who was at fault in this tragedy, because being unconscious is NOT the same as getting a good nights sleep.

I hope you stay on Trajectory during this Holiday Season,

Scott L. Tamura DMD, LVIF