Anesthesia as the ‘Best Sleep Ever’ - The Secret To Waking Up Refreshed

By Sree Roy

How desperate must someone be to beg a certified anesthesiologist assistant to come to their house and give them propofol because they want to sleep as they did under anesthesia?

That’s the question that tugged at Nyree Penn, MHSc, CAA, well after she declined that patient’s request. But she wondered if there might be a legitimate route for people with trouble sleeping to undergo anesthesia in a safe environment to achieve the refreshed feeling many patients have after waking up from a surgery that starts with propofol.

When Penn’s Google search didn’t find any medical clinics that offered anesthesia as a sleep service, she developed a protocol herself—and opened PROSOMNIA Sleep Health & Wellness in Aventura, Fla, in 2023. One facet of PROSOMNIA is a traditional sleep center (including home sleep tests and CPAP therapy setups), but its cash-pay signature services include an intravenous infusion of propofol.

Anesthesia & Sleep

As a journalist who exclusively covers sleep medicine, I was astonished when I read a press release about anesthesia as a sleep service that people could pay for in a healthcare facility. I messaged a colleague, “Isn’t that what killed Michael Jackson?”

Penn has heard that before. “Unfortunately, we’re all aware of what happened with Michael Jackson,” she told me during a video interview, before I even broached the subject of the pop superstar. “I was in anesthesia school at that time [of Jackson’s death], and I thought, ‘That’s so unfortunate because I know there’s a way to do this in a safe and controlled environment.’”

I quickly learned that the anesthesia community is much better informed than I was about the overlapping neurobiological mechanisms of sleep and anesthesia.1 “I’ve been in the field of anesthesia for 15 years. This isn’t really a new idea or a new concept,” Penn says.

Patients describing anesthesia as “the best sleep ever” is commonplace, according to Cassandra Headley, MHSc, CAA, CNIM, REEGT. Now a staff neurophysiologist at PROSOMNIA, when Headley learned of Penn’s anesthesia-as-a-sleep-service concept, her response was, “That’s a great idea. I wish I’d thought of it myself.”

Gregory Arneaud, CRT, RRT, clinical director at iSD Health Solutions, does in-person and virtual consultations for PROSOMNIA patients (which include screening people with insomnia for sleep-disordered breathing using a ResMed NightOwl). Though initially skeptical, he told me, “It blew me away when I was learning and reading about it.” He agreed to be part of PROSOMNIA because “I saw the need, and [Penn] has the expertise.”

Supporting Research

Surprisingly (to me), there is quite a bit of scientific research supporting propofol as a way to treat sleep disorders. Among others, a randomized, double-blind, placebo-controlled study of 103 people found propofol therapy to be an “efficacious and safe choice for restoring normal sleep in patients with refractory chronic primary insomnia.”2 A study in rats found that “a recovery process similar to that occurring during naturally occurring sleep also takes place during anesthesia and suggest[s] that sleep and anesthesia share common regulatory mechanisms.”3

As such, Penn suspects that most people only need one or a few propofol sessions for their natural sleep to improve. “We anticipate that the neuroplasticity will reestablish itself,” she says. “You’ll remind your brain of how to get into REM sleep…somewhere along the way, our brains forgot how to go to sleep without that drug, without that drink, without that situation, without whatever. So we remind them, ‘This is what it looks like.’”

Most scientific research focuses on the similarities between a propofol-induced state and non-REM slow wave sleep (N3),4 but Penn says her team has developed a way to use propofol to “intentionally induce REM sleep, release adenosine sleep pressure via the glymphatic pathway, and immediately provide relief for sleep disorders associated with REM sleep.”

PROSOMNIA has a clinical trial underway to determine whether PROSOMNIA Sleep Therapy increases the quality of REM sleep, increases the duration of REM and/or NREM sleep, and/or decreases sleep onset latency.5

Anesthesia & Sleep Monitoring

Penn emphasizes that safety is PROSOMNIA’s number-one priority.

Safeguards include requiring consultations before any services are rendered, limiting propofol infusions to patients between the ages of 18 and 65, making American Society of Anesthesiologists status determinations, restricting eating or drinking six hours prior, and mandating only an anesthesiologist, certified anesthesiologist assistant, or certified registered nurse anesthetist administer the propofol. “One of those people is in the room with you the entire time while another anesthesia professional is watching the recording the entire time,” Penn adds.

Brainwaves are monitored so the team knows the patient’s sleep stage—though, of course, there are differences here compared to brainwaves seen in natural sleep. For example, “you won’t really see the sleep spindles,” and the hallmark eye movements of REM sleep don’t occur, according to Headley.

Still, the Masimo SedLine gives a “Patient State Index” from 0 to 100, indicative of the depth of sedation.6 With that, plus the raw electroencephalogram data and the compressed spectral array, Headley says she extrapolates a person’s sleep stage.7

How Good of a Sleep Solution Is Anesthesia?

Desperate people try a lot of wild solutions for their sleep problems, many of which have much less scientific evidence than anesthesia for sleep debt (see the surge in melatonin sales). And scientifically recommended solutions, such as cognitive behavioral therapy for insomnia or simply allowing more time for sleep for lifestyle-related sleep deprivation, are far from universally accepted by those with chronic sleep problems.

While there are prescription pharmaceuticals cleared by the US Food and Drug Administration for sleep disorders such as insomnia, those pills have downsides too. So is the administration of anesthesia in a controlled environment surrounded by airway specialists a viable solution?

In Arneaud’s opinion, “If you have a chronic insomnia patient who just can’t sleep, then by all means I’d rather consider doing this once or a couple times a year than be taking pills a couple of times a day and drinking caffeine to wake up.”

Penn is confident the use of this anesthesia-based sleep therapy will only increase the scientific literature in its support. Safety, she says, is the primary hurdle—and one she says her clear and effective protocols have overcome. “It’s not an issue of efficacy at this point,” she says. “It’s an issue of safety, which is what I have established.”