Hi Friends,
Dr. Tabibian here.
In medicine, we talk a lot about polyps, cancer prevention, and gut health.
But when I close the exam room door, the conversation often shifts to something much more primal.
The patient looks at me, lowers their voice, and asks:
"Doc, honestly... am I going to wake up in the middle of this?"
I recently posted a TikTok about this that touched a massive nerve (and went viral for good reason).
The comment section was a flood of stories…
Some of you had the "best nap of your life," while others had... well, a less peaceful experience.
This is a big topic with significant variability in patient experience.
So today, I want to give you the honest answer. Yes, it can happen.
But it usually happens for specific reasons that are often within your control to discuss before you go under.
With this in mind, let’s talk about redheads, "twilight sleep," and how to guarantee a good nap (unless you prefer to be awake).
WHY YOU SHOULD READ THIS NOW
Find out if you’re “hard to sedate”. Do you have red hair? Do you vape? Do you drink alcohol frequently? We will explain why these factors might make you more resistant to sedation medications.
Know exactly what to ask your provider to ensure you stay asleep, or at least comfortable.
Today’s Opponent:
Waking Up During Your Colonoscopy (new fear unlocked)
For many patients, the fear is less about the colonoscopy and more about the sedation.
That makes sense, because if the sedation isn't "adequate" for your specific biology and scenario…
You might be more awake or feel more than what you’d like or can reasonably tolerate.
Are You "Hard to Sedate"? (Checklist below👇)
In my recent TikTok, dozens of people shared stories of waking up despite being sedated.
Often, this is because your body metabolizes sedative medications faster than the average person and/or have a higher tolerance.
You need to have a conversation early on with your gastroenterologist (and anesthesiologist) if:
👉 You have red hair: The gene that causes red hair (MC1R) also affects how you process pain and sedation/anesthesia medications. As a result, you may need up to 20% more medication.
👉 You use cannabis/vape: Regular cannabis use significantly increases the amount of sedation required to keep you under (also other sedatives, some antidepressants, or anxiety medications). You should be honest about this with your doctors. We aren't the police, we just want you to sleep!
👉 You have a history of abdominal or pelvic surgeries: This can make the anatomy of your colon more challenging to navigate and thus more uncomfortable, sometimes too uncomfortable to get through without deep sedation.
"It’s vitally important to select the right type of sedation for each patient. We can tailor the plan to your individual scenario. Some patients want to be unsedated and watch the procedure, others want a little bit of sedation, and others want or need to be deeply sedated. In the end, we want a complete, safe, high-quality exam."
“I always tell patients: We want a boring procedure. We want you to have the best nap of your life. If you are worried about awareness, be loud about it during your consult."
Ask Before You Go
The "fix" for this fear happens days before the procedure, not in the procedure room just before starting.
Ask this question:
"Do you use Propofol (MAC) or Conscious Sedation?"
If you are in the US and want to be "out," ensure Propofol is on the menu.
If you checked any boxes on the "Hard to Sedate" list, tell the team immediately.
They can adjust the dosage/sedation plan before they start.
Even if you are on conscious sedation and start to feel discomfort, the team monitors your vitals.
A spike in heart rate tells us you are uncomfortable, and we can usually administer more medication immediately.
May your nap be deep and your recall be zero😴 (unless of course you want to be awake and remember)!
What’s On Your Mind?
Respond to this email and let us know!
As gastroenterologists, we definitely have a lot to talk about when it comes to your gut health and well-being. But we can’t always get to everything (you know… like coffee enemas)! So reply directly to this email or DM us on TikTok below and maybe YOUR topic will be featured soon!
