Twilight sleep
What is twilight sleep?
Twilight sleep is a state of consciousness just below the waking state. This is a specific level of sedation. The affected person is sleeping or has his eyes open and is not fully focused. The affected person can be awakened all the time through loud speech or pain.
It is brought about artificially by certain drugs. The central nervous system is dampened with medication. Benzodiazepines such as midazolam, for example, can be used for this. Twilight sleep is often used in conjunction with local anesthetics and painkillers during unpleasant examinations or small operations.
Twilight sleep is a way of reducing physical and psychological stress during medical interventions.
If medically necessary, the health insurance company bears the cost of twilight sleep.
After an intervention in twilight sleep, the person concerned must be picked up by a previously determined relative or friend and is not allowed to drive vehicles for 24 hours. In rare cases, those affected react paradoxically to the medication and become restless.
Read more about sedation at: Sedation - Everything You Should Know
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Indications for twilight sleep anesthesia
A twilight sleep anesthesia is used for psychological and physical relaxation and is intended to reduce the stress for the person concerned during medical interventions.
Twilight sleep anesthesia is used, for example, in diagnostic procedures.
Colonoscopies and gastroscopy are often described by those affected as a very unpleasant experience and this can be prevented by using a twilight anesthetic. The gastroscopy prevents the gag reflex and the colonoscopy is described as less painful. The interventions also seem much shorter to those affected.
For children or people who are afraid of confined spaces, twilight sleep anesthesia is also performed with MRIs or CTs, as the person has to lie still.
A common use of twilight anesthesia are dental operations, such as the removal of wisdom teeth.
Twilight sleep anesthesia can also be performed during operations with spinal cord anesthesia, so that the person concerned does not perceive the noises in the operating room as much.
At the dentist
Visits to the dentist are frightening for many people. Dental interventions are often only performed under local anesthesia, with full awareness. The person concerned hears all the noises, tastes the blood in the mouth and clearly notices pressure on the jaw. This is both physically and mentally demanding.
Some dentists therefore offer their patients to carry out major interventions under twilight anesthesia. During the procedure, those affected can be awakened when spoken to and breathe independently. A conscious perception of the environment is limited, however, so that anxiety and stress are reduced.
Twilight sleep anesthesia is used particularly for somewhat larger operations, such as the removal of wisdom teeth.
During a gastroscopy
During gastroscopy, a camera is pushed through the mouth into the esophagus. Although the mouth and throat are locally anesthetized, many of those affected still notice a strong gag reflex. The examination is often described as uncomfortable.
In this case, the affected person can be given twilight sleep anesthesia in order to get through the procedure stress-free. The procedure itself only takes a few minutes, but sedation means that no motor vehicle may be driven for 24 hours after the procedure.
Get more information on the topic Gastroscopy.
During a colonoscopy
A colonoscopy was previously described by many people as a terrible experience, which made them fearful of the procedure. Today, the experience reports after colonoscopies are much more positive and those affected report that they slept through the procedure.
This is due to the twilight anesthesia that is almost always performed today. Those affected hardly notice the sometimes painful procedure and are much calmer. Sedation for colonoscopies is usually covered by health insurance companies.
The course of a twilight anesthesia
The patient must be informed before any medical intervention. Usually this information takes place on a separate date.
Before the procedure, the person concerned is given a venous access in the back of the hand or the crook of the elbow. In children, this is sometimes dispensed with and the benzodiazepine is given directly through the nasal mucosa.The medication is either injected directly into the bloodstream or atomized into the nose. Frequently used benzodiazepines, such as midazolam, start to work within a few minutes. The person concerned becomes tired and his ability to concentrate falls. Some people fall asleep straight away. Depending on the drug used, a follow-up injection is necessary for longer interventions.
After the drug is fully effective, local anesthesia is applied if necessary.
The person concerned does not notice anything about the procedure itself and can hardly remember it after the procedure.
After the procedure, the affected person can usually sleep for an hour and can then be picked up by a family member. No motor vehicle may be driven in the first 24 hours after the twilight anesthesia.
Benefits of twilight sleep anesthesia
Twilight sleep anesthesia means a significant reduction in fear and stress for those affected compared to an exclusively local anesthetic.
This is also noticeable physically. The heart rate and blood pressure are lower, and oxygen consumption also decreases.
In addition, if the experience is positive, the likelihood that the person will refuse a necessary examination the next time is lower. Less post-traumatic stress disorders can be observed especially in children after twilight anesthesia.
Compared to general anesthesia, twilight sleep anesthesia also has some advantages.
Since the person concerned breathes independently, there is no need to use a ventilator. Artificial respiration has some side effects, such as irritation of the vocal cords, which can be avoided in this way.
Twilight sleep anesthesia also has central depressive effects on the circulatory system, but it is not as effective as general anesthesia, which means that circulation-stabilizing medication has to be used less often.
During the procedure, less control of the vital functions is necessary and those affected can go home directly after the procedure. The only restriction remains the inability to drive for 24 hours.
Risks and Side Effects
Sedative medication calm the sufferer both physically and mentally. This effect can overshoot the actually defined goal. In medical procedures, this can mean the difference between twilight sleep and anesthesia.
Sedatives also work on blood pressure, heart rate, and respiratory drive. If the dosage is too high, breathing can stop and the circulation collapses, as both areas are downregulated. In this case, the affected person must be ventilated and the circulation must be stabilized with medication.
In some patients, especially children, a paradoxical reaction to the sedative is possible. Those affected become restless and the procedure has to be interrupted. In the event of strong reactions, an antidote must be given. The benzodiazepines used also cause amnesia, so those affected can feel like they have a blind spot in their memory.
In older people, frequent use increases the likelihood of developing dementia.
What does twilight sleep cost?
Twilight sleep anesthesia for medical interventions or diagnostic procedures costs around 75 euros per half hour or part thereof. However, those affected do not always have to pay these costs themselves.
The medical necessity is important here. The twilight sleep anesthesia during a regional anesthetic operation is covered by health insurance.
Sedation during a colonoscopy is also a health insurance benefit.
Sedation during a dental procedure depends on the patient's age. For minors, twilight sleep anesthesia is covered by the health insurance fund. Adult patients have to bear the costs themselves, depending on the procedure.
Some health insurance companies offer their patients additional services and also do not assume any statutory costs. Those affected should inquire about this with their health insurance company before an operation.
Compared to general anesthesia, sedation is the more cost-effective alternative and at the same time has fewer side effects. The necessary local anesthesia, which is also performed on sedated patients, is always a health insurance benefit.
How do I feel in twilight sleep?
Most of those affected can hardly remember the time during an operation under twilight anesthesia, as the benzodiazepines have an amnestic effect.
Some report feeling far away or feeling very light.
The medication eliminates anxiety and stress. The tension that often exists before such interventions dissolves and those affected become very tired.
The perception of time also changes in twilight sleep anesthesia, so that the affected person feels the duration of the procedure is significantly shorter.
Although those affected can be woken up during twilight sleep anesthesia, they are not aware of the situation.
Experience reports also tell of the feeling that everything is wrapped in cotton wool and that they have only removed voices and perceived them through a dampening.
Do I have to be sober to use twilight anesthesia?
Even with twilight anesthesia, the person concerned must appear sober. this means
- stop eating about six hours before the procedure.
- Also stop drinking about two hours before the procedure.
- prescribed medication can be taken with a sip of water.
- a renunciation of tobacco products.
These precautionary measures are intended to ensure safety during anesthesia. With twilight sleep anesthesia, the patient usually breathes independently, but intubation must be possible in an emergency. In addition, many anesthetics cause nausea and vomiting.
Which means are used for twilight sleep anesthesia?
The most common drugs used for twilight anesthesia are benzodiazepines, such as midazolam. Benzodiazepines
- dampen the central nervous system and thus consciousness.
- have an anti-anxiety effect.
- have an amnestic effect, so that the person concerned has hardly any memories of the operation.
Other sedating drugs, such as narcotics, are often too strong for a light twilight sleep, but can also be used for sedation.
What pain do you feel in twilight sleep?
The sedating drugs used in twilight sleep anesthesia are not pain relievers. For this reason, regional or local anesthesia is always used in addition to twilight sleep anesthesia.
If these local anesthesia do not sit properly or the dose is insufficient, this pain can be felt. Pain, which is independent of the surgical area, can also be perceived.
When can I smoke again?
Since sobriety is necessary before the procedure, which also includes smoking, many of those affected want to smoke again immediately after the procedure. As long as the person concerned does not go out alone, but is under the supervision of a relative or carer, there are no contraindications.
During dental operations, smoking may be contraindicated until the suture is removed. However, this has nothing to do with twilight sleep anesthesia, but is necessary because of wound healing.
Alternatives to twilight sleep
For some people, twilight sleep anesthesia is not feasible for various reasons. This can be due to pregnancy or at the request of the patient, for example.
Many interventions that are carried out under twilight sleep anesthesia can also be carried out in exclusively regional anesthesia. In the case of dental treatments or gastroscopy, sedation is only one way of making the procedure fear-free and stress-free, but not necessary.
If necessary, such as standing still during the MRI, general anesthesia can replace sedation. In contrast to sedation, general anesthesia means that the person concerned has to be ventilated and continuous monitoring of the circulatory system is necessary.
In addition to medicinal sedation, hypnosis or behavioral support during surgery is also possible.
