Dr. Richard Bruno is Chairperson of the International Post-Polio Task Force and director of The Post-Polio Institute and International Centre for Post-Polio Education and Research at Englewood (NJ) Hospital and Medical Center. His new book, How to STOP Being Vampire Bait: Your Personal Stress Annihilation Program, will be published in 2004. E-mail him at ppsforum@newmobility.com.

Note: This column is for information purposes only and is not intended as a substitute for professional medical advice.

Last month we discussed the different types of medication used to treat high blood pressure and the finding that certain groups of drugs, for example beta and alpha blockers, cause or increase symptoms polio survivors may already have, like fatigue and cold feet. Some of the newer antihypertensive drugs, like the calcium-channel blockers, angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers, don't always have fatigue as a side effect. I asked, given their side-effects, should polio survivors never take certain antihypertensives, like the beta and alpha blockers, and always use others, like the angiotensin inhibitors and blockers?

If only it were that simple.

First, some of these "antihypertensive" medications have applications other than lowering blood pressure. Beta blockers are used to treat abnormal heart rhythms. They also are used to treat angina by reducing the force of contraction of a heart that has too little blood flowing to it. Calcium-channel blockers are also used to treat angina and to prevent migraines. And alpha blockers are used to treat enlarged prostates and can actually help to warm cold hands and feet. Second, since some people have hypertension that is difficult to manage with only one medication, a combination of drugs may be needed that might necessarily include a beta or alpha blocker.

When taking any new medication, it is important that polio survivors keep a log of side-effects and discuss these with their doctors. The dose or time of day when you take a medication--for example, taking a fatigue-producing medication before bed, or taking a long-acting, slow-release form of a drug--may minimize its side effects. As we've discussed before, don't let doctors get away with telling you that a drug couldn't be causing new fatigue or weakness because they haven't seen those symptoms in other patients. Polio survivors are not like other patients. If your doctor doesn't listen to you, get another.

And if you're not comfortable with the medications your family doctor or internist is using to treat your hypertension, or if your blood pressure isn't coming down in spite of taking a combination of drugs, don't hesitate to consult a cardiologist who's also a hypertension specialist. Remember: The stroke you prevent by keeping your blood pressure down will be your own!

Q: I have had trouble staying asleep for years. My sleep study showed many awakenings throughout the night, but no problems with breathing or muscle twitching. I have also had dry eyes for years. My eye doctor said my eyes don't close all the way and that's why they're drying out. He said to use a sleep mask at night. When I did, I slept through the night! Were my "open eyes" causing me to sleep poorly?

I'd say so. We have been puzzled over the years by people at the Post-Polio Institute whose brains awaken a lot during the night but who don't have sleep-disturbing apneas, hypopneas (shallow breathing) or the muscle twitching and jumping so common in polio survivors. It makes sense that if your eyes don't close completely while you're sleeping, light in the room may stimulate your brain and cause it to awaken during the night, even if you don't actually wake up.

Recently, we have seen a number of patients whose eyes don't close completely, what eye doctors call "lag opthalmos." Some patients have daytime lag opthalmos and report that their eyes dry out; others have it only at night and don't necessarily have dry eyes. Some who have lag opthalmos had their facial muscles affected by polio, causing muscles to be weaker and allowing their lower eyelids to droop. Others have no facial muscle weakness. When we've suggested that these patients use a black sleep mask at night, they slept much better. So if you have unrefreshing sleep or daytime fatigue even after a sleep study shows that muscles aren't twitching and that you have no problems with breathing (or if breathing problems have been treated successfully using CPAP or BiPAP), talk to your doctor about trying a sleep mask. When it comes to finding the cause of an undiagnosed sleep disorder, the eyes may indeed have it.