Practice is for patients’ benefit

Dear Dr. Gott: In a recent column, you addressed the problem of a day-night syndrome, something that patients with Alzheimer’s disease exhibit. You stated that people who sleep during the day in nursing facilities and then stay awake at night need to have powerful medicines to reverse this phenomenon.

It seems to me that the philosophy behind such a recommendation is faulty. When rearing a baby, do we train it to sleep at night so we can sleep as well? So why train Alzheimer’s patients (who have basically reverted to infancy) to submit to our pattern of life? I always thought that the patient came first, and caregivers came at least second. Forcing a patient to follow a caregiver’s convenience is not the way to go.

Dear Reader: First of all, parents do train their infants to sleep during the night once the night feeding has been outgrown. Parents also train their children not to soil themselves, to eat at reasonable hours and to adopt other “adult” habits.

Second, brain chemicals, such as melatonin, typically encourage nighttime sleepiness and daytime wakefulness. This is the normal physiologic balance.

Third, in an assisted-living arrangement or nursing facility, patients who exhibit “sundowner’s syndrome” are extremely disruptive. Their inappropriate sleeping patterns interfere with other residents’ quality of life. Also, because most activities in skilled-nursing facilities are carried out during the day, Alzheimer’s patients who have their days and nights reversed are deprived of therapy sessions, interaction with other residents, treatment plans, family visits, adequate nutrition and many other benefits.

It is precisely because the patient comes first that the treatment of “sundowner’s syndrome” is oriented toward nighttime sleeping and daytime activities. This is the way to go. I believe that if you had more hands-on experience with severely demented patients, you would agree.

To give you related information, I am sending you a copy of my Health Report “Alzheimer’s Disease.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dear Dr. Gott: I have nightly leg cramps, for which my doctor prescribed quinine, the “only cure” he knows.

It didn’t work.

Therefore, after reading about the soap-under-the-bed-sheet suggestion in your column, I tried it.

No more cramps. You are great! Why is it effective?

Dear Reader: I haven’t a clue.

All I can say is: the technique is effective in a large percentage of patients.

To recap: Put a bar of soap (not Dial or Dove) under the sheet at the foot of the bed. See what happens. Please report the results to me.