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Sleep Disorders

Bed Wetting

09/18/2007

Question:

Hello Dr., I don`t know if it is ADHD. Pls do reply. I`m a female - 22 yrs. I have no knowledge of any family history of bed wetting. My younger sister also did bed wet but by the age of 11 yrs she overcomed it. But still I have not been able to overcome it. I don`t know what all my parents did to overcome this but till date I have not overcome this problem. Six months back I started taking a drug named - imipramine on advice by a Dr. which seemed to have reduced my problem but still I haven`t got completely cured of it. I`m a dep sleeper, once I fall asleep its difficult for me to wake up. What can I do to get completely cured of it? Can it create a problem in my married life?

Answer:

Bed wetting in sleep, also known as sleep enuresis, is quite common in children but begins to decrease in frequency once above the age of 5. Only about 1-2% of 18 year olds will have this problem and it was previously thought to become less frequent in adulthood, though recent studies suggest 0.5-2% of adults report enuresis. It then becomes more common in the elderly population, when other factors, such as urinary incontinence during waking hours may develop.

Additional information would be needed to help sort out whether you have primary sleep enuresis or secondary sleep enuresis. In primary sleep enuresis, individuals are older than 5 years, experience enuresis at least twice per week and have never been consistently dry during sleep. In secondary sleep enuresis, the criteria are the same, but individuals have had periods where they have been dry for at least 6 months. It’s important to determine whether sleep enuresis is primary or secondary as they have different causes and thus different treatments.

Many cases of sleep enuresis in adulthood are secondary sleep enuresis and are due to underlying medical problems that do not represent a problem with the urinary system per se. These conditions may include obstructive sleep apnea (repetitive airway closing in sleep), congestive heart failure, diabetes, nighttime seizures, depression, severe psychological stress, and dementia. Problems or disorders of the urinary tract system that can result in enuresis include urinary tract infections, an overactive bladder muscle or loss of control of the bladder sphincter. Of course, the excessive intake of fluids or substances that promote urination (i.e. diuretic medications, caffeine, and alcohol) can lead nighttime bedwetting.

There is known link between sleep enuresis and attention deficit hyperactivity disorder (ADHD) in children. It is not clear to me from your question if you have been diagnosed with ADHD, but this would be important to know as treatment of the ADHD may help with control of the sleep enuresis. Without knowing additional information, it is not possible to make specific recommendations for treatment.

If there is not something obvious you can identify and change (such as avoiding caffeine 4-6 hours before bedtime, avoiding alcohol near bedtime, etc.), then it would be worthwhile discussing this problem with your primary care physician. Specific factors in your history will be useful in determining how best to further evaluate and treat your problem. Referral to a Sleep Specialist or Urologist in your area may also be needed. You should not be embarrassed by this problem as it is quite common and almost all of the underlying causes can be treated successfully.

If you would like further information about sleep disorders or sleep itself, I recommend the American Academy of Sleep Medicine website. In addition to information about sleep medicine, the website also contains a list of accredited Sleep Centers and may help you to locate one nearest you. Good Luck!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University