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Thursday, May 23, 2013
My husband has problems wetting the bed when he is asleep. He snores a lot, there are sometimes pauses in his breathing pattern. This almost always occurs when he has more than 5 beers to drink in an evening. Do you think this is a sleeping disorder or is it related to the drinking? Not all people wet the bed when they have a few drinks. Do they?
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 urinary incontinence may develop. However, urinary incontinence during sleep should not be considered to be normal in adults.
Your husband appears to have a few possible explanations for his bed wetting. For one, he is a snorer who develops apnea (breathing pauses) during sleep, and this is made worse after alcohol consumption. This presentation, along with his male sex, and possibly his age, place him at high risk for having obstructive sleep apnea (OSA), a condition where individuals stop breathing in their sleep. OSA can be associated with urinary incontinence in sleep (among other consequences) and often identifying and treating the OSA condition can improve the incontinence. He also appears to consume excessive amounts of alcohol, which can worsen underlying OSA and thus the bed wetting.
Another effect of alcohol is that, while it facilitates sleep in the beginning part of the night, it promotes sleep disruption in the second half of the night. Furthermore, beer will increase his urinary output at a time when he is deeply asleep, and may make it difficult for him to awaken so he can realize that he needs to urinate.
Assuming that he is not on other medications, and does not have prostate or bladder problems, another possible concern would be whether your husband might be having seizures in his sleep. Alcohol intoxication or withdrawal may promote seizures and seizures are frequently associated with urinary incontinence.
I recommend the following:
1- Your husband should stop drinking within at least four hours of bedtime. Ideally, he should stop drinking alcohol altogether, though at a minimum, he should reduce his consumption to less than 1-2 beers per evening, the last of which should be no less than 5 hours before bedtime.
2- Your husband should certainly see his Primary Care Physician (PCP). His PCP will review his medications and history, and, based upon his findings, will decide if further evaluation is needed (i.e. if he may order a neurology evaluation, EEG, or even a urology consultation).
3- Your husband should see a local Sleep Physician to get a sleep study. The sleep study will mostly help to determine if he has OSA and, if present, how best to treat it.
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.
Rami N Khayat, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University