By: Alexander Golbin, M.D.
Bedwetting (Nocturnal Enuresis) is a disorder of sleep. Not all experts would agree with this statement, and scientists still fight over the nature of this affliction that destroys self-esteem and the quality of life for at least two million children and their families. There are numerous reasons for bedwetting, forming into several types. Some are related to bladder problems but some are seen in the perfectly healthy kids. Those situations are related to sleep mechanisms or, to put it into everyday words, the “software” of sleep.
A large group of undesirable phenomena occur during sleep; individually each condition is called a parasomnia, and bedwetting is one of them. Based on our research, we proposed the hypothesis that these parasomnias are not just byproducts of sleep, but have active functions compensating and stabilizing the sleep mechanisms. In their initial stages, parasomnias stabilize or “switch” one stage of sleep into another one, when this transition does not occur for some reason(s).
Bedwetting, or nocturnal enuresis, is defined as an involuntary urination during sleep that is not caused by a known organic disorder. Bedwetting is an extremely common problem afflicting about 7% of the early adolescent population. The literature about nocturnal enuresis is as large as the patient population, but the real nature of this affliction is still unclear. If nocturnal wetting has been present since infancy – it is called Primary Nocturnal Enuresis (PNE). If there has been a clear “dry” period for several years without wetting and enuresis reappeared again – this type is called “secondary” Nocturnal Enuresis (SNE).
Patients and their families commonly ask what organ is responsible for NE? Actually, there is no organ or system of the body that has not been blamed for causing enuresis. The reality is that PNE is a system problem. It is a disorder of the bodies “software” rather than any specific organ (“hardware”).
By definition, nocturnal enuresis occurs during periods of sleep. During the day, the majority of patients have no trouble holding urine for many hours. Parents know that the child-bedwetter sleeps “too deep” for the first two hours of sleep – the time when enuresis most commonly occurs. Frequently, children with enuresis have other parasomnias – teeth grinding, sleepwalking, talking, night terrors. Disturbances of sleep are an essential part of the enuretic syndrome. Another essential feature of enuresis is changes in the level of alertness: many enuretics have quick changes of mood, attention, motor activity and exhibit symptoms of ADHD, behavior and emotional problems.
One of the most puzzling features is resistance to direct therapeutic intervention and, at the same time, spontaneous remission. If spontaneous remission does not occur, enuresis might deteriorate in terms of its frequency and other the appearance of additional parasomnias.
Many theories suggest why enuresis appears. Most of them are of little practical significance. The breakthrough came with the “partial arousal” theory by DR. Broughton in Canada. He proved that enuresis is a phenomenon strongly associated with disturbances in the normal sleep mechanisms causing partial and inadequate arousal from deep sleep. Our study of children’s sleep led to the next step in understanding the nature of enuresis. It was very exciting to discover that in some cases of primary enuresis the act of bedwetting served a special function for the brain by sending a stream of stimuli to the brain to produce a compensatory “switch” from the deep to the next stage that normally should follow. Simply stated, the body is compensating for the weakness in its “transmission” system with the help from another organ.
The real treatment of nocturnal bedwetting consist of the stabilization and maturation of the sleep mechanisms with methods that do not disturb, but rather improve the quality of sleep. Several medications help stabilize sleep and decrease the frequency of enuresis, but the use of such medications is individual and must be prescribed by a doctor. On the other hand, behavior modification techniques are very helpful, and several organizations specialize in education and behavior treatment of enuresis.
Recently, more advanced behavior modification methods have been developed based on high tech and the knowledge of sleep physiology. One of these devices, called “SleepDoc” will be on the market shortly. SleepDoc is a small computerized pager that can “sense” the time, position and other body parameters BEFORE the act of enuresis, and by gentle vibration transforms the urinary reflex into scratching or movement without alarm or other disturbing signals. We will write about this in detail later.
The good news is that bedwetting is not a hopeless and damaging self-esteem problem any longer. Treatment is available. If you are interested to learn more, see our website www.sleepandhealth.com or contact a sleep specialist in your area