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Sleep Disorders

Bed wetting

07/06/2011

Question:

Hi, im an 18 year old female and have not wet the bed since i was maybe 4 years old but a few days ago i did again I dont understand why i would start again. my life is very stressful juggling school, work, a relationship, and sports espically with university acceptances lately. and i do have a family history of epilepsy. could that be whats causing it?

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 may develop.

The causes of adult sleep enuresis are varied and generally require a thorough evaluation. Problems of the urinary tract system, such as prostate or bladder disorders, are more likely to cause bedwetting than an intrinsic sleep problem. Problems or disorders of the urinary tract system resulting in enuresis include urinary tract infections, an overactive bladder muscle or loss of control of the bladder sphincter. However, there are many conditions that have been associated with sleep enuresis and these may include obstructive sleep apnea (repetitive airway closing in sleep), congestive heart failure, diabetes, nighttime seizures (uncommon), depression, severe psychological stress, and dementia. Nighttime seizures are usually accompanied by additional symptoms, such as tongue biting, confusion, and sore muscles, and experiencing bed wetting as the only symptom would be unusual.

Of course, the excessive intake of fluids or substances that promote urination (i.e. diuretic medications, caffeine, and alcohol) can lead nighttime bedwetting. Stress and over the counter sleep aids can also worsen enuresis if you are prone to this happening. This happens via several mechanisms that include changes in sleep architecture (the type and depth of sleep we are getting) and arousal threshold (likelihood of awakening from sleep) to impaired reflexes.

Given your age and the fact that this may have been an isolated episode, it is reasonable to wait and monitor for a short period. However, you should make some changes. These include proper sleep hygiene to optimize your sleep. You should maintain a regular sleep and wake up time and avoid a lack of adequate sleep. Limit your fluid intake in the 2-3 hours leading up to bedtime. Certainly you should make sure to avoid alcohol or over the counter sleep aids. You also need to make sure to empty your bladder before bed. In some cases you may set the alarm to wake up to urinate if you find yourself needing to go the bathroom frequently at night.

Try this strategy for a couple of weeks. If the problem persists after the stressful season and despite making these changes, you should get a medical evaluation.

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Response by:

Rami N Khayat, MD Rami N Khayat, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University