Archive for the ‘Research’ Category

Sleep Research and Bedwetting

Tuesday, March 16th, 2010

I read with interest an article that was published on-line on 3/10/10 in Acta Pediatrica.
“Effects of desmopressin on the sleep of children suffering from enuresis”
This article presented research on that done in Germany last year. The aim was to evaluate the effect of DDAVP (desmopressin) on the sleep architecture and arousal reactions in children with bedwetting. The method of the study was a prospective, placebo-controlled, randomized, cross-over study that was performed over a 7-day period of time. Placebo and DDAVP were given for 7 days each after which an unattended home polysomnography was recorded. 20 bedwetting children, aged 6-15 years, were enrolled.

Results: The number of wet nights decreased with DDAVP treatment. Delta power, distribution of sleep stages, number of arousals, arousal index and the effect of arousals on sleep stages did not differ significantly between the two groups. Bed-wetting occurred within each sleep stage and did not follow any particular pattern. In most cases, it was preceded by an arousal reaction, but no awakening occurred.

Conclusion: DDAVP has no effect on the sleep architecture of children with bedwetting.

This study concluded that DDAVP did not affect the sleep patterns of children who take it. Since its mechanism of action is to work locally on the kidneys to produce more concentrated urine, the results are exactly what I expected.

The reason that this study was so interesting to me; however, was that these sleep studies indicated that bedwetting occurs during every sleep stage and does not follow a particular pattern. This is exactly what I see clinically in the families that I work with each day. There are some organizations that talk about bedwetting as a sleep disorder and how bedwetting children stay in the deep sleep phase longer and wet during this phase. This is based on research that was done in Canada in 1968. In the more recent research report that I just read, bedwetting did not occur only in the deep sleep stage but throughout the entire sleep cycle, with no pattern. Families report that the bedwetting alarm goes off at different times each night, anywhere from 30 minutes after bedtime to 30 minutes before wakening in the morning. The child cannot be in deep sleep all of these times.

Anyway, it would have been nice to have a larger sample size but this is good information.

Causes of Bedwetting

Monday, December 14th, 2009

AS writes, “Is there a certain type of child that seems to have more bedwetting than others? Two of my kids are affected, but they are as different as night and day. My 10 year old daughter is very neat and clean, does well in school, but is a little overweight and not very athletic. My 8 year old son is messy, does ok in school and is very outgoing and athletic. Bedwetting affects them both, as it did for both their father and my sister.

Although bedwetting is very common in children, the cause seems to be multi-factorial and not well understood. We do know that bedwetting runs in families and the actual genetic marker has been determined. With both sides of your family affected, more than 70% of offspring are affected. We don’t know exactly what that genetic trigger is, however. For example, do these kids sleep differently, do their bladders contain less, do they pay less attention, etc?

Research has been done to look at risk factors for children with bedwetting. I’d like to share with you some research that was just published online in The Journal of Urology online, Dec 2009. The research was done in Australia using a questionnaire for the parents of 2,856 children. The questionnaire asked about the prevalence of bedwetting among many other general questions about their children. The average age was 7 years and the prevalence of bedwetting was 18%. Bedwetting was defined as any wetting in the previous month, with mild-1-6 nights, moderate-more than 7, severe-every night.

This research did confirm some modifiable risk factors that have been identified in the past years. Encopresis (leaking stool) and daytime wetting were associated with 23% of the kids with bedwetting. I think it is important to note that these two issues should be solved before bedwetting is addressed. In some situations, bedwetting will cease with the cure of the other problems. Males were also more likely to have severe enuresis, when adjusted for age.

Emotional stressors and social concerns were only associated with the moderate bedwetting, not the nightly wetting. This is good news for parents who worry that there is a psychological reason or bad parenting as the cause for their children’s wetting.

AS, if either of your children have encopresis, constipation or daytime wetting, this should be brought to your pediatrician’s attention immediately. As for the other temperamental characteristics that you mentioned, it doesn’t seem that there is a pre-disposition for one type to be more affected than others. I do see all shapes, sizes and personalities of kids in my bedwetting practice but most are just great kids. There is a little higher correlation of ADHD in children with bedwetting, but they can still achieve dryness. From your description, it sounds like both of your children would benefit from treatment using a bedwetting alarm.

Cure for bed wetting

Tuesday, August 11th, 2009

I’m looking for a cure for bed wetting for my 10 year old son, writes LB from Atlanta. I’ve read the reviews about how bedwetting alarms work but I’m wondering if these really cure the problem or are just a temporary fix? Why hasn’t my son’s doctor mentioned a bedwetting alarm to us?

A cure is defined as a means of correcting or relieving anything that is troublesome or detrimental. The “curative approach” to bedwetting is presently limited to bedwetting alarms. Research demonstrates that the success rate of using a bedwetting alarm approaches 80%. “Supportive approaches” help buy time until your son stops wetting on his own. Examples of these include: waterproof pants and bedding, waking him when you go to bed, restricting fluids, setting alarm clocks, motivational techniques and medication. Many families try these techniques during the years that it takes for their child to stop wetting on their own. Using a bedwetting alarm speeds up the development of dry nights, with the average child achieving dryness in 10-12 weeks. Once the behavior of getting up and going to the bathroom is achieved, the relapse rate is low.

Bedwetting alarms have been around for 30 or 40 years, but the technology has improved to the point that they are small, comfortable, safe and reasonably priced. Using a non-medicinal, behavioral approach to bedwetting should be a first-line recommendation. However, there is a lot of information to be covered in medical school and residency, and common childhood problems such as this get little attention. Health care providers learn through continuing education, as well as by listening to their patients and through their own personal experiences. Once your son gets to dryness after using a bedwetting alarm, let your doctor know about your experience. Over time, he or she may pass this information to other families with this problem.

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