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Friday, April 18, 2014
I have just been married, and my husband is regularly wetting. He doesn`t snore, his breathing seems fine, but he sleeps VERY deeply. It`s hard to wake him up. Almost acts as if he`s drug or alcohol induced sleep (but he doesn`t take anything) He is physically very fit (blue collar worker and regularly runs and lifts weights). He doesn`t have any difficultly falling to sleep, and he wakes up normally. (hitting the snooze a couple of times) It seems like it`s in the first couple of hours of him falling asleep, but i haven`t been logging it. Any suggestions or advise (p.s. we have no insurance or regular doctor)
Bed wetting during sleep, also known as sleep enuresis, often has a variety of underlying causes. 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 becomes even less frequent in adulthood until urinary incontinence becomes a problem with aging (mostly in the over 65 year old population).
In children, enuresis is divided into "primary" and "secondary" types. If the child has never been dry at night for more than 3 months, then the condition is referred to as primary enuresis, which is the most common type. Secondary enuresis is nighttime urination that redevelops in a child who was previously dry during sleep for at least 3 months. It would be very interesting (and helpful) to know how old your husband is and if your husband has had this problem his entire life, or if it just recently started.
Most cases of sleep enuresis in adulthood are due to other underlying medical problems and usually do not represent a problem with the urinary system per se, although urinary tract disorders can also lead to enuresis. Medical conditions associated with enuresis include obstructive sleep apnea (repetitive airway closing in sleep), congestive heart failure, diabetes, urinary tract infections, nighttime seizures, depression, severe psychological stress, and dementia. Of course, excessive intake of fluids or substances that promote urination (i.e. diuretic medications, caffeine, and alcohol) can also lead nighttime bedwetting.
You mention that there may be an association between your husband's bedwetting and the first part of the night. This suggests that he is wetting the bed during slow wave, or deep, sleep. During deep sleep, we are very difficult to arouse and thus he may not be sensing the urge to empty his bladder.
Based on the limited information in your question, it's hard to pinpoint an exact cause for your enuresis. 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 you should have your husband try avoiding all fluids within 2 hours of bedtime and making sure he uses the bathroom right before going to sleep. If problems persist despite this, then it would be worthwhile discussing this problem with a primary care physician. Specific factors in your husband's history will be useful in determining how best to further evaluate and treat the problem. Referral to a Urologist or Sleep Specialist in your area may also be needed. He 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, if needed. The website Sleep Education.com also can provide consumer-friendly information about sleep disorders. Good Luck!
Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University