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Sleep Disorders

Bedwetting while sleeping

12/03/2008

Question:

For last few years I wet the bed while sleeping. I am a diabetic. While sleeping I feel I am urinating in a toilet or in a park, not in bed. When the feeling passes away I awake. Please tell if the mind is not concious to this problem or is there some other problem?

Answer:

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).

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. Problems with the urinary tract system (such as an enlarged prostate, overactive bladder muscle or underactive bladder sphincter) may also lead to enuresis, though individuals with these conditions often have problems with daytime urine control and not just bedwetting.

You mention that you are diabetic. Diabetes can affect the nerves of the bladder and could potentially lead to problems with the urinary system, including enuresis. You also mention there is an association between your episodes of bedwetting and dreaming. This could also suggest a possible dream sleep (REM) – related sleep disorder, though usually other symptoms are present (such as acting out dreams, feeling paralyzed, nightmares, etc.). Based on the limited information in your question, it’s hard to pinpoint an exact cause for your enuresis. A routine physical examination may not completely exclude a number of the above mentioned medical conditions.

If there are lifestyle changes you can make (such as avoiding alcohol or caffeine near bedtime), then I would try these first. If these fail to resolve the problem, then further evaluation should be considered. You should not accept that this is normal.

If your problems persist, then I recommend you readdress this issue with your primary care physician. Additional specific factors in your history will be useful in determining how best to further evaluate and treat this problem. Referral to a Urologist may be needed. Evaluation by a Sleep Specialist in your area might also be considered if there is concern for an underlying sleep disorder.

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!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University