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Sleep Disorders

Bed Wetting While Dreaming

02/06/2009

Question:

I am a 72 year old healthy male. Several years ago I started wetting the bed a few times a years. It is not "leaking". It is deliberate wetting while dreaming that I am in an appropriate place to do so. I go to the toilet every time my sleep is interrupted, whether I feel the need or not, so as to minimize the risk. I have tried to train myself to ask when I get into one of these dreams whether or not I`m dreaming. I now seem to conclude in the dream that I am not dreaming, then go ahead and wet the bed dreaming I am awake and urinating in an appropriate place. If I feel the urine on my body I stop immediately. But since I sleep nude, if I am on my side or stomach I may completely void my bladder with no immediate awareness that I have wet the bed. I can`t relate it too tiredness, excess hydration, excess alcohol or any other cause. There was a reduction in frequency when I started taking meds for BPH, and I can go months without an occurance. But 3 months ago on vacation I wet the bed two nights in a row (never before had I done this twice within the same month even), and it occured again last night while dreaming I was peeing into a urinal in a Mexican home. I am becoming afraid of travel because of the risk of embarassment and damaged beds. Are there unbulky waterproof pads available to place under the sheet? Any suggestions would be appreciated. Thank you.

Answer:

Bed wetting during sleep, also known as sleep enuresis, often has different 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, and can become quite frequent in your age group.

Many cases of sleep enuresis in adulthood are due to other underlying medical problems and do not represent a problem with the urinary system per se. These conditions may include primary sleep disorders, such as obstructive sleep apnea (repetitive airway closing in sleep), as well as nonsleep disorders such as congestive heart failure, diabetes, prostate problems, nighttime seizures, depression, severe psychological stress, and dementia. Problems or disorders of the urinary tract system that can result in enuresis include urinary tract infections, an overactive bladder muscle or loss of control of the bladder sphincter. Of course, the excessive intake of fluids or substances that promote urination (i.e. diuretic medications, caffeine, and alcohol) can lead nighttime bedwetting.

Based on the information you provided in your question, it’s possible that your problems may be related to your history of benign prostatic hypertrophy (BPH) or a primary sleep disorder. However, additional information will be needed to determine the exact cause. It’s important to try to figure out the cause of your bed wetting as most disorders leading to this problem can be effectively treated.

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 it would be worthwhile discussing this problem with your primary care physician. Specific factors in your history will be useful in determining how best to further evaluate and treat your problem. Referral to a Urologist or Sleep Specialist in your area may also be needed. You should not be embarrassed by this problem as it is quite common and almost all of the underlying causes can be treated successfully.

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Response by:

Meena S Khan, MD Meena S Khan, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
Clinical Assistant Professor of Neurology
College of Medicine
The Ohio State University