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Sleep Disorders

Narcolepsy, Alcohol and Bedwetting

07/22/2009

Question:

Hi, I`m newly 20 years old and when I was a senior in highschool I found out if had sleep apnea and a mild case of narcolepsy. I got my tonsils taken out and then re tested, and they said the sleep apnea went away, and the narcolepsy got better, but was still present.

I`ve been drinking alcohol since I was 14. About half a year into college I began to wet the bed after drinking. And the amount of times it has happened as increased as i went through my sophomore year.

I also black out while drinking more than anyone I know. Sometimes I`m okay, but sometimes nights that I didn`t think I drank that much, or I didn`t think I blacked out, come to find out after talking to my friends, I did and there are a lot of things I don`t remember. Its kind of scary.

I tell myself I`m not going to drink as much, and I don`t ever plan on getting black out drunk, but it always seems to happen unless I literally sip on a few beers very slowly.

I was just wondering if any of these problems could be related to my narcolpsy? Or if there`s anything I can do. I`m obviosly going to really try to monitor my level of intake..but that hasn`t worked out so much yet. I`m going to try to drink less, but to be honest, and i know this sounds terrible, it`s hard becuase that`s what most 20-21 years olds want to do these days.

Any help would be greatly appreciated. Sorry this is so long

Answer:

You have really raised 3 issues that may or may not be related: your history of sleep apnea, possible narcolepsy and then the bed wetting. I’ll address each of these individually and talk about where potential overlaps may exist.

As far as the sleep apnea is concerned, it is likely that this resolved after tonsillectomy based on the information that you provided. However, it does not mean that you may not redevelop sleep apnea. Sleep apnea could recur as the result of weight gain, additional anatomic changes or certain behaviors (such as drinking alcohol to the point of blacking out). So I don’t think you can safely assume that your sleep apnea has not come back and is not part of the picture.

Narcolepsy, on the other hand, should not resolve following upper airway surgery. Some physicians inappropriately use the term narcolepsy to describe excessive sleepiness from any reason. If you truly had narcolepsy then, it is likely that you still do now. Narcolepsy is associated with severe sleepiness and attacks of sleep. Patients may also experience episodes of loss of muscle tone and sudden weakness. It is possible that what you had was just sleepiness that was related to sleep apnea and you never really had narcolepsy.. Only a thorough evaluation by a sleep physician can confirm or rule that out. Sleep attacks and episodes of loss muscle tone (cataplexy) occur when patients are laughing or emotional, such as during drinking with friends. Therefore, it could be possible that some of your symptoms may be related to narcolepsy.

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. There are a number of possible reasons why you may be wetting the bed after a night of drinking. This could be a sign of failure to arouse in sleep to alcohol intoxication or, less commonly, a symptom of alcohol withdrawal seizures. It’s also possible it could be related to excessive fluid intake, untreated sleep apnea or other problems (such as urinary tract disorders, medication side effects, etc) .

My recommendations are as follows:

1- Please do limit your alcohol consumption or even abstain entirely for at least a period of time. Binge drinking to the point of passing out should not be considered normal behavior, even for someone in your age group. You should consider seeking help if you are unable to abstain from alcohol use on your own. In addition, some individuals metabolize alcohol less effectively than others, and they can be more susceptible to intoxication. The amount you consume is certainly much more than your system will be able to metabolize. If you can’t abstain, at least find a strategy to limit your consumption. Eat while consuming alcohol, and maintain adequate hydration (1-2 glasses of water with every beverage).

2- You need to seek a sleep specialist to evaluate the possibility of recurrent sleep apea or narcolepsy. These are serious conditions that are easily treatable. Medications for narcolepsy will improve your daytime function and academic performance, and may save your life from an attack of sleep during a dangerous situation. I am not certain that you have narcolepsy, but I recommend that you confirm that.

3- If your symptoms persist after you abstain from alcohol for a period of time (perhaps a month or so, depending on the frequency of your attacks now), and the symptoms do not appear to be related to a primary sleep disorder, then you need specific evaluation for seizure disorder.

I hope this helps.

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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