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Sleep Disorders

Nocturnal Urination

07/22/2009

Question:

Hello, i`m an 18 year-old girl and i have visited 2 doctors the past years who have given me two types of medication, the minirin nasal spray and vesicare pills and i have used them for a period of three months or more. Unfortunately I have not seen much difference since then and now I am not taking any medication. I had an ultrasound and everything seemed normal. My main problem is that, except of the need to go to the bathroom several times a night, i can`t wake up easily. I was wondering if there is any medicine that can help me not to sleep so deeply and make it possible for me to wake up during the night. Thank you in advance

Answer:

While you didn’t clearly state that you are having problems with wetting the bed at night or just needing to use the bathroom frequently, I’ll assume that the problem is bed wetting as much of this can be applied to frequent nighttime bathroom trips as well. 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 and it was previously thought to become less frequent in adulthood, though recent studies suggest 0.5-2% of adults report enuresis. It then becomes more common in the elderly population, when other factors, such as urinary incontinence may develop.

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 obstructive sleep apnea (repetitive airway closing in sleep), congestive heart failure, diabetes, 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 (and without knowing additional information), it’s not clear you’re your underlying problem may be that is driving your need to frequently urinate at night. A primary sleep disorder, diabetes and lifestyle issues all should be considered.

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 further evaluation should be considered. 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.

The fact that you sleep “deeply” is probably not a major issue. In your age group, individuals still experience a fair amount of slow wave sleep. This type of deep sleep is difficult to arouse from and is part of the natural sleep physiology you need at your age to ensure good health and growth. I would not recommend medications or other maneuvers to interrupt your slow wave sleep.

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. 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