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Stages of Sleep and Bedwetting

By Ryan Hurd ; Updated June 13, 2017

Many parents have noticed that their children are difficult to wake up when wetting the bed, leading to a popular notion that bed-wetting, or enuresis, occurs only in the deepest stage of sleep. However, most sleep research indicates that enuresis can occur in all stages of sleep. The claim that bed-wetting is related to stages of sleep is still controversial, but new sleep research using computer analysis has reopened the debate.

Bed-wetting 101

Bed-wetting is quite common with children under age 6 and can continue for some into adolescence. Most researchers and medical practitioners view enuresis as a development problem; some children are simply late-bloomers. Others have small bladders or poor urination habits. However, a slim minority of bed-wetting cases turn out to indicate a more serious health risk, such as a bladder infection or sleep apnea. When a child has stopped bed-wetting for 6 months or longer and begins wetting the bed again, the condition is called secondary enuresis. Peg Dawson, EdD, a school psychologist from Seacoast Mental Health Center, suggests that secondary enuresis is generally associated with emotional distress, not a physiological issue. It is not uncommon for adults to also experience occasional secondary enuresis due to anxiety and life changes. For children and adults, shaming can only make the symptoms worse, so an attitude of positive acceptance and love is recommended.

Heavy Sleepers or Deep Sleep?

Parents often tell pediatric doctors that they have difficulty waking up their bed-wetting children, and for years these observations were ignored due to sleep lab research. An oft-cited study published in 1999 from the journal “Pediatrics” indicates that enuresis can occur in all stages of sleep, including the lighter stages of sleep and rapid eye movement, or REM, sleep. In his article “Bed wetting and its causes,” Pediatrician Dr. Alan Greene has suggested that both these observations may be true because there have not been many studies that directly determine the ease of waking up sufferers of enuresis. Furthermore, one such study supports parents’ observations that bed-wetting children are more difficult to awaken than the control group.

New Evidence for Delta Waves

The debate about the stages of sleep associated with bed-wetting is ongoing and has become more complex as new technologies are used in sleep studies. In 2000, researchers from the International Enuresis Research Center in Denmark published new evidence that supports the link between bed-wetting and deep sleep. What changed? The study used new computerized methods for mapping brain activity that resulted in a more accurate representation of the sleep stages than the conventional electroencephalogram, or EEG, allows. In particular, bed-wetting was found to be associated with abnormally high levels of delta wave (stages III-IV) sleep.

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