Sleep quality and Bedwetting in Kids
Bedwetting, or monosymptomatic nocturnal enuresis (MNE), is common in children, affecting about 10% of 6 year olds and decreasing proportionately with age (Neveus, 2000). There are several possible causes. Usually if a child is producing more urine that the bladder can hold, they will be wet.
Questions a kids continence physiotherapist will help answer:
How much urine is being produced overnight? Is this age appropriate? This can be worked out by weighing the nappy in the morning and adding together with a volume measurement of the first wee of the day.
How much urine can the bladder hold? Is your child’s bladder capacity small? Or, could there be something irritating the bladder (such as caffeine in drinks, or a UTI)? Or, could there be something pressing on the bladder (such as hard stools)?
Van Gool (1999) noted that a number of children who are bedwetters do not have the normal rise in the antidiuretic hormone (ADH), also known as arginine vasopressin. The amount of urine produced during the day and night is regulated by this hormone. During the day, less of this hormone is secreted and more urine is produced. At night time, more of this hormone is secreted and less urine is produced. Desmopressin (Minirin) is a commonly prescribed synthetic antidiuretic hormone used in children who are bedwetters who are producing too much urine overnight.
….But what about deep sleepers?
Most kids who are bedwetters report they sleep very deeply and can be difficult to rouse. Sound familiar? Van Gool hypothesized a relationship between bedwetting, difficulty with arousal, and melatonin production. Melatonin is our sleep promoting hormone, and production increases when it is dark which is associated with circadian melatonin release. The levels of the hormone peak around 2am, and decreases in the morning. Ferrara et al (2016) had some promising results their research with children having less wet nights when receiving melatonin in addition to desmopressin, compared to desmopressin alone. More research is needed in this area… but stay tuned.
Does screen time affect sleep quality?
Research has demonstrated that light evokes an alerting response among humans (Cajochen, 2007). Using self-luminous tablets for more than two hours has been shown to cause statistically significant melatonin suppression (Wood et al, 2013). Several studies have hypothesized that interactive screen time (computers, video games, mobile phone use) is more detrimental to sleep than passive screen time (television) (Weaver et al, 2010; Gradisar et al, 2013). Keep track of how much screen time you and your family are having in the evenings, as this may be affecting your melatonin production, and sleep quality.
Sources:Ferrara, P., Sbordone, A., Cutrona, C., Ianniello, F., Guadagno, C., Perrone, G., … Lazzaro, V. D. (2016). Melatonin’s Effect on the Efficacy of Desmopressin in the Treatment of Enuresis. International Neurourology Journal, 20(3), 203–208. http://doi.org/10.5213/inj.1632518.259
Hale, L., & Guan, S. (2015). Screen Time and Sleep among School-Aged Children and Adolescents: A Systematic Literature Review. Sleep Medicine Reviews, 21, 50–58. http://doi.org/10.1016/j.smrv.2014.07.007
Merks, B, Burger, H., Willemsen, J., van Gool, J., de Jong, T. (2012). Melatonin treatment in children with therapy-resistant monosymptomatic nocturnal enuresis. Journal of Pediatric Urology, 8(4), 416-420.