Sleep Apnea and Bed Wetting: What to Know

Wetting the bed, known medically as nocturnal enuresis, is quite normal in children, affecting up to 15% of 5-year-olds. This usually occurs because children have a small bladder that cannot hold as much urine, resulting in nighttime leaks. Some children have a developmental delay and may not be aware when their bladder is full. Also, many children drink a lot of fluid, such as milk, before bedtime or even during their sleep, and this can increase the chance of bed wetting. Eventually, children outgrow the condition without any intervention.

Although significantly less common, bed wetting can affect adults as well, which can be highly embarrassing or distressing. Common causes include urinary tract infections, diabetes, an overactive bladder, and neurological disorders. Certain medications can also cause bed wetting in adults, as can caffeine and alcohol. 

Sleep apnea is another cause of bed wetting in both adults and children. Although it is more likely to develop later on in life, sleep apnea can also affect children. Understanding the connection between sleep apnea and bed wetting is essential for accurate diagnosis and effective treatment.

What is Sleep Apnea?

Sleep apnea is a potentially serious sleep disorder which is characterized by pauses in breathing during sleep. The most common type is obstructive sleep apnea (OSA) which is caused by a collapse or obstruction of the airway during sleep, causing interrupted breathing, loud snoring – and broken sleep throughout the night.

This can affect both children and adults, although it is less common in children and is more likely to develop after the age of 50, and affects men more commonly than women. 

Sleep apnea prevents deep, restful phases of sleep, leading to symptoms such as excessive daytime sleepiness, morning headaches, and difficulty concentrating.

What is Bed Wetting?

Bed wetting, or nocturnal enuresis, is the involuntary urination during sleep. In children, it is relatively common and often resolves on its own as they grow older. However, when it persists into adulthood or begins later in life, it can become a significant issue. 

There are two types of bed wetting: primary and secondary. Primary nocturnal enuresis is where a patient has been suffering from nighttime incontinence all their life. Secondary nocturnal enuresis is when the patient develops nighttime incontinence later on in life.

Sleep disorders such as sleep apnea can be associated with bed wetting in both children and adults. It may be due to the body's response to disrupted breathing patterns and the resulting changes in blood pressure and fluid balance. 

Evidence Linking Sleep Apnea to Bed Wetting in Children

The connection between sleep apnea and bed wetting in children is well-documented and supported by multiple studies. Research shows that children aged four or older who suffer from sleep apnea are at a significantly higher risk of bed wetting. Up to 80% of children with bed wetting issues also suffer from obstructive sleep apnea (OSA). Those with a higher Respiratory Disturbance Index (RDI)—a measure of the frequency of apneas and hypopneas per hour of sleep—are more likely to experience bed wetting. 

Enlarged adenoids and tonsils are common causes of OSA in children. Surgical removal of these tissues through tonsillectomy and adenoidectomy can improve breathing and reduce bed wetting in affected children.

Sleep Apnea and Adult Bed Wetting

Adults with untreated sleep apnea can experience bed wetting in the same way as children. The intermittent lack of oxygen and resulting stress on the body can impair bladder control and increase urine production during the night.

Sleep apnea can also worsen existing urinary issues, such as nocturnal polyuria (excessive nighttime urine production). This can increase episodes of bed wetting which can be distressing and negatively impact an individual's quality of life.

What’s Going On?

The connection between sleep apnea and bed wetting involves several physiological and neurological mechanisms. 

In patients with sleep apnea, the brain works harder to draw in oxygen, which can reduce control over other bodily functions, such as urinary hormone secretion and bladder pressure. This leads to increased urine production and a diminished ability to wake up in response to the need to urinate.

Additionally, the stress associated with obstructed breathing triggers the release of hormones like atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). These hormones increase urine production and can cause bed wetting. 

Controlling Sleep Apnea

To reduce bed wetting in adults and children who suffer from sleep apnea it is important to diagnose and treat the sleep disorder. Continuous Positive Airway Pressure (CPAP) therapy is the gold standard for managing and alleviating the symptoms of sleep apnea.

A CPAP machine provides air pressure to keep your upper airway open while you sleep allowing you to breathe comfortably, inhaling oxygen and exhaling carbon dioxide as required without any pauses or interruptions. Other alternatives include bilevel positive airway pressure (BiPAP) devices, adaptive servo-ventilation (ASV) for central sleep apnea, and expiratory positive airway pressure (EPAP) devices. 

Surgical options include tissue removal or shrinkage surgeries, uvulopalatopharyngoplasty (UPPP), and hypoglossal nerve stimulation. Lifestyle changes such as weight loss, quitting smoking, avoiding alcohol before bedtime, and sleeping on one's side can also significantly improve sleep apnea symptoms. 

Treatment for Bed Wetting

If sleep apnea is managed effectively then episodes of bed wetting should decrease until it stops completely. For children, behavioral treatments such as bladder training, alarm systems that detect moisture and alert the child to wake up, and motivational therapy can also be helpful. In some cases, medications like desmopressin, which reduce nighttime urine production, may be prescribed.

Adults can try a combination of behavioral and medicinal approaches. Behavioral strategies include fluid restriction before bedtime, avoiding caffeine and alcohol, and practicing pelvic floor exercises to strengthen bladder muscles. Medications such as anticholinergics or desmopressin can also help reduce urine production and improve bladder control.

Any underlying medical conditions that may contribute to bed wetting, such as diabetes or neurological disorders, must be diagnosed and managed. Regular follow-up with a healthcare provider to monitor the effectiveness of these treatments and make necessary adjustments is essential for best results.

When to Seek Professional Advice

If you or your child is experiencing persistent bed wetting and suspected sleep apnea, it is important to seek professional advice. Your healthcare provider can conduct a thorough evaluation, including sleep studies, to diagnose sleep apnea and other potential underlying conditions. Early diagnosis and treatment is very important for your health and well-being.

Signs that you should seek professional advice include persistent or recurrent bed wetting, loud snoring, daytime fatigue, and other symptoms of sleep apnea. Your health care provider will be able to put together the best treatment plan for you. 

Talk To Your Doctor

Bed wetting is a common condition in children up to the age of five however it can also affect some older children and adults. There are many different causes of bed wetting, one of which is untreated sleep apnea. Sleep apnea is a serious sleep disorder which mainly affects adults but can also be found in some children.

Certain symptoms of sleep apnea such as disrupted breathing patterns, fatigue, and hormonal imbalances impact bladder control resulting in bed wetting. For children, studies indicate that up to 80% of those with bed wetting issues may also have OSA, and addressing sleep apnea often resolves the issue.

The effective management of sleep apnea through methods such as CPAP therapy can help reduce episodes of bed wetting until it stops completely. At the same time, it will help improve the quality of your sleep and reduce the risk of developing serious health complications. 

If you or your child is suffering from bed wetting and suspects that you may be affected by sleep apnea then you must speak to your healthcare provider. Early diagnosis and intervention is very important. Your healthcare provider will assess your symptoms and put together an individually tailored treatment plan, helping to combat your symptoms, enjoy a good, restful sleep and improve your overall quality of life.