Sleep apnea and bedwetting might seem entirely unrelated. Sleep apnea, a disorder characterized by repeated interruptions in breathing during sleep is often associated with snoring, daytime fatigue and various health risks.
On the other hand, bedwetting or also called nocturnal enuresis is a common childhood issue that is usually resolved when they grow up. But researchers suggest a surprising connection between these two conditions. Understanding this link is important for effective diagnosis and treatment.
What is Sleep Apnea?
Sleep apnea is a common yet serious sleep disorder where breathing repeatedly stops and starts during sleep. It is characterized by pauses in breathing, known as apneas. This can last from a few seconds to minutes. These interruptions can occur up to 30 times or more per hour. There are three main types of sleep apnea. Obstructive sleep apnea (OSA), central sleep apnea (CSA) and lastly, complex sleep apnea syndrome.
- Obstructive Sleep Apnea (OSA): The most prevalent form. OSA occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe. This blockage causes snoring, choking or even gasping sounds as the body struggles to regain airflow.
- Central Sleep Apnea (CSA): This is less common than OSA. CSA happens when the brain fails to send proper signals to the muscles that control breathing. Unlike OSA, there is no physical blockage in the airway. Rather a communication problem between the brain and muscles.
- Complex Sleep Apnea Syndrome: Also known as treatment-emergent central sleep apnea. Happens when a person initially diagnosed with Obstructive Sleep Apnea (OSA) develops Central Sleep Apnea (CSA) during treatment for OSA.
Sleep apnea affects people of all ages. Though it is more common in adults. Risk factors include obesity, large neck circumference, narrowed airway, gender, older age, family history, use of alcohol or sedatives, smoking and certain medical conditions such as congestive heart failure or high blood pressure.
Why is Sleep Apnea Concerning?
Untreated sleep apnea may lead to many health problems. The repeated interruptions in breathing can cause fragmented sleep, leading to daytime fatigue, irritability, and difficulty concentrating. More severe complications include high blood pressure, heart disease, stroke, diabetes, and even premature death.
Statistics indicate that more than 29 million Americans ( 12%) suffer from sleep apnea, with 80% of these cases undiagnosed. Given these figures, understanding sleep apnea’s impact on health is crucial for early diagnosis and management.
And, What is Bedwetting?
Bedwetting, or nocturnal enuresis, is the involuntary urination during sleep. It typically occurs in children aged five and older. While it is a common childhood condition, sometimes it can also persist into adolescence and adulthood. Bedwetting is classified into two types: primary and secondary enuresis.
- Primary Enuresis: Occurs when a child has never achieved consistent nighttime dryness. It is often linked to delayed bladder maturation, a small bladder capacity, or genetics. If one or both parents experienced bedwetting, their children are more likely to face the same issue.
- Secondary Enuresis: This form develops after a person has been dry for at least six months but then starts wetting the bed again. Stress, infections or other medical conditions like diabetes or sleep apnea can trigger secondary enuresis.
Prevalence and Impact
Bedwetting a common condition that affects many children across the world. For instance, in the United States alone an estimated five to seven million children experience bedwetting. Around 10-15 percent of these children will continue to wet the bed until they reach the age of six. Annually, about 15 percent of bedwetting children will stop on their own. Yet 1-2 percent may continue to deal with this issue into adulthood.
The impact of bedwetting can be profound. For children, it can severely affect their self-esteem. Making them feel different or ashamed. This can hinder their social interactions and emotional well-being.
On the flip side, adults also often experience embarrassment and anxiety due to this problem. The sense of shame could be overwhelming. Their quality of life and mental health are significantly affected. Meanwhile whether child or adult, bedwetting’s emotional toll is undeniable. It disrupts daily life and relationships. Addressing the underlying causes and providing support is important.
Is There a Link Between Sleep Apnea and Bedwetting?
Yes, there is a notable link between sleep apnea and bedwetting. As stated earlier this connection is particularly evident in children but can also affect adults, although less frequently.
Connection in Children
Sleep apnea affects around 30% of children and is a well-documented cause of bedwetting. Apnea disrupts sleep and can interfere with the signals between the brain and bladder, leading to nighttime accidents. When the body is repeatedly jolted from deep sleep to lighter stages of sleep or wakefulness, the normal inhibitory signals to the bladder may be compromised, resulting in bedwetting.
Evidence in Adults
Though less common, enuresis in adults can also be linked to sleep apnea. A study titled “Enuresis and Obstructive Sleep Apnea in Adults” observed five adults who developed enuresis concurrent with the progression of their OSA symptoms.
In all cases, the enuresis resolved once the individuals were treated with nasal continuous positive airway pressure (CPAP), a common treatment for OSA. This suggests that severe OSA may lead to new-onset enuresis in adults, and effective treatment of sleep apnea can resolve this issue.
Postulated Mechanisms
One theory suggests that the negative intrathoracic pressure generated during obstructive events can increase the return of blood to the heart. Triggering a reflex that increases urine production. Various article authors suggest that atrial natriuretic peptide (ANP) plays a role in these changes in renal function. When a person struggles to breathe against a blocked airway, the pressure inside the chest changes leading to more blood returning to the heart.
The lack of oxygen (hypoxia) during apnea can cause blood vessels in the lungs to constrict, putting extra pressure on the right side of the heart and causing it to stretch and dilate. This stretching of the right atrium triggers the release of ANP. A hormone that helps regulate blood pressure and fluid balance by increasing urine production. Studies have found that higher levels of ANP are linked to lower oxygen levels and greater chest pressure changes during apnea episodes, further supporting this theory.
How Can Sleep Apnea and Bedwetting be Treated?
Effective treatment of sleep apnea and bedwetting involves addressing the root causes of each condition. Continuous positive airway pressure (CPAP) therapy is a cornerstone of treatment for sleep apnea, especially obstructive sleep apnea (OSA).
Bedwetting when linked to sleep apnea, can also be resolved by treating the underlying sleep disorder.
CPAP Therapy for Sleep Apnea
CPAP therapy is the most common and effective treatment for OSA. It involves using a machine that delivers a continuous stream of air through a mask worn over the nose or mouth. This stream of air keeps the airways open during sleep, preventing the interruptions in breathing that characterize sleep apnea.
Why CPAP Therapy Works
- Maintains Open Airways: Delivering a continuous flow of air, CPAP keeps throat muscles from collapsing and blocking the airway. This ensures smooth, uninterrupted breathing and enhances oxygen levels throughout the night.
- Improves Sleep Quality: With CPAP, sleep becomes less fragmented. Allowing for deeper, more restorative sleep cycles. Patients often report feeling more rested and alert during the day.
- Reduces Health Risks: Untreated sleep apnea is linked to several serious health issues, including high blood pressure, heart disease, and stroke. CPAP therapy can significantly reduce these risks by normalizing breathing patterns.
- Enhances Quality of Life: Better sleep translates to improved mood, concentration, and overall quality of life. Many patients experience a dramatic improvement in their daily functioning and well-being.
CPAP and Bedwetting
As mentioned above, CPAP therapy not only addresses the symptoms of sleep apnea but also has been shown to resolve bedwetting in patients where sleep apnea is the underlying cause.
In cases of adult enuresis linked to OSA, studies have demonstrated that using CPAP effectively eliminates bedwetting episodes. So by stabilizing breathing and improving sleep quality, CPAP normalizes the body’s signals to the bladder, reducing the likelihood of nighttime accidents.
Other Treatment Options for Bedwetting
While CPAP is highly effective for bedwetting caused by sleep apnea, other cases of bedwetting, particularly in children, may require additional strategies. These can include:
- Behavioral Interventions: Techniques like bladder training, which involves gradually increasing the time between bathroom trips during the day, can help improve bladder control.
- Moisture Alarms: These devices wake the child when they begin to urinate, helping them learn to wake up when their bladder is full.
- Medications: In some cases, drugs that reduce urine production or increase bladder capacity can be prescribed.
- Lifestyle Changes: Reducing fluid intake before bed, ensuring regular bathroom trips, and addressing constipation can also be beneficial.
Disclaimer: The information provided is for general informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional for any medical concerns or conditions. For personalized advice, please consult with us at The Insomnia Institute of Arizona.
When Should You See a Doctor?
If you or your child experience symptoms of sleep apnea or persistent bedwetting, it’s essential to consult with a specialist. The Insomnia and Sleep Institute of Arizona offer comprehensive treatment options. Including CPAP therapy which may resolve bedwetting linked to sleep apnea.
Our experts provide top-tier sleep care for both adults and children. Benefit from our physician-owned and operated clinic’s expertise. Message us to start.
References
Bedwetting | CS Mott Children’s Hospital | Michigan Medicine. (2023). Mottchildren.org. https://www.mottchildren.org/posts/your-child/bedwetting
Children’s Hospital. (2016). Bedwetting solutions: Expert pediatrician offers help for kids | Patient Education | UC Davis Children’s Hospital. Ucdavis.edu. https://health.ucdavis.edu/children/patient-education/bedwetting-solutions
CPAP improves daytime sleepiness even in patients with low levels of symptoms. (2024). ScienceDaily. https://www.sciencedaily.com/releases/2011/05/110515122452.htm
Goyal, M., & Johnson, J. (2017). Obstructive Sleep Apnea Diagnosis and Management. Missouri Medicine, 114(2), 120–124. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140019/
Kramer, N. R., Bonitati, A. E., & Millman, R. P. (1998). Enuresis and Obstructive Sleep Apnea in Adults. Chest, 114(2), 634–637. https://doi.org/10.1378/chest.114.2.634
Kingshott, R. (2010, December 21). Study shows that CPAP therapy reduces fatigue, increases energy in patients with sleep apnea – American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers. American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers. https://aasm.org/study-shows-that-cpap-therapy-reduces-fatigue-increases-energy-in-patients-with-sleep-apnea/
