Case Study of 11-Year-Old Twins Who Wet the Bed

Patricia, 42, a mom of twins we’ll call Adam and Aaron, reached out to our Bedwetting Clinic as a referral from her pediatrician’s nurse practitioner.  This practitioner had seen many youngsters come into their office whose parents were trying desperately to stop bedwetting only to have to tell them there was nothing they could do except wait and hope it stops.  The alternative was a drug with substantial side effects, and which could only provide temporary relief from the wetting—if that.   The medical profession feels that bedwetting is caused by a physical problem.  The nurse practitioner revealed to Patricia that it’s been seen as a physical issue in less than 1% of all reported bedwetting cases.

Patricia remembers being a devastated 13-year-old who wet the bed, and she didn’t want her twins to reach their teen years still wetting the bed, especially since there was no guarantee they would. She continued having vivid memories of shame.  She remembers being subjected to all sorts of invasive tests and had to wear disposable diapers in middle school.  She refused to go to sleepovers for fear of discovery.  She said it was a “dark family secret” that she did not share with her husband…that is until the twins continued to wet the bed beyond potty training. She did not want her twin boys to miss out on the social development opportunities like sleepovers and making important childhood connections.  An added worry in her mind is that one twin might stop wetting before the other, and she didn’t even want to imagine the potential psychological impact of that experience.

Fortunately for Patricia and her boys, the practitioner started to see some of her patients returning to them dry at their annual wellness visits.  This is how she came to discover Enuresis Treatment Center’s specialized programs that provide a proven bedwetting solution.

Our Initial Assessment:

Our initial assessment is a purposeful inquiry designed to understand a child’s circumstances, patterns, behaviors, and challenges prior to them stating the program.  This is essential to being able to develop a specialized protocol for each patient to meet their particular needs.  The information and insights we obtain are also essential to be able to tell parents what to expect as it relates to their child’s particular protocol.

The twins were delivered six weeks premature.  They were healthy and showed no medical issues, yet they remained in the hospital for seven days.

Patricia wondered if premature birth might have been the cause of their very heavy sleep as well as the wetting the bed.

At their first encounter with the nurse practitioner, it was when the boys were seven and a half years of age.  The nurse suggested they wait until they were eight to see if the bedwetting resolved on its own.  Six months later, they were back in the office.  The next step was a prescription for Desmopressin, otherwise known as DDAVP.  Aaron was also prescribed Zoloft for symptoms of anxiety with which he presented.  As it turns out, the boys took the DDAVP for four years with only sporadic results.  They would have only one or two nights a week when they would be dry, even though they were both at the highest dosage allowable.  What the medical profession is calling “bedwetting medication” is actually intended to slow down kidney function and limit urine production.  Essentially it is creating a condition of dehydration.  When Patricia decided to stop the intake of medication, the bedwetting ramped up to every night of the week.

In addition to the medication, Patricia was told to restrict fluids before dinner.  It was recommended that an ultrasound be done of the kidneys and bladder.  They explored the idea of enemas for constipation, which is sometimes believed to cause bedwetting.  Yet the boys did not present with constipation symptoms.  All methods were expectedly unsuccessful to end bedwetting

As for the twins’ father, he was diagnosed with severe sleep apnea two years ago, and currently wears a c-pap device, also known as continuous positive airway pressure therapy to help regulate breathing.  Since we learned that the father was a former bedwetter, sleep apnea is not an uncommon diagnosis stemming from the sleep disorder that both of the boys have.  Bedwetting is one symptom of the disorder, and apnea is another.  It’s the result of an inherited gene.  The father’s brother also wet into his teens.  Another brother was a sleepwalker as well as their father.  This is another common symptom inside the sleep disorder, which can also include night terrors, teeth grinding, and heavy snoring.

Side note:  Bedwetting (enuresis) is treatable.  The other symptoms are not.  The only possibility somebody has in living with apnea, for example, is to manage these symptoms as best as they can.  For the father, it’s wearing the c-pap device.  Since the bedwetting symptom was “outgrown” by their mother, father and father’s brother, the detriment it poses is that these other untreatable conditions can effect their quality of life, and if the boys’ sleep pattern is not changed, they stand the possibility of experiencing future untreatable symptoms like apnea.  Almost three times as many males wet the bed than females.  Three times as many males as females have sleep apnea.

Adam: 

Adam, born three minutes before his identical twin brother, was daytime potty trained at age 2.5.  He is slightly below average weight for his height and age and has no medical diagnoses, nor is he currently taking any prescription medication. He has a good intake of fluids, very athletic, and plays two school sports.  He sometimes talks in his sleep.  Adam experiences multiple wets every night.  It was determined that he wets the bed approximately three hours after bedtime, and again closer to morning.  He wears underwear with pads to bed.  He will wet through a pullup and does not wake up, even when Patricia attempts to change the pullup.  Adam has zero recall in the morning and would argue with her stating nothing happened in the night.

Adam has daytime symptoms of urgencies and dribbling during the day.  The daytime dribbling has increasingly become an issue at school.  A change of clothing needs to be in his school locker, and a few students have mentioned the smell of urine.   We have found that if a child is discovered by his peers to have accidents or even come to know that they wet the bed, bullying can become a real problem.  There is also a real concern about challenges arising relating to one’s self esteem.  A child can feel traumatized, withdrawn, and even depressed.  At this time, Adam is not presenting with those symptoms, although he is extremely sensitive to his condition.  He also feels very tired during his waking hours.

Aaron:

Aaron has a stockier build, no medical abnormalities, a low intake of fluids, and an average level of activity.  He sweats and thrashes while sleeping.  He presented with a sporadic wetting pattern.  Patricia was unable to pinpoint a time frame as to when the bedwetting might be taking place.  It is likely he has an underdeveloped bladder because he has to use the bathroom quite often during the day.  He also experiences lethargy during the day.

Aaron suffers from anxiety.  He was diagnosed with Acute Anxiety/Mild Depression, and he was put on small dosage of Zoloft.  (.05)   Patricia reported that he is also “easily triggered” by things people say or do.  His teachers say he is beginning to have trouble focusing on tasks that she gives to him.

Patricia reported that both boys have a “horrendous” time waking up in the morning.  It’s “impossible” to awaken them at night, and clearly very difficult to awaken them in the morning.

This private assessment was conducted via a Skype call since the family resides on the west coast, and was unable to visit the clinic for the clinical assessment. It was explained that even though they were not able to come in, the treatment is no less effective than if they were to see us in person.

Given the important preliminary information provided by the parents in their assessment, it was clear that needed to develop different protocols for each boy, even though they are the same age and have similar genetic presentations given their twin status.

Our Bedwetting Programs:

Dr. Roger Broughton, a neurologist and foremost sleep researcher from McGill University in Montreal, is an expert upon whose findings led to the development of our successful and specialized programs.  He conducted an extensive and long-term sleep study of people who wet the bed which was entitled “Sleep Disorders: Disorders of Arousal? Enuresis, Somnambulism, and Nightmares Occur in Confusional States of Arousal, not in ‘Dreaming Sleep’.”

The result of this seminal study shows the differences in healthy, normal sleep patterns and those of someone who wets the bed.  In normal, cyclical sleep, individuals fall slowly from Stage 1 (lightest sleep) into Stage 4 (deepest sleep), and then back to lighter stages where it’s easy to awaken.  A full cycle takes approximately 90 to 100 minutes to achieve.  An individual who wets the bed–which can include a child, teenager or an adult–falls quickly into deep sleep and stays there for longer periods.  This is the problem.  The brain is not supposed to stall in Stage Four.  Rhythmic cycling doesn’t take place consistently throughout the night, and the bedwetting occurs as a result.

The study’s findings concluded that all individuals who wet the bed share a particular type of sleep: A very deep and heavy sleep.  Our bedwetting center has decades of clinical and anecdotal experience which proves that the only effective treatment and cure for bedwetting is to change the heavy and unhealthy pattern of sleep, and that’s what we do.  Chronic bedwetting is the symptom caused by the inherited sleep disorder.  According to Dr. Broughton, this same sleep disorder causes sleep apnea, excessive snoring, sleepwalking, night terrors, insomnia, and bruxism.

This type of deep, heavy sleep produces a poor-quality sleep rather than a high-quality sleep.  This is essentially a sleep-deprived event and can result in:

  • Irritability
  • Cognitive impairment
  • Memory lapses or loss
  • Impaired moral judgement
  • Severe yawning

–    Symptoms similar to ADHD

  • Impaired immune system
  • Increased heart rate variability
  • Risk of heart disease
  • Decreased reaction time and accuracy
  • Tremors
  • Aches
  • Risk of diabetes Type 2
  • Growth suppression
  • Risk of obesity
  • Decreased temperature

In the past 44 years that we have been ending bedwetting for children, teens, and adults, there is validation that a new pattern of sleep is needed regardless of the age of the individual, their circumstances, their diet or fluid consumption, and regardless of any physical or psychological condition. Creating a new pattern of sleep will not only eliminate bedwetting, it also prevents the possibility that any of the untreatable conditions—especially the life-threatening condition of sleep apnea–will arise.

As of this writing, both boys are progressing wonderfully as expected.  Their counselor laid out the proper protocol plan of action for each boy, and walked the parents through the process step by step.  As a result, a comparison is becoming available between “good sleep and bad sleep”, (before treatment and after treatment), and it’s now clearly seen that the good sleep (new sleep pattern) is positively effecting mood, energy levels, their ability to focus, and Aaron no longer needing Zoloft.  His symptoms of depression lifted once his brain was able to get what it needed through healthy sleeping.

Mornings are much easier during the awakening progress, and each boy is down to wetting an average of once every two weeks.  Both outcomes indicate that the sleep pattern has changed drastically, and the treatment is nearing completion.  They will be entering an observation phase wherein we can be certain that the new sleep pattern has taken root and the bedwetting has been permanently resolved.  Because of our bladder and pelvic floor muscle exercises, daytime issues have been resolved for the boys.  With everything in place, soon they will successfully graduate from our care.

Author:  Michael Stallsmith, M.A., Sp.A.

The Enuresis Treatment Center’s Director of Treatment is also a school psychologist.  Michael has been involved in successfully treating over 20,000 children, teens, and adults who wet the bed.  He is responsible for overseeing the counselors on our staff who work directly with the patients, and he is effective at implementing what’s needed for any challenging situations that may arise during treatment.

Michael continues his outreach with the medical community and school systems educating them about bedwetting and its relationship to the non-arousable sleep disorder.  Michael has been on staff at the Enuresis Treatment Center since 1982.

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