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Case Study of Adult Bedwetting Patient

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This is a case review of a 42-year-old Caucasian male, who we will refer to as William. He was suffering from bedwetting for his entire life.  Bedwetting is also known as nocturnal enuresis and primary nocturnal enuresis.   William reached out to our clinic after reading about our expertise in solving adult bedwetting.  He commented about his experience of relief while reading our website information, and that it made so much sense.  He then knew unequivocally that his heavy, deep sleep had to be the underlying issue, not only for his years of nighttime accidents, but also for his teenage son’s bedwetting.

Family History of Bedwetting:  

William’s father experienced bedwetting into his teen years.  William’s grandfather also wet the bed as a teenager.  His father’s father experienced teenage bedwetting as well.  Now William’s son continues to experience nighttime bedwetting as a teen.  He has always wet the bed – never been dry at night.

In recent years, William’s father was diagnosed with sleep apnea, and he currently wears a c-pap device, also know as a continuous positive airway pressure therapy, to help regulate breathing.  This is not an uncommon diagnosis stemming from the sleep disorder with which we work.   Also, not uncommon is the sleepwalking and night terrors experienced by his aunt.  These are symptoms that cannot be eliminated.  The only possibility is to manage these symptoms as best as somebody can.  Since bedwetting was “outgrown” by his dad and aunt, the detriment it poses is that these other untreatable conditions can surface and affect quality of life.

We know  a new pattern of sleep is needed which will not only eliminate bedwetting; it will also cut off the possibility that the untreatable conditions will arise.   

Dr. Roger Broughton, a neurologist and foremost sleep researcher from McGill University in Montreal, is an expert upon whose findings have led to our initial protocol.   He highlighted a condition called deep-sleep bedwetting.  The sleep study conducted by Dr. Roger Broughton is titled, “Sleep Disorders: Disorders of Arousal? Enuresis, Somnambulism, and Nightmares Occur in Confusional States of Arousal, not in “Dreaming Sleep.”

The result of this study shows the differences in normal sleep patterns and those of a bedwetter.  In normal sleep, people 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 minutes to achieve.  A person who wets the bed falls quickly into deep sleep and stays there for longer periods.  This is the problem.  The brain is not supposed to stay in Stage Four for very long.  Cycling doesn’t take place consistently throughout the night, and the bedwetting occurs as a result.

The study’s findings concluded that all bedwetters share a deep sleep pattern. Our center has decades of clinical and anecdotal experience, which proves that the only effective treatment and cure for bedwetting is to change the pattern of sleep. Chronic bedwetting is the symptom caused by the inherited sleep disorder. 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.  The infographic below illustrates the effects of sleep deprivation:

sleep deprivation

Initial Assessment:

A thorough assessment, required for preparing for one of our programs, revealed  that he also experiences difficulty awakening in the morning, had sleepwalking episodes as a child, and was prescribed Ritalin during his late teen years to help with focusing and hyperactivity.

When we discussed the frequency that the bedwetting is occurring, William claimed he has wet the bed every week of his life.  In the past year he has seen an increase in the frequency of the bedwetting with a pattern of two to three times a week on average.  

Currently he has no medical issues other than seasonal allergies.

He has previously – during childhood and even as a teen – been examined by two pediatricians, three urologists, and a neurologist to determine a cause of the bedwetting, also know as primary nocturnal enuresis.  At no time was a physical symptom diagnosed.  Enuresis workups included:  Urinalysis, urethral obstruction scope, several ultrasounds, and an MRI.  

According to the American Pediatric Association, less than 1% of bedwetting is caused by a physical problem.

He stated that typically the physicians’ focus of bedwetting treatment was placed upon managing the bedwetting rather than a full resolution.  After a failed attempt using a bedwetting alarm, being told to wait and do nothing until puberty when he is likely to stop wetting was the direction his parents were given.   Clearly it turned out to be inaccurate (as it is with most of our patients)

He did not recall a physician providing any statistics regarding the length of time he would suffer from bedwetting, and of course he was not provided the statistics for primary enuresis: 1-30 for teenage bedwetting or 1 -100 adults who would continue wetting the bed as an adult.  

No medications were prescribed until he reached age 24.  Over time, he was placed on three different drugs, which included Ditropan and Tofranil to no avail.  His last desperate attempt was with Desmopressin.  William researched the side effects of Desmopressin when the dosage was increased to three pills each night, and when he started regularly feeling queasy and irritable, which he said was not typical.   William lives in a warm climate, is physically active, and knew how important hydration was to his well-being.   Desmopressin is meant to purposely cause dehydration in the body in an attempt to eliminate the bedwetting.  When his discovered the extensive list of side effects of Desmopressin, as well as the ineffectiveness, he stopped taking the drug immediately.

What makes drug intervention for bedwetting a completely ineffective approach is because it doesn’t remotely touch the causal factor of the core issue – sleep.   

Below is a list of some of the side effects of Desmopressin.  

Source  https://www.rxlist.com/ddavp-side-effects-drug-center.htm

Also known as DDAVP, it is an antidiuretic and anti-hemorrhagic drug used to treat bed-wetting, central cranial diabetes insipidus, and increased thirst and urination caused by head surgery or head trauma. DDAVP is also used to treat bleeding due to platelet dysfunction. DDAVP is available in generic form.

Common side effects of DDAVP include:

Headache, nausea, upset stomach or stomach pain, diarrhea, or flushing of the face (warmth, redness, tingly feeling). DDAVP can infrequently cause low levels of sodium in the blood, which can be serious and possibly life-threatening. Seek immediate medical attention if you have symptoms of low levels of sodium in the blood, including:  loss of appetite, nausea, vomiting, severe headache, muscle weakness/spasms/cramps, weight gain, unusual tiredness, dizziness, severe drowsiness, mental/mood changes (confusion, hallucinations, irritability), loss of consciousness, seizures, or slow/shallow breathing.

Physicians continued to tell him he was not trying hard enough, which he confided was scarring his self-esteem, and resigning him to the point of view that he would have to live out his life continuing to wet the bed. He expressed a deep resentment over the dismissal of this problem of wetting the bed, and was amazed and confused that it would even be intimated that he hasn’t done his part to end the stress of this condition.  

We can see more about how the problem with doctors saying bedwetting will be “outgrown” can cause psychological havoc to its victims, attacking self-esteem, increasing a sense of failure, and feeling “different”.   For many of our adult patients, they tend to live more solitary lives because they feel too uncomfortable disclosing the bedwetting to a potential mate.  Unfortunately, intimacy often becomes what they feel is an impossibility to them.   We understand it can be difficult to open up to somebody about this condition.  Many adults in our program have expressed anger or sadness or regret for having “missed out” on opportunities as a result of having to hide an extremely sensitive and often shameful part of their lives.

He was highly motivated to enter as well because his wife had recently filed for divorce.  One of the reasons involved her perspective on William’s bedwetting.  She eventually began to accuse him of deliberately wetting the sheets.   In fact, in a most unfortunate experience for William, his wife used this perspective and had her attorney introduce it publically in divorce court.   We have the utmost respect for William to ride that through, and then do whatever it would take to eliminate a problem that he thought he had no control over, and that has clearly impacted his life to the extent of being publically humiliated.  

Enuresis Treatment Center

Years of research and development dictates a two-week meeting schedule in order  to properly develop a  personalized plan.  We assign to our patients one of our staff counselors to work closely with them and facilitate their plan.  Our counseling staff includes a school psychologist, nurses, and teachers.  William was offered the opportunity to conduct his appointments via Skype.  He chose instead to have phone contact because, as he described, “the pain and embarrassment is too deep to face anyone”.

Our protocol dictates that our Director of Treatment reviews each case before a customized program is designed.  It was determined that a male bedwetting counselor would work with William throughout his program.  

Focus was placed upon ending the heavy and problematic sleep that had caused the continuation of the nocturnal enuresis.   Besides the enuresis, William presented with always feeling unrested, having difficulty focusing, being exhausted upon awakening rather than refreshed, and becoming more and more withdrawn over the years.  

We found out that William had symptoms of urgencies, a need to empty his bladder multiple times during the day, and we know this was attributed to the bedwetting itself.  It was determined that this is an actual a symptom of the bedwetting because the bladder tends to remain underdeveloped as a result of emptying regularly in the night.   We therefore developed and implemented a seriesces of targeted exercise, introduced at varies segments of his program ,develop to needed to fully support him and thus eliminate excessive needs to urinate during the day.   

In week six of our progressive and holistic approach, William began to see a change in his wetting pattern, and he was thrilled.  Of course, he would be!  For the first time in his life, he began to see progressive results leading to an end to the bedwetting.  He told his counselor that he was able to see progress and the finish line was in sight!

What is required for each appointment is pertinent data as it relates to the bladder development and the sleep intervention training.  Incremental changes are often difficult for the patient to detect, but the job of the bedwetting counselor is to identify and design the next step to maintain progress.

Enuresis Treatment Center’s sleep training protocol focuses on the relationship between the deep sleep and the disconnect with the bladder signals.  

As we know, the brain becomes less malleable as we age, and it was known that Williams program would possible take longer than it would take a child’s brain to respond.  

William’s counselor noted that he followed all directives in a timely fashion.  The Reinforcement Phase took longer, as was anticipate, but completed.  His counselor was satisfied, via current data, that his new sleep pattern had emerged.  The bladder and brain synchronized and the adult bedwetting ceased to be a problem.

William entered his teenage son into one of the Enuresis Treatment Center’s specialized teenage bedwetting programs four week after he finished his program.   
Source of graphic:
http://jonlieffmd.com/wp-content/uploads/2012/07/800px-Effects_of_sleep_deprivation2-300×220.png

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

The Enuresis Treatment Center’s Director of Treatment is also a school psychologist.  Michael Stallsmith has, over the past 20 years, been involved in over 20,000 cases.  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.

Teen Bed Wetting …Why Would A 13-Year-Old Wet The Bed?

“Don’t worry, they will outgrow it”. Is this something you’ve heard before? How many times has the bedwetting teen heard this?  After years of waiting and being frustrated, people are saying they’ve had enough! This is why we continue to see more teenagers and adults enter our program. They don’t want to wait another year.

Your pediatrician is undoubtedly committed to your child’s health and wellbeing, yet wetting the bed is not a medical condition. So without expertise in the field of bedwetting treatment, doctors are often telling families to wait, and this can come with a price.

There may also be well-meaning family members or friends who suggest to wait. Or perhaps you, yourself, had outgrown bedwetting, and it seemed logical to wait for your child to outgrow it as well.

Yet outgrowing bedwetting is not a certainty. In fact, if it should happen, doing so may be counterproductive to one’s health. More about that in a moment.

We know what bedwetters and their families are experiencing with the day-to-day, week-to-week, month-to-month challenge of waiting…of having to even think about bedwetting. The costly disposable diapers, the wet sheets, the labor to clean the sheets; living with the resignation, guilt, and confusion. This causes stress, of course, and it’s actually unnecessary and can be ended. We imagine you’re feeling relieved to hear that.

We’ve heard hundreds of stories of despair over the years, and we’d like to share one here that highlights the impact of holding on to the hope that bedwetting will be outgrown.

We are focusing on teen bedwetting. Since the average of our patients is 15. So here’s the story about 13-year-old Ben.

Imagine you’re a boy of 13 who is in middle school with lots of friends, and you excel in sports. Your academic, family, and personal life are all going well. Yet you live every day with a secret–one that you have been keeping for most of your life.

There have also been limitations and consequences for you that are hidden from others. Perhaps you’ve had to turn down invitations to sleepovers and avoid camp stays, and your friends began to wonder why. Slowly they stopped inviting you, and your world got smaller and disconnected.

You had reached a point where you pleaded with your mom to stop asking the doctor for bedwetting help during your Well Visit. After all, what’s the point? All you keep hearing is “Wait, Ben…you’ll outgrow it. You will not have to wet the bed for long. One day you’ll just suddenly stop. Can’t say when, though”. Surely it’s discouraging and embarrassing to talk about your bedwetting any further.

In the back of your mind, you must be feeling helpless. Maybe you’re resigned to thinking you’ll have to live with the hardships of bedwetting for the rest of your life.

“Why can’t a doctor fix this”?

Going to bed every night is difficult knowing that when you open your eyes in the morning, you’ll feel the cold, wet bed or diaper, and you may start your day discouraged. We are guessing you’re feeling unrested as well. This is another sign of the sleep disorder at the heart of the bedwetting issue.

Let’s explore that assertion here.

With 42 years as bedwetting specialists, we clearly understand the relationship between a deep, heavy sleep pattern and bedwetting. In fact, our entire process is based on a groundbreaking study that was discovered by our founder, Barbara Moore, in 1976. This was the breakthrough that was needed to stop bed wetting for our founder, Barbara Moore’s daughter, for whom the protocol was developed.

In 1969 when a foremost sleep researcher by the name of Dr. Roger Broughton had identified what he called the non-arousable sleep disorder, he proved the pattern of sleep for a bedwetter is far different from healthy (non-bedwetting) sleep. For the healthy sleeper, the body actually goes through various sleep cycles. We cycle from light to deep (Stage 1 to Stage 4), then enter a lighter stage known as REM (dream sleep), and then we begin all over again. This cycle occurs approximately every 90-120 minutes, and this is what creates restful sleep and ensures the brain is appropriately nourished and responsive.

Such is not the case with the specific pattern of sleep that produces bedwetting. Dr. Broughton spent years studying sleep and validating why bedwetting happens. This is why our approach is based on his findings and why it’s working. It’s based in science. Our program has been highly successful since we have been treating patients from this proven perspective. When a 13-year-old like Ben falls asleep, they drop into a very deep, heavy sleep and stall rather than cycle. He remains in this very hard sleep much longer than is required, and it can rob him of the opportunity for restorative, restful sleep. It’s actually a sleep deficiency. Anytime there’s a deficit in any given situation in life, it has a negative effect. So imagine if someone is experiencing bad sleep every night of their life? Parents of a seven year old cannot image the possibility of their child experiencing teen bedwetting. Yet it’s a real concern, and it gets increasingly more detrimental as time goes on.

For tweens and teens, sleep is even more important. “One possible implication of our study is that if you lose too much sleep during adolescence, especially chronically, there may be lasting consequences in terms of the wiring of the brain,” according to investigator Chiara Cirelli, MD, PhD, associate professor in the department of psychiatry at the University of Wisconsin’s School of Medicine and Public Health. “Adolescence is a sensitive period of development during which the brain changes dramatically. There is a massive remodeling of nerve circuits, with many new synapses formed and then eliminated.”

Let’s take a moment to take a closer look into the stage of REM sleep.

  • REM sleep important to the health of the brain for many reasons, including the creation of long-term memories.
  • REM sleep also increases brain activity, promotes learning, and creates dreams.
  • REM is also attributed to the fact that during this phase of sleep, your brain exercises important neural connections which are key to mental and overall well-being and health.

It’s also imperative for us to mention that not having the normal cycling of sleep stages—not accessing REM sleep regularly throughout the night and thus creating the sleep deficit–can also pose challenges during waking hours, as you can imagine. Waking up wet and tired, a bedwetter faces the day differently. Now they have to go to school and interact, and also be expected to perform to full potential. This can be quite difficult. In fact, many difficulties that a bedwetter faces—including ADD and ADHD—are not often traced back to the sleep disorder by professionals. It’s not a lack of competency; it’s a lack of proper knowledge. Therefore, challenges persist–if not increase—over time. Even if doing well academically, there is the underlying and increasingly challenging sleep issue which expresses itself more obviously over time.

Also worthy of noting: We have seen over the years that as a child continues to wet and becomes more acutely aware of their challenges and feeling “different” or even defeated, they tend to withdraw from social activities that are important to them, but are now feeling too uncomfortable to participate in.

We mentioned that outgrowing bed wetting can be counterproductive to one’s health. That’s because IF somebody happens to outgrow the bedwetting issue, the sleep disorder remains, and other symptoms can emerge over time such as sleep apnea, sleep walking, night terrors, excessive snoring, teeth grinding, etc. There can be unpleasant life-altering consequences to each of these. Changing the pattern of sleep is not only going to stop bedwetting, it’s also going to prevent any other symptoms from developing.

Our experience has shown that once the sleep pattern has been impacted and there’s normal cycling, as Dr. Broughton references, healthy sleep cycling has a chance to take root. You begin to see significant improvements, such as with disposition, focus, concentration, energy expenditure, alertness, connection, etc.

When a patient is free of detrimental sleep and achieving good sleep for the first time in their lives, positive benefits abound. Besides, it’s rewarding to see your child start their day in a dry bed and knowing you made that difference for them. And what an enormous difference they will feel!

Working 42 years as bedwetting specialists, we have helped thousands of children, tweens, teens—and yes, adults–who continue wetting the bed. We find most of our adult patients have led solitary, isolated lives hiding in shame. This is sad and unfortunate considering that nobody has to live with bedwetting. Nobody.

83% of parents of 9-16 year olds tell us that they regret following their physician’s advice to wait. They reported feeling misled and dismissed. You can see the impact that the hoping, wishing, and waiting can have. We are here to ensure that our patients experience the sleep they are born to have—need to have–and the dry bed every morning that they deserve to have.

GaileGaile Nixon,
International Director and First Patient of ETC