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CHANGES IN SLEEP OF ENURETICS
BEFORE AND AFTER SUCCESSFUL NON-MEDICATION TREATMENT


Alexander Golbin, MD
Sleep & Behavior Medicine Institute at
Rush North Shore Medical Center
Chicago

Objectives:
1. To investigate polysomnographic (PSG) changes in sleep of children with
enuresis;
2. To evaluate the effect of treatment on sleep architecture.


Method: 20 children with nightly primary enuresis, medication free, ages 6-13 (17 males,
3 females) were evaluated in a Sleep laboratory before they underwent an independent
non medication program of enuresis elimination, developed by Pacific International Ltd.
Treatment was claimed to be achieved after 30 successive dry nights. All children
pronounced dry after 3-5 months. Two recessed and had a second course.


Nine children (8 males and 1 female) came back to the Sleep Llab for the post treatment sleep
study.PSG and scoring were standard except of an additional "Wet sensor" for the
registration of act of enuresis.
Published PSG values (William R. L. Karacan I. Hurch, C. J. 1975) were used as a
control.


Results: As a group, enuretics in our sample had a short sleep latency (mean 5.5 + 3.1),
increased delta stage (29.8 + 5.8), an essentially normal amount of REM stages for this
group (20.1 + 3.2). For bedwetters with deep sleep, almost all delta sleep was in the first
1-2 cycles (means REM latency - 201.4 + 37).


Additional finding in enuretics before treatment were: high amplitude delta paroxysms
- 9 children (41%), apnea (RDI - 5.0) - 7 children (20%), heart arrhythmia with PVC's-
3 children (15%), reversed sleep architecture (delta sleep was predominantly in the
morning) - 2 children (10%).


After successful elimination of enuresis, children slept less deeply and had a more normal
sleep architecture: sleep latency (14.0 + 3), REM latency (108.7 + 29), no apnea episodes,
and awakened more easily in the morning.


Conclusions:
Preliminary data suggest the following:

1) Non-medication intensive educational/behavioral program was successful in
treatment of enuresis.
2) Children with enuresis, as group have polysomnographic abnormalities in sleep.
3) Elimination of enuresis is associated with normalization of sleep architecture.



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