NOCTURNAL BEDWETTING.
Nocturnal bed wetting bedwetting (enuresis nocturna) as a disturbance is so important that it must be particularly stressed in is . It is extremely widespread; 10% to 15% of all children suffer from it. Often the condition is wrongly diagnosed and is not properly understood by doctors. Certainly the symptom of bedwetting cannot be overlooked. What is meant, though, by wrong medical diagnosis of the condition is the failure to distinguish accurately between the two forms of bedwetting. The cause of each is fundamentally different and therefore requires a different therapy. Anyone who does not know this will moreover wonder why this phenomenon accompanying a child’s sleep is considered a sleep disturbance. In fact, it must be regarded as a real symptom of a sleep disturbance. What is meant, however, is not secondary bedwetting that occurs among children who were dry a moment before the incident and who already have mastered at around age two the complicated task of controlling their bodily functions. The cause of this form of wetting can be prompted by a withdrawal of love resulting from the arrival of a new sibling or as a protest reaction against a decisive change of surroundings such as being placed in an institution or clinic. Such trauma causes the child to regress to earlier behavioral patterns, consequently losing the already learned capability of reacting to the stimulus of a full bladder by getting up and emptying it. This form of bedwetting is doubtlessly a problem in behavioral psychology and has nothing to do with sleep disturbance.
But the problem of primary nocturnal bedwetting is another matter. Children having this disturbance sleep extremely soundly. It is impossible to awaken them, and if one attempts to place them on the pot, they simply go limp. The same thing happens when one puts them to bed. Even when they start to wake up, they are unable to use their muscles, because the muscles are too lacking in tone. If, despite everything, they have urinated and are put back to bed, on the following morning they can remember nothing about the incident. The sleep disturbance underlying this behavior consists in extended and extremely deep states of sleep. The vesical sphincter seems to relax during these periods of sleep, and the other muscles that control the emptying of the bladder contract. This usually occurs before a dream stage, because as a rule no dream experiences are reported upon awakening.
Another striking characteristic of the disorder is that evidently children with a cyclothymic personality structure are most inclined to have this form of sleep disturbance, which again shows what a close connection exists between this disposition and sleep problem. On the other hand, this correlation provides the opportunity, especially with these children, of controlling bedwetting through the use of suitable medication, as is also done in treating endogenous depressions.
