Brianna is reported to be a “heavy” sleeper - difficult to wake up during the middle of the night but does not have difficulty going to sleep.
Bedtime problems are usually not a primary issue. However, in families in which bedwetting has become a “stress” involved with guilt, self esteem issues, or related to some trauma, it is important to screen for these issues.
No reports of daytime sleepiness - see below.
Excessive sleepiness usually is not a significant concern in primary enuresis. If there are other signs and symptoms suggestive of sleep apnea or nocturnal seizures with secondary nocgtural enuresis, then excessive sleepiness may be a concern. Overeall, a child with excessive sleepiness and bedwetting desereves further evaluation/consultation.
Brianna does not routinely awaken at night which tends to be the issue.
Awakenings - is the parent / caregiver trying to awaken child to go to the bathroom during the night? Is child awakening during the night AFTER going to the restroom?
Awakenings are not typical of bedwetting. However, if they are occurring, this deserves further questioning
- What is waking them up?
- How often are they waking up?
- What happens when they wake up?
- Is it related to a secondary issue - seizures, diabetes mellitus, OSA, periodic limb movement, psychosocial stress?
Brianna is reported to go to sleep easily. She needs to be awakened on school days but wakes on her own on weekends.
Regularity / duration of sleep - it is important to get enough sleep based on recommended duration of sleep per age. If a child is overtired, it will be more difficult to awaken on own to go to the bathroom
Additionally, an irregular bedtime and wake up time can also contribute to bedwetting. This often contributes to daytime sleepiness.
Reported to snore only with colds. Her parents don’t think she snores more than half the nights.
No history of recurrent ear infections.
Snoring - bedwetting can be related to Obstructive Sleep Apnea (OSA). It is very important to screen for OSA when evaluating for bedwetting. If snoring is occurring more than 50% of the nights, witnessed apneas, dry mouth, chronic nasal congestion, tonsillar hypertrophy, or other concerns for OSA, Brianna should be evaluated for OSA in the context of bedwetting.