Dr. Culebras of SUNY Upstate Medical University at Syracuse received an honorarium from Jazz Pharmaceuticals for a speaking engagement.)
This article includes discussion of sleep enuresis, nocturnal enuresis, enuresis nocturna, nocturnal bedwetting, familial enuresis, functional idiopathic enuresis, symptomatic enuresis, and essential enuresis. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.
The author points out how therapeutic strategies stress a combined pharmacologic/behavioral approach for therapy-resistant enuresis, especially when psychiatric comorbidity is diagnosed.
• Primary nocturnal enuresis is a common parasomnia often comorbid with neurodevelopmental disorders.
• A combination of pharmacological treatment and behavioral therapy with the aid of mechanical alarm devices is highly successful at almost any age.
• Social embarrassment and stigmata may be easily overcome by appropriate management.
Historical note and terminology
One of the most prevalent and distressing of the childhood parasomnias, sleep enuresis has been discussed in medical papers since 1550 BC (Glicklich 1951). Understanding of the problem has developed slowly, and many enuretic children remain untreated or are treated ineffectively.
Early sleep research suggested that enuresis occurred as a "dream equivalent" (Pierce et al 1961). Later, Broughton proposed that enuresis is a disorder of arousal, originating in the deepest NREM sleep stage (Broughton 1968), but Mikkelsen and Rapoport demonstrated that enuretic episodes occur more or less randomly throughout the night, independent of sleep stage (Mikkelsen and Rapoport 1980).
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