Bed-wetting can be hard on families. Children may feel embarrassed by not being able to hold their urine (pee), while parents and caregivers can feel frustrated and helpless.

Nighttime bed-wetting — what doctors call nocturnal enuresis — is a common problem for children. Sometimes, bed-wetting can be a sign of an underlying sleep disorder like sleep apnea.

Sleep apnea is one of many possible causes of bed-wetting in children. Obstructive sleep apnea (OSA) is a type of sleep-disordered breathing in which breathing is disrupted by a full or partial blockage of the upper airway. Because of how disrupted breathing during sleep impacts the body, OSA leads some children to wet the bed.

The good news is that treating the underlying OSA may help children get better sleep and stay dry. Read on to discover how sleep apnea may be linked to bed-wetting in children.

How OSA Can Affect Bladder Control

Disrupted airflow in children with OSA lowers blood oxygen levels while increasing carbon dioxide levels. This causes blood vessels within the lungs to tighten. The result is added strain on the heart as extra blood flows into its upper chambers, causing them to stretch.

When a child tries harder to breathe, it increases chest pressure, further stretching the heart. This type of stretching signals the body to release a hormone called atrial natriuretic peptide (ANP). The release of ANP can cause the body to make and release urine.

Having OSA can also interfere with a child’s ability to wake up during the night. In OSA, the brain can have a harder time sending this message to the body because of how the brain partially wakes up with each breathing episode. Frequent, partial wake-ups can make it harder for children to wake up when they really need to, such as when their bladder is full.

Meanwhile, low oxygen levels during sleep can make the brain less sensitive to signals from the bladder. Poor sleep quality and snoring can also lead a child to sleep more deeply and be more difficult to wake up.

Also, children’s brains aren’t fully developed. This means the part of their brain in charge of waking them may not be working as it should yet. This can lead to bed-wetting if the child’s brain can’t signal their body to wake up when their bladder is full.

Signs of OSA in Children

The most common signs of OSA are frequent loud snoring and gasping or snorting for breath. Poor sleep at night can also lead to less obvious symptoms, such as:

• Bed-wetting
• Irritability or moodiness
• Trouble focusing at school
• Excessive daytime sleepiness
• Behavior that’s hyperactive, disruptive, or busy
• Slower-than-average growth and development
• Issues with insulin resistance, high blood pressure, or the heart or lungs
• Excess fat tissue

If your child wets the bed and also frequently snores loudly, gasps for air, or thrashes around, talk to their pediatrician. In addition, any mood, behavior, or academic issues along with bed-wetting should be discussed with their doctor. Your child’s pediatric provider may suggest an assessment by an ear, nose, and throat (ENT) doctor.

Can OSA Cause Bed-Wetting in Adults?

Adults with OSA are far less likely to experience bed-wetting than children, but it can happen.

One study found that adult males with OSA were four times more likely to experience urinary incontinence (loss of bladder control) than those without OSA.

Bed-wetting is much more common among children with OSA. Studies estimate that between 33 percent and 50 percent of children with OSA experience bed-wetting.

Another study noted that children who wet the bed were more likely to have sleep issues, such as breathing disorders and daytime sleepiness, than children who didn’t bed-wet.

Other Causes of Bed-Wetting in Children

There are many reasons other than OSA that may be causing your child to wet the bed.

One possible cause is delayed maturation. This means the central nervous system takes a longer time to notice what a full bladder feels like during sleep. This is why healthcare providers usually consider bed-wetting in children younger than 7 to be nothing to worry about.

Bed-wetting can also be caused by:

• Having a small bladder capacity
• Making too much urine during sleep due to fluid intake
• Being stressed

Mouth breathing at night has also been shown to be a risk factor for bed-wetting. Also, some children just sleep more deeply than others.

In some cases, bed-wetting in children can be due to a medical condition, such as:

• Urinary tract infection (UTI)
• Urinary tract dysfunction or structural issues within the urinary tract
• Trouble breathing, such as due to a blocked airway
• Chronic constipation
• Diabetes
• Nervous system issues, such as structural problems or disorders like spina bifida
• Attention-deficit/hyperactivity disorder (ADHD)

Whether a child bed-wets or not can also be related to whether their biological parents wet the bed as kids. A child with a family history of bed-wetting is more likely to wet the bed at night.

When both parents wet the bed as kids, the child has a 70 percent chance of bed-wetting. If only one parent wet the bed, a child has a 40 percent chance of bed-wetting. Children without a family history of bed-wetting have a 15 percent chance of wetting the bed at night.

How OSA Treatment Can Help Bed-Wetting

If OSA is causing a child to wet the bed, treatment may help reduce bed-wetting episodes and improve quality of life.

Surgery

A common cause of sleep apnea in children is having tonsils or adenoids — glands in the throat — that are too large. Enlarged tonsils and adenoids can make a child’s already small airway more narrow, allowing less air to pass through.

Children bed-wett due to OSA often benefit from treating these underlying structural issues. Doctors often consider tonsillectomy and adenoidectomy — surgery to remove both the tonsils and adenoids — as the best treatment option for children who have OSA and large glands. In fact, most of these surgeries are performed to address sleep-disordered breathing.

Studies have shown that these procedures can also be effective treatments for bed-wetting. One study found that between 62 percent and 90 percent of children who bed-wet children were no longer doing so after surgery.

Other studies reported that 52 percent to 61 percent of children with OSA stopped bed-wetting after surgery, while 26 percent to 48 percent were wetting the bed significantly less.

But surgery isn’t always recommended to treat sleep-disordered breathing. As with any surgical procedure, there are certain risks involved with removing the tonsils and adenoids. Surgery may lead to infection, bleeding, complications in the airway or from anesthesia, or difficulties related to swallowing or talking.

Due to the risks involved, monitoring is usually recommended prior to surgery for children who:

• Have only mild or occasional symptoms
• Don’t have large tonsils or adenoids
• Are close to puberty, during which tonsils and adenoids typically get smaller
• Don’t have related behavioral or academic performance issues

Other Treatments

Some children with OSA may continue to have symptoms even after surgery. For this reason, children may need to see a sleep specialist for a sleep study after surgery if they continue to have sleep apnea symptoms.

Doctors may suggest that children who continue to have OSA symptoms like snoring and bed-wetting after surgery, or who aren’t good candidates for surgery, receive other treatments.

For example, continuous positive airway pressure (CPAP) therapy may help your child breathe better while they sleep. If OSA is related to weight, weight-loss interventions may be recommended. In some cases, additional surgeries may also be suggested.

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