Bedwetting and sleep cycles

Bedwetting Occurs In What Stage of Sleep?

A boy sleeping happily and soundly after being in the Stay Dry at Night program to stop bedwetting

Bedwetting can be a challenging issue for both children and parents, often causing heaps of worry, a lot of frustration, and lots of broken sleep. 

Bedwetting occurs at different times of the night for different children. Some may wet the bed early in the night, whilst others may do so in the early morning. For many chronic bedwetters, bedwetting happens more than once a night. As parents, we want the best for our children, including restful and uninterrupted sleep. Let’s face it, a good night’s sleep without interruption is something we all cherish!

Children, like adults, cycle between different types of sleep during the night.  Understanding these cycles can be helpful for children and adults because the nature of your sleep and ability to wake up from it vary in each stage within a sleep cycle.  Since many parents report that their child who wets the bed is also a deep sleeper, it suggests that bedwetting might predominantly happen during deep sleep stages. Let’s take a closer look at sleep cycles and explore whether bedwetting occurs at any particular stage of the sleep cycle.

About Sleep Cycles

Non-Rapid Eye Movement (NREM) Sleep

Stage One (N1): As you begin to fall asleep, you enter stage one of the sleep cycle. It’s easy to be awakened from this stage, and if you were to be woken up, you might not even realize you had been asleep. This stage often involves drifting in and out of consciousness.

Stage Two (N2): Upon entering stage two of the sleep cycle, you’re still in a state of ‘light sleep.’ Depending on how far you’ve progressed into stage two, you can be easily awakened. Your body further relaxes, your heart rate slows down, and your body temperature decreases.

It is in stages one or two of NREM sleep where we sometimes experience the hypnagogic startle, a sudden jerk of your whole body that wakes you momentarily, and that is quite normal. 

One example of a night's sleep in an adult: Tracked using an App

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Deep Sleep

Stage Three (N3): This is followed by stage three of non-rapid eye movement (NREM) sleep which is now a ‘deep sleep’ (formerly divided into stages three and four). Your brain waves slow down and it becomes more difficult to wake up. In fact, someone calling your name would not necessarily wake you up. If you take your child to the toilet in this sleep stage, he or she may stay in a semi-sleep state and fall straight back to sleep with no recollection of going to the toilet in the morning.

This is the most restful and restorative sleep and during this stage, your body undergoes important restorative processes including tissue repair, muscle growth, and immune function strengthening. 

According to Dr Ferber, author of Solve Your Child’s Sleep Problems, young children tend to spend more time in deep sleep during the first few hours of the night. And early in the morning, children typically have a period of very deep sleep before awakening.

REM sleep

Finally, REM (Rapid Eye Movement) sleep occurs. During this stage, your eyes move rapidly, and most of your dreams occur. Your heart rate accelerates, and your breathing becomes irregular. Your muscles are relaxed, and you don’t move your body much. You’re more easily awakened during this stage of sleep. REM sleep is believed to be crucial for cognitive function, memory consolidation, emotional regulation, and creative problem-solving.

Then the cycle starts all over again.  In general, each cycle lasts approximately 90 minutes in adults and around 50 minutes in children, however, the duration and order of each stage within the sleep cycle can vary from person to person and may be influenced by factors such as age and overall sleep quality.  

There is often a brief awakening at the start of the cycle, when you may become aware of your environment, adjust your position, you might check the time, reach for the blankets, or become consciously aware that you need to go to the toilet.

When does bedwetting occur?

Studies have given mixed results about when bedwetting occurs, suggesting it can happen during any sleep stage. However, recent research, indicates that it primarily happens during stage two (N2) of sleep, followed by deep sleep. Bedwetting during the first stage of sleep (N1) and REM sleep is less common. 

Interestingly, there is growing evidence to suggest that children who wet the bed have fragmented, or poorer quality sleep, and they may move around more during sleep. Studies also confirm that these children are more difficult to wake up, which won’t come as any surprise to most parents!

Conclusion

In conclusion, children can wet the bed at any stage of the sleep cycle, though bed-wetting predominately occurs in stage two of the sleep cycle and to a lesser extent in deep sleep.

There is no evidence to support that bedwetting only happens during deep sleep which is surprising since so many children who wet the bed are hard to wake up.

Considering that bedwetting children often experience fragmented or poor sleep, it stands to reason that they may require additional sleep to compensate. Enhancing both the quantity and quality of sleep could contribute to their emotional well-being and improve their ability to wake up when necessary to go to the toilet at night. 

Learn more about how to increase sleep quality and the dilemma that some parents face: should you wake your child up to pee at night?

When children who wet the bed can understand that they naturally come out of their deep sleep at least a few times a night, it opens up the possibility that they can check in with their bladder at these times to see if they need to go, and getting out of bed will be easier at that stage in the sleep cycle. Whilst this may not be a bed wetting solution on its own, it can help build confidence and empower children to be more aware of their bladder needs during the night.

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References

Ferber, R. (2006). Solve Your Child’s Sleep Problems. Vermilion London.

Health Boosters by Withings. Accessed 2023. Retrieved from http://blog.withings.com/2015/03/17/the-4-different-stages-of-sleep/

Learning while you sleep: Dream or reality? Accessed 2023. https://www.health.harvard.edu/staying-healthy/learning-while-you-sleep-dream-or-reality#:~:text=Sleep%20begins%20with%20the%20NREM,start%20a%20new%20sleep%20cycle

National Sleep Foundation. Accessed 2023. Retrieved from https://www.sleepfoundation.org/stages-of-sleep/rem-sleep

Nevéus, T., Stenberg, A., Läckgren, G., Tuvemo, T., & Hetta, J. (1999). Sleep of Children With Enuresis: A Polysomnographic Study. Pediatrics, 103(6), 1193-1197. DOI: 10.1542/peds.103.6.1193

Pedersen, M. J., Rittig, S., Jennum, P. J., & Kamperis, K. (2020). The role of sleep in the pathophysiology of nocturnal enuresis. Sleep Medicine Reviews, 49, 101228. https://doi.org/10.1016/j.smrv.2019.10122

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