Have you ever asked yourself, “Why didn’t I do this sooner?” That happened to me once when we replaced the countertop in a bathroom. It was a small change that was easy on the budget, but it gave a huge facelift to that bathroom. We then sold the house, so I hardly got to enjoy the “new” bathroom. I wished we had figured that out earlier.
Sometimes we have an “Aha!” moment about a child’s struggle or behavior, once we discover the underlying need or lagging skill that requires support. If a “Eureka!” moment happens regarding your child, please try to offer yourself a ton of grace in not figuring it out “sooner.” Bedwetting, or enuresis, is one of those areas where parents may attempt to treat or stop the symptoms but possibly miss a root cause of the behavior. Many of us have heard step-by-step instructions of how to train a child to stay dry through the night, including withholding fluids before bedtime, waking them to use the restroom, and wearing certain kinds of pajamas or underpants to sleep in that allow them to feel wetness. On those lists of suggestions, one thing often missing is to rule out sleep apnea as a possible cause.
Did you know that bedwetting is a flag for sleep issues such as mouth breathing and sleep apnea? Bedwetting often accompanies sleep apnea. Below are additional possible signs of sleep apnea. Your child does not need to exhibit all of the signs to be identified as someone with sleep issues.
Signs of Sleep Apnea in children
Bedwetting (enuresis)
Mouth breathing
Enlarged tonsils
Snoring (but FYI a child can have sleep apnea and not snore!)
Irritability
Mood swings
Difficulty concentrating or paying attention
Sleepwalking/night terrors
Daytime sleepiness
In addition to all of those symptoms, sleep apnea puts strain on the body. Over time, untreated sleep apnea leads to a greater risk of heart disease, stroke and Type 2 Diabetes. Whether you identify it in childhood or as an adult, treating it will make a big difference in your quality of life.
If you have a child who is wetting the bed, I heartily suggest getting a sleep study done. You could ask the pediatrician for a referral. For my children, the orthodontist gave us a referral for our sleep studies. Often, there is the choice of having the sleep study take place in-home or in the lab. There are pros and cons to both. For an in-home study, this means it is more convenient and your child has their familiar surroundings. You don’t have to go spend the night in a lab. It is more comfortable. Also, if there are other children at home and you don’t have someone to supervise them overnight, then in-home is especially helpful. However, the in-lab sleep study is much more thorough and the results will be more detailed. They can gather more data during an in-lab study. For this reason, if possible, I recommend the lab. It will be set up like a hotel room and a parent or guardian will come along and sleep in the same room.
If the sleep study reveals sleep apnea, the doctor will offer recommendations to treat and improve your child’s sleep based on the data from the study. Sleep apnea means the child needs more airway access to get enough oxygen while they sleep. There are a number of ways to achieve this. Often, the doctor will recommend a combination of treatments for best results:
Myofascial evaluation. This evaluation will look for any possibility of tongue tie, and will look at how independent the tongue is from the lower jaw. If there is any tongue tie or issues with tongue independence, this makes it difficult for the tongue to rest in the right spot during sleep. The tongue then causes a blockage to the airway and the child may “mouthbreath” to get more air. In this mouth-breathing position, they won’t take in enough oxygen. Note: a mouth breathing tongue posture can also inhibit the upper palate from forming and expanding properly, causing further issues with the airway later in life. In addition, the jaw and face may develop in a more narrow, elongated shape, causing ongoing airway issues. The good news: if needed, a tongue tie release procedure as well as myofascial therapy can help give the tongue more independence and improve sleep. This can also help the other facial and jaw issues mentioned, if intervention takes place before the jaw and palate are fully grown and formed.
Surgery. If tonsils and adenoids look to be inhibiting the airway, then the doctor may recommend having them removed. Feel free to ask lots of questions. Keep in mind that this procedure is more simple for children than it is for adults, and is more effective in improving the airway if done in childhood. So, just know that if you plan to do it, childhood is the time. If you do the surgery, they may also recommend a simple procedure that shrinks tissue in the nasal cavity. This further opens the airway, but is not permanent.
Palate expansion may be recommended. This would be done with an orthodontist. Select an orthodontist who has a good reputation of being proactive in regard to airway. Again, this can be done with children because the palate is still growing and forming. Later, as an adult, the palate is fully formed. At that point, they can do an invasive surgery where they break the jaw to create more space. So, this is a wonderful preventative measure for children.
Follow Up Study and Sleep Devices. After treatments have taken place, it will be recommended that you do a follow-up sleep study. Hopefully, this will show loads of improvement in the child’s sleep apnea. If more improvement is needed, the doctor could then make recommendations around CPAP machines or a nighttime oral device that gently pulls the jaw forward during sleep, opening the airway.
If you suspect sleep issues, don’t give up! Push for a sleep study. The study won’t cause harm, and it will give you more information about your child. Keep in mind if you identify sleep apnea in one family member, there is a hereditary component. It may be time to consider sleep studies for siblings and parents!
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