Bedwetting (or nocturnal enuresis or sleepwetting) is involuntary urination while asleep. It is the normal state of affairs in infancy, but can be a source of embarrassment when it persists into school age or the teen years.

Primary enuresis is when the child has never been dry at night or would not sleep dry without being taken to the toilet by another person or has some dry nights but continues to average at least two wet nights a week with no long periods of dryness. Secondary enuresis occurs when a child goes through an extended period of dryness and begins to experience night-time wetting again. Secondary enuresis is often caused by emotional stress.

Regulation in the organism

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Children usually achieve nighttime dryness by developing one or both of two abilities. There appear to be some hereditary factors in how and when these develop.

More on [ Bedwetting ]

UPHS - Penn Sleep Centers Newsletter

Asleep at the Wheel?
Truck drivers who routinely get too little sleep or suffer from sleep apnea show signs of fatigue and impaired performance that can make them a hazard on the road, according to a major new study by Penn Sleep Centers researchers. The study results, entitled “Impaired Performance in Commercial Drivers: Role of Sleep Apnea and Short Sleep Duration,” were published in the August 15th issue of the American Journal of Respiratory and Critical Care Medicine.
Sleep Apnea and Heart Disease
Along with the epidemic of obesity, the incidence of sleep apnea has risen at an alarming rate. The most common form, known as obstructive sleep apnea (OSA), is caused by extra tissue in the upper airway that collapses and literally blocks the airflow to the lungs. The risk factors for OSA include male sex (women’s risk increases after menopause), obesity, and neck size greater than 17 inches. The symptoms of sleep apnea include fatigue, early morning headaches, snoring, falling asleep during the daytime, depression and witnessed episodes of irregular breathing while sleeping.
Cognitive-Behavioral Treatment of Insomnia
Insomnia is the most prevalent sleep disorder, representing one of the most common complaints reported to doctors by their patients. In an effort to provide non-pharmacologic treatment options for insomnia, research and clinical practice have focused on developing cognitive- behavior treatments as an alternative.
Do Flies and Worms Sleep?
Can you tell if a fly is asleep? This is precisely the question asked seven years ago by Dr. Joan Hendricks, who is now the Dean of the School of Veterinary Medicine at the University of Pennsylvania. In collaboration with Dr. Amita Sehgal and Dr. Allan Pack of the Penn Center for Sleep and Respiratory Neurobiology (CSRN), Dr. Hendricks wanted to determine if the fruit fly Drosophila melanogaster, an animal used since the early 1900s for genetic studies in biology, has a sleeplike state much as we do. But unlike human studies, where one can measure brain electrical activity to distinguish sleep from the waking state, one cannot easily measure fly brain waves. Instead, Dr. Hendricks used behavioral measures.
Advice for Sleepy Students
Each fall, Grace Pien, MD in the University of Pennsylvania Division of Sleep Medicine sees teenagers being brought into her office by parents. The teens complain about difficulty falling asleep at night. After several follow-up questions, Pien often determines that these patients suffer from a sleep disorder called delayed sleep phase syndrome (DSPS) - when the body's circadian rhythm delays the urge to sleep until much later than what is considered to be a normal bedtime.
New Headquarters for Penn Sleep
In April of this year, the practices and sleep laboratory facilities of the Penn Sleep Centers at the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center were merged into a single new site at 3624 Market St. which serves as headquarters for the Penn Sleep Centers. This newly renovated facility provides pleasant and spacious areas for both patients and staff.

SLEEP Articles

Let Her Sleep…But How Much?
A commentary on Miller et al. Gender differences in the cross-sectional relationships between sleep duration and markers of inflammation: Whitehall II study. Sleep 2009;32:857-64.
Autonomic Arousals in Sleep Related Breathing Disorders: A Link Between Daytime Somnolence and Hypertension?

Factual Errors in Brooks and Peever’s Rebuttal to Critiques

Sleep and Depression in Postpartum Women: A Population-Based Study
Study Objectives:(1) To describe the prevalence of and risk factors for postpartum maternal sleep problems and depressive symptoms simultaneously, (2) identify factors independently associated with either condition, and (3) explore associations between specific postpartum sleep components and depression. Design: Cross-sectional. Setting: Population-based. Participants: All women (n = 4191) who had delivered at Stavanger University Hospital from October 2005 to September 2006 were mailed a questionnaire seven weeks postpartum. The response rate was 68% (n = 2830). Interventions: None. Measurements and results: Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI), and depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). The prevalence of sleep problems, defined as PSQI > 5, was 57.7%, and the prevalence of depression, defined as EPDS ≥ 10, was 16.5%. The mean self-reported nightly sleep duration was 6.5 hours and sleep efficiency 73%. Depression, previous sleep problems, being primiparous, not exclusively breastfeeding, or having a younger or male infant were factors associated with poor postpartum sleep quality. Poor sleep was also associated with depression when adjusted for other significant risk factors for depression, such as poor partner relationship, previous depression, depression during pregnancy and stressful life events. Sleep disturbances and subjective sleep quality were the aspects of sleep most strongly associated with depression. Conclusions: Poor sleep was associated with depression independently of other risk factors. Poor sleep may increase the risk of depression in some women, but as previously known risk factors were also associated, mothers diagnosed with postpartum depression are not merely reporting symptoms of chronic sleep deprivation. Keywords: Postpartum, sleep, depression, PSQI, EPDS
Gender Differences in the Cross-Sectional Relationships Between Sleep Duration and Markers of Inflammation: Whitehall II Study
Objective: To examine the relationships between sleep and inflammatory markers because these may be important in the development of cardiovascular disease. Methods and Results: The relationship between self-reported sleep duration and interleukin-6 (IL-6) (n = 4642) and high-sensitivity C-reactive protein (hs-CRP) (n = 4677) was examined in individuals from the Whitehall II study. Following multiple adjustments, there were no overall linear or nonlinear trends between sleep duration and IL-6. However, in women but not men (interaction P < 0.05), levels of IL-6 tended to be lower in individuals who slept 8 hours (11% [95% confidence interval 4 to 17]) as compared to 7 hours. With hs-CRP, in the adjusted model, there was no association between hs-CRP and sleep duration in men. However, there was a significant nonlinear association in women, the level of hs-CRP being significantly higher in women short sleepers (5 hours or less) after multiple adjustments (P = 0.04) (interaction P < 0.05). Conclusions: No significant variation in inflammatory markers with sleep duration was observed in men. By contrast, both IL-6 and hs-CRP levels varied with sleep duration in women. The observed pattern of variation was different according to the inflammatory marker observed. Further longitudinal studies are required to fully investigate possible temporal relationships between short sleep and markers of inflammation. Keywords: Inflammation, Sleep, Cardiovascular disease
Estradiol and Progesterone Modulate Spontaneous Sleep Patterns and Recovery from Sleep Deprivation in Ovariectomized Rats
Study Objectives: Women undergo hormonal changes both naturally during their lives and as a result of sex hormone treatments. The objective of this study was to gain more knowledge about how these hormones affect sleep and responses to sleep loss. Design: Rats were ovariectomized and implanted subcutaneously with Silastic capsules containing oil vehicle, 17β-estradiol and/or progesterone. After 2 weeks, sleep/wake states were recorded during a 24-h baseline period, 6 h of total sleep deprivation induced by gentle handling during the light phase, and an 18-h recovery period. Measurements and Results: At baseline and particularly in the dark phase, ovariectomized rats treated with estradiol or estradiol plus progesterone spent more time awake at the expense of non-rapid eye movement sleep (NREMS) and/or REMS, whereas those given progesterone alone spent less time in REMS than ovariectomized rats receiving no hormones. Following sleep deprivation, all rats showed rebound increases in NREMS and REMS, but the relative increase in REMS was larger in females receiving hormones, especially high estradiol. In contrast, the normal increase in NREMS EEG delta power (an index of NREMS intensity) during recovery was attenuated by all hormone treatments. Conclusions: Estradiol promotes arousal in the active phase in sleep-satiated rats, but after sleep loss, both estradiol and progesterone selectively facilitate REMS rebound while reducing NREMS intensity. These results indicate that effects of ovarian hormones on recovery sleep differ from those on spontaneous sleep. The hormonal modulation of recovery sleep architecture may affect recovery of sleep related functions after sleep loss. Keywords: Ovariectomy; female sex hormones; sleep homeostasis; REM sleep; EEG delta power

Sleep and Breathing

Sleep technologist performance: a call for standardization and performance feedback
Tue, 30 Jun 2009 15:41:28 -0000
Sleep technologist performance: a call for standardization and performance feedback Content Type Journal ArticleCategory EditorialDOI 10.1007/s11325-009-0272-4Authors Reena Mehra, University Hospitals Case Medical Center Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine Cleveland OH USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512
Standardization of quality assurance for sleep technologist: a model
Tue, 30 Jun 2009 15:41:26 -0000
Abstract Introduction  Since the last decade, there has been a tremendous growth of sleep centers in the US to meet the increasing need of diagnosing and treating sleep disorders. However, this unregulated growth has resulted in tremendous variance in the quality of sleep centers across the nation. The American Academy of Sleep Medicine, in an attempt to provide a benchmark standard, has introduced a voluntary accreditation process, part of which involves assessment of technical quality parameters. However, measuring technical quality is not easy. Hypothesis  We undertook a study to determine if the implementation of point system and schematic feedback on technologist performance can result in improvement and tracking of their performance. Materials and methods  We randomly reviewed 100 charts from the preimplementation phase as control and 1,739 charts from the post implementation of the point system phase as study group. Results  There was a statistically significant difference in the score among technologist between the control and study groups with the average being 75 ± 4.12 and 87.53 ± 0.91, respectively, with a p value being 0.0001. Conclusion  Evaluating the performance of the sleep technologist can be a way to track and monitor their performance in a standardized way and to identify weakness at an earlier stage. We present a system, which we have developed and implemented at our sleep center, as a possible model of assessing and subsequently standardizing technical quality for polysomnography. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11325-009-0271-5Authors Salim Surani, Baylor College of Medicine Houston TX USARaymond Aguillar, Torr Sleep Center Corpus Christi TX USARoy Aguillar, Torr Sleep Center Corpus Christi TX USAShyam Subramanian, Baylor College of Medicine Houston TX USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512
Efficacy of a modified mandibular advancement device for a totally edentulous patient with severe obstructive sleep apnea
Thu, 25 Jun 2009 06:54:05 -0000
Abstract Background  It has been asserted that the success rate of oral appliances was more satisfactory for mild to moderate obstructive sleep apnea (OSA) than severe ones; besides, there is a lack of literature about mandibular advancement device (MAD) application for edentulous patients with OSA. Report  This clinical case shows fabrication method and treatment efficacy of a modified MAD, which is aiming to displace bulky masseter muscles laterally, to provide more space for tongue on totally edentulous patient with severe OSA. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11325-009-0273-3Authors Bulent Pıskın, Van Military Hospital Department of Dental Service Van TurkeyFatih Sentut, Van Military Hospital Department of Dental Service Van TurkeyHaldun Sevketbeyoglu, Van Military Hospital Department of Chest Disease Van TurkeyHakan Avsever, Gulhane Military Medical Academy Center of Dental Sciences Ankara TurkeyKaan Gunduz, Gulhane Military Medical Academy Center of Dental Sciences Ankara TurkeyMurat Kose, Divan Hayat Hospital Department of Otorhinolaryngology Van TurkeyDemet Oguz, Van Military Hospital Department of Dental Service Van TurkeySezai Uyar, Van Military Hospital Department of the Psychiatry Service Van Turkey Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

pubmed: 1389-9457

Commentary from the Italian Association of Sleep Medicine on the AASM manual for the scoring of sleep and associated events: For debate and discussion.
Parrino L, Ferri R, Zucconi M, Fanfulla F Related Articles Commentary from the Italian Association of Sleep Medicine on the AASM manual for the scoring of sleep and associated events: For debate and discussion. Sleep Med. 2009 Jun 27; Authors: Parrino L, Ferri R, Zucconi M, Fanfulla F In 2007, the American Academy of Sleep Medicine (AASM) completed a new manual for the scoring of sleep and associated events. The AASM manual is divided into separate sections relative to the parameters reported for polysomnography. The present commentary, accomplished by a Task Force of the Italian Association of Sleep Medicine, focuses on sleep scoring data, arousal rules, movement and respiratory events. Comparisons with the previous Rechtschaffen and Kales system are detailed and a number of methodological weaknesses are pointed out. Major comments address the 30-s scoring epochs, the restrictive approach to arousals and EEG activating patterns, the incomplete quantification of motor events and the thresholds for the definition of hypopnea. Since the new AASM manual is an iterative process, proposals for discussion and re-examination of the agreed criteria with other national and international organizations are encouraged. PMID: 19564132 [PubMed - as supplied by publisher]

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