Can Anxiety Cause Nocturnal Enuresis?
Anxiety itself doesn’t cause nocturnal enuresis. But overly apprehensive behavior could be a contributing factor. Here’s how:
Nocturnal enuresis (wetting the bed when sleeping) has been linked to emotional problems and the toll they take on the body. Anxiety disorder is considered an emotional problem.
In addition to the emotional upset and the impact it has on a normal lifestyle, overly apprehensive behavior stresses the body. When the body becomes overly stressed, it can enter into a state of stress-response hyperstimulation. Once the body becomes hyperstimulated, it can experience a wide variety of unusual sensations, symptoms, and problems. Some of these problems could contribute to nocturnal enuresis. For example:
1. Increase in the production of urine when sleeping.
Stress can interfere with the body’s normal sleep patterns, and in many ways. One way is making our sleep less restful and more restless. An increase in restlessness can cause an increase in metabolism, which can cause an increase in the production of urine while sleeping.
Typically, the body produces less urine while sleeping due to the low metabolic rate when the body is deeply relaxed, such as when in deep sleep. This is why we can sleep for many hours and yet not feel the urge to urinate.
An increase in metabolism during sleep, however, can cause an increase in urine production when sleeping. So rather than sleeping for many hours and not feeling the urge to urinate, we could sleep for an hour or so and have a full bladder. Most often dreams associated with trying to find a bathroom or having to urinate are a result of having a full bladder and actually needing to urinate.
This increased need to urinate isn’t the sole cause of nocturnal enuresis. But it can play a role when combined with the next two factors.
2. More time spent in the semiconscious states of sleep rather than in the deeper, unconscious states of sleep.
Another way elevated stress can interfere with good sleep is rather than spending most of our sleep time in the deeper, unconscious stages of deep rest associated with good sleep, the body spends more time in the semiconscious stages of sleep.
The semiconscious stages of sleep (stages one, two, and six) are associated with having a hard time telling the difference between being fully awake and being asleep dreaming. Hypnagogic and hypnopompic experiences occur during these semiconscious stages of sleep.
For more information about the many sleep stages, and hypnagogic and hypnopompic experiences, Recovery Support members can read the many sections in our Sleep section (Chapter 18).
If you have a full bladder and you're feeling the urge to urinate yet you can’t tell the difference between being fully awake and still being asleep dreaming, some people wet the bed thinking that they are actually awake when in fact they are still dreaming.
Moreover, people often have more vivid, realistic, and unpleasant dreams (as well as more hypnagogic and hypnopompic experiences) when the body has experienced a number of nights of disrupted sleep. Again, this is a result of spending more time in the semiconscious stages of sleep rather than in the unconscious stages of sleep.
3. Hyperstimulation can adversely affect the nervous system, which can affect nerve and subsequent muscle control.
The body's voluntary and involuntary muscles are controlled by nerve impulses. The sphincter muscle, the muscle around the opening of the bladder which squeezes to prevent urine from leaking through the urethra, uses a combination of voluntary and involuntary actions.
The body manages both types of muscles normally when the body's nervous system is not overly stressed. But both voluntary and involuntary muscles can behave erratically when the body becomes stress-response hyperstimulated. Examples of this erratic behavior include muscle twitching, involuntary tremors, weak muscles, muscles that shake when you move them, and bladder control problems, to name a few.
Also, some people wet themselves when they become overly excited, such as when afraid because of how the nervous system and involuntary muscle control is affected by stress.
The combination of the above three factors can contribute to nocturnal enuresis for some people. So again, while anxiety doesn't directly cause nocturnal enuresis, it can be a contributing factor.
Addressing your body’s overly stressed state and the underlying factors associated with your overly apprehensive behavior could eliminate episodes of nocturnal enuresis.
Because there are some medical conditions that can cause nocturnal enuresis, we recommend you discuss this with your doctor. If your doctor concludes that this is associated with anxiety/stress, you can be assured that there isn’t another medical condition causing it. Generally, most doctors can easily differentiate between stress and anxiety caused symptoms from those caused by other medical conditions.
If you are uncertain about your doctor’s diagnosis, however, you may want to seek a second and even third opinion. But if all three opinions agree, you can feel confident that anxiety/stress is the cause of this issue and not some other medical or biological problem.
The combination of good self-help information and working with an experienced anxiety disorder therapist is the most effective way to address anxiety disorder and its many symptoms. Until the core causes of anxiety are addressed - the underlying factors that motivate apprehensive behavior - a struggle with anxiety disorder can return again and again. Identifying and successfully addressing anxiety's underlying factors is the best way to overcome problematic anxiety.
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