Training the brain (Neurofeedback) for bedwetting (Enuresis) in children

For children, nighttime bedwetting (enuresis) is a common problem, often requiring intervention. Targeting neuronal activities of the brain through neurofeedback has shown promising results.

There are different causes for bedwetting. We will explore the brain aspects of it, but in general many times the person in in a state of very deep sleep, sometimes too deep for the brain to wake them up when the bladder is full. Other reasons include food sensitivity or bladder issues (like low capacity). Up to 9% of children older than age 5 continue to wet the bed at night, according to the National Association for Continence. Only 15 percent of children who wet the bed during the night will overcome the problem without any intervention.


Current treatments for bedwetting include alarm therapy, desmopressin acetate therapy, anticholinergic therapy, and imipramine therapy. Depending on few factors, including the age of the person, these treatments do not always eliminate the problem, and some patients relapse when the treatment is discontinued.


Studies show that it is usually possible to eliminate the problem using quantitative electroencephalography (QEEG)-guided neurofeedback. For example, a study published in 2012 by Walker J. MD reported the successful elimination of enuresis in 11 consecutive patients using this approach. Before looking closer into the research in the field, lets understand briefly sleep and brain patterns.



The cycles of sleep


We go through 5 stages of sleep which repeat in a cycle throughout the night. Stages 1-4 are sleep with no dreams (Non-REM) and stage 5 is the dream stage (which is called REM as we have Rapid Eye Movements when dreaming).


When a person has just fallen asleep and is in stage 1, it is still fairly easy to wake them up. Sometimes all you have to do is say their name. As they move to stage 2, 3 and 4 the sleep becomes deeper. Stages 3 and 4 are also called ‘Slow Wave Sleep’ (SWS), or delta sleep. At these stages sometimes even loud noises will not wake the person up.


This stage of sleep is very important. Sleep lab research has shown that when a person was sleep deprived, when they eventually go to sleep, the brain tends to get straight into stage 3 of deep sleep. We also see that as people age the brain spends less time in Delta sleep and more time in the lighter stages (stage 2), which many time results in a feeling of not sleeping well or enough (even when the person slept for a full night).


Cognitively, if we are woken up in the middle of stage 3 sleep, our mental performance is impaired for 30min to an hour following the awakening. Feeling a bit of a metal-fogginess.

Stage 5 is when we dream. That is when our EEG is the most active. It is the same as when we are awake. So If you are dreaming about eating an ice cream, your brain activity is the same as it would have been when you are aware and really eating the ice cream. We are able to dream also during a non-REM sleep, but that happens usually more in the morning hours when the brain activity in sleep gets naturally faster to prepare us for waking up.



What happens in the brain when a child wets the bed?


Most of the times the common brain pattern that shows in children who wet the bed is dominance of slow frequencies. Slow dominant brains show slow frequency activity in a higher ratio compared with the other frequencies. When it comes to sleep, these children tend to get into very deep sleep (theta/delta), almost coma-like deep, with limited brain metabolic facilities. As such, there is not enough “brain power” to raise into a more wakeful stage that will signal to the person that the bladder is full, and they need to go to the toilet.


The brain’s limited metabolic levels also mean that these brains do not go into REM sleep as often during the night as needed. At the end of a full night sleep the child will still be very tired and it is many times hard for the parents to get them to wake up in the morning.



Training the brain to improve other symptoms at the same time


There are many approaches to brain training and to research in the field. Some of them go by the quick fix habit that we are all used to from taking medication – you aim to treat one symptom by addressing one physiological (or neurological) aspect.

So, there are trainers out there, as well as researchers who will choose to train one range of frequencies up in one area of the brain. And it might be very successful.


But if we look at the brain as a system, in which every change we do makes the whole system shift towards a different balance, we will also see that these slow dominant brains who wet the bed, are also the children that find it hard to focus and concentrate, or have issues with language processing, with following instructions with multiple steps, being motivated to do their school work or to complete them and more.


Based on that, if we teach the brain as a whole system to speed up in all areas that need to “charge up”, we don’t just train the brain to wake up to the toilet at the right time, but we also allow it to learn to hold attention levels for longer when focusing and studying, to be more motivated to do, to take decisions better and to manage executive functions in a better way.





-----

Hallioglu, O., Ozge, A., Comelekoglu, U., Topaloglu, A. K., Kaik, A.Duzovali, O. 2001. Evaluation of cerebral maturation by visual and quantitative analysis of resting electroencephalography in children with primary nocturnal enuresis.. Journal of Child Neurology, 16(10): 714–718.


Kaada, B. and Retvedt, A. 1981. Enuresis and hyperventilation response in the EEG.. Developmental & Medical Child Neurology, 23: 591–599.


D. Corydon Hammond PhD Pages 27-36 | Journal of Neurotherapy. Investigations in Neuromodulation, Neurofeedback and Applied Neuroscience Volume 9, 2005 - Issue 1


Remediation of Enuresis Using QEEG-Guided Neurofeedback Training. Jonathan E. Walker, MD

Biofeedback (2012) 40 (3): 109–112. https://doi.org/10.5298/1081-5937-40.3.04