Dear Dr. Greene, thank you so much for what you wrote about bedwetters being deep sleepers! I knew that my 7-year-old (who wets the bed every night) was a deep sleeper, but my doctor said it had nothing to do with that. Your answer made so much sense! My question is, how can I help him learn to wake up when his bladder is full? I tried a bed-wetting alarm for two weeks, but it was a miserable failure -- it never woke him up!!!

How frustrating! His sleeping through the alarm, though, is a sign that treatments aimed at making it easier for him to wake up are likely to be particularly effective for him.

All rational treatments for primary nocturnal enuresis, the most common form of bed-wetting, are aimed at either teaching the child to wake up when the bladder is full or at decreasing the need for nighttime urination. I will discuss with you several ways to teach children to wake up. Any child beyond the sixth birthday, though, should have a medical evaluation to rule out other underlying problems before instituting any therapy for bed-wetting.

Bed-wetting alarms are among the safest and most effective of all therapies. The alarms have a simple moisture-sensor that snaps into your son's pajamas. A small speaker attaches up on the shoulder with Velcro. At the first drop of urine, a piercing alarm goes off, that sounds similar to a smoke alarm. Instantly, the child reflexly stops urinating. Next, the household awakes, EXCEPT for the deep sleeper who wets the bed. Precisely those children who sleep through the alarm are most likely to be helped by it.

For the alarm to be effective, someone else must wake your son up (the most trying part -- I'm sure he's difficult to awaken), walk him to the bathroom, and get him to finish urinating in the toilet -- all before resetting that annoying alarm. If this ritual is continued, the alarm will likely begin to wake him up directly within 4 to 6 weeks. Within twelve weeks, your son will very likely master nighttime bladder control, and no longer need the alarm. Relapses after alarm therapy are uncommon.

I participated in a conference on enuresis where one of the speakers described the use in Africa of frogs strapped to the child as a 'natural' alarm. Today's electronic alarms are more effective, and I dare say, more comfortable (for the frog as well as the child). Many good alarms are available. I like SleepDry, produced by StarChild/Labs (in which I have no financial interest whatsoever). It may be obtained for approximately $59.00 by calling 1.800.346.7283.

Star charts prove very beneficial to some children, used either alone or with a bed-wetting alarm. As you know from experience, you wake up more easily when the day holds promise and excitement. On holiday mornings it is easier to get out of bed; on dreary mornings it is easier to hit the snooze-alarm. Star charts use this to advantage. A child is offered a star on the calendar for each dry night. When the child collects a predetermined number of stars (usually 3-7), he is given a small reward. When he collects 21 in a row, he gets a larger, looked-forward-to, prize. This puts the reticular activating system of the brain in a more heightened state of readiness to wake up when the bladder signals that it is full. For some children, this is enough to make them responsive to nighttime bladder fullness. If no improvement occurs within 2 weeks, however, it should not continue to be used without an alarm or some other therapy.

Hypnotherapy and guided imagery are other techniques available to help deep sleepers gain nighttime bladder control. Hypnotherapy requires a trained therapist, but guided imagery can be employed by anyone. Have your son relax, close his eyes, and listen to what you say. Tell him that his kidneys are a pee factory, making urine day and night. His bladder is a storage tank where the pee is kept until he is ready to put it in the toilet.