Arousing The Deep Sleeper - The Enuresis Alarm

Basic Principals

The enuresis alarm is a device that sets off a bell. buzzer, or other noise makers when a child begins to wet. Originally wire together from a modified mattress pad and an electric doorbell, the enuresis alarm has been in use since 1940. Today's modern alarms hardly resemble the original. Enuretic alarms sold nowadays are easy to operate and smaller than a pager. They consist of a moisture sensor, a pair of metal strips or a metal snap, that attaches to the child's underpants and sounding mechanism, such as a buzzer or vibrator.

The enuresis, device which on average cost about eighty dollars, works mechanically in the following way, because urine contains electrolytes, urine conducts electricity, so if urine touches the metal strip of the alarm sensor, it completes a microcircuit in the device, allowing the tiny electrical current created with the battery to sound the alarm.

As we have said they are any types of enuresis alarms on the market. At minimum, a good alarm will respond quickly to moisture and sound loudly enough to wake a parent sleeping nearby. We prefer alarm with sounding devices that are worn on the pajama shoulders so the alarm is close to the child's ear. The sound from devices worn on the waist can be hard to hear because it tends to be muffled by blankets. Alarms that just vibrate in response to wetting do not awaken the parent.

The sensor in contemporary alarms are quite sensitive, when the child begins to wet they require very little moisture to make the buzzer sound. The bell, which can be as small as an earring box, is powered by a button-size battery similar to does used on hearing aids. Some alarms are affixed to the child's underwear with velcro straps or worn on the wrist like a watch.

Although the bell and mattress pad device is still available, it is certainly no longer the best choice for treatment. With this older type of alarm, the child must wet through his bedclothes onto and through the bed sheets before the moisture reaches the wire mesh mattress pad and causes the alarm to go off. If the child rolls off the pad entirely or wets while sleeping on his back, the pad may not get wet at all when the voiding occurs. Also, this type of alarm is more likely than the newer alarms to sound in response to preparation.



How Does The Enuresis Alarm Work?


Good question. We thought you'd like to know. So would we, actually, there is no consensus among health professionals on the precise mechanism at work when an alarm help a child stop wetting. So, rather than compare several theories and risks sounding like a text book, we will present you with the explanation that we think is most likely the correct one.

The enuresis alarm seems to stop bedwetting through training. Teaching or training an alert person to change his behavior is easy enough. In the case of bedwetting, the challenge is to control the wetting behaviors that occurs while a child is asleep. The alarm is necessary because the child sleeps so deeply that he cannot perceive an impending bladder contraction or the sense of urgency it creates. Her bladder contracts with out her awareness or attempt to stop it. Treatment with an alarm attempts to break that chain of events by training the child to sense an impending contraction and get up to urine.

We use the following explanation to understand how the alarm usually helps to bring about a change in behavior from wetting to dryness.

1- During the night, as the child's bladder fills with urine, it tends to contract.

2- Because the child sleeps so deeply , he does not sense the contraction and so cannot inhibit it. He begins to wet.

3- The first drops of urine cause the alarm to sound as a bladder burglar alarm, but the deeply asleep child does not respond to the noise or the wetness. (the drug Ditropan is very helpful in keeping this first release of urine to just a spot, check with your health care provider.)

4- A family member, a deputy bladder police officer, will respond to the burglar alarm, by taking the child to the toilet, trying to awaken him ( but not necessarily succeeding) If you are able to awaken your child, you may find that learning dryness will be achieved faster. But if you can't rouse him, don't be frustrated, it's often next to impossible to wake a deep sleeper. Be satisfied in the meantime to get him to the toilet before his bladder is completely empty.

Although there are various ideas about what a parent should do when the alarm sounds, one thing you should not do is simply stay in bed. You should rush to the child's room and take him to the toilet, whether you manage to awaken him or not. Do use gentle measures, such as turning on the lights in the room or saying "Please, get up, the alarm's has gone off," in trying to awaken your child. Avoid harsh measures, such as slapping or screaming.

5- The child finishes urinating in the toilet and then goes back to bed.

6- Eventually, the repetition of this procedure conditions the child to associate the urge to urinate with the need to go to the toilet. After a few weeks of going to the bathroom every time the alarm goes off, the child will begin to tune in to his bladder while asleep. He also will begin to develop the skill of inhibiting the release of urine.

Perhaps an analogy with stroke patients is helpful toward understanding how such training may awaken dormant portions of our nervous system. When an adult experiences a stroke, which result in a portion of the brain becoming incapacitated due to a lack of blood flow, the segment of the body served by this portion of the brain looses its function. Perhaps an arm may be paralyzed or a leg may fail to support walking, The brain cannot re-grow or construct this lost segment. So, how can physical and occupational therapists bring about such good results in stroke victims, simply by having their patients repeatedly do specific exercises that focus on retraining the affected arm or leg?

In the case of stroke victims, we believe that the central nervous system has back up, nerve bundles that are dormant and come to be enlisted and aroused by the process of physical therapy. In similar manner, the enuresis alarm may encourage the brain to arouse dormant or immature never bundles, which now permit the children to inhibit a nighttime bladder contraction or arouse themselves to use the toilet. Perhaps, in the case of children who outgrow the bedwetting without any treatment, this arousal occurs naturally and when it happens we think of them as matured.

Once the training process is underway, about half of the children who use the alarm get out of bed themselves and walk to the potty to urinate. The other half seem to start inhibiting their bladder contraction, so they do not get up at all at night.

In time, children who have been to the potty at night learn to inhibit the release for longer and longer durations. Ultimately, most children who follow the alarm routine end up staying in bed all night rather than getting up to urinate. After about eight weeks of alarm use, the typical child should have an improved record of dryness at night, by about twelve weeks, most children should have complete bladder control all night long.

Will the enuresis alarm end bedwetting for every child? No, but it will for the majority of children, when its used consistently and in conjunction with other treatments. It will not correct wetting in cases of incontinence or of primary sleep disorder, or in the relatively rare instances in which deep sleep is not a factor in the child's wetting.



Why Hasn't The Alarm Been More Popular In The Past?


1- It Takes Too Long.

In our quick fix society many people are impatient with a treatment that takes significant time and effort, especially in the middle of the night. I may be easier to have your child, take a pill or just ignore the wetting, hoping that it will go away.

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While it is true that when used alone, the alarm method may take six months to work, when the alarm is used consistently in conjunction with other treatment children show improved dryness much more quickly, commonly within a few weeks.

2- Alarms are unfamiliar to many health-care professionals and most parents.

Even more than fifty years after the first alarm's introduction, the medical community at large still has little personal experience with the enuresis alarm, so doctors may not readily suggest using it.

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We anticipate that wider appreciation of successful alarm use will make it more familiar.

3- Parents may be apprehensive that, by focusing attention on their child's genitalia every night at bedtime, they are sending him some kind of negative unconscious message.
Because of this concern, they may just instinctively reject the idea of attaching a mechanical device near their child's genital area.

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While parents are entitled to their apprehensions, there is no evidence that affixing such a device to the underpants causes psychological harm.

4- Parents may fear that their child could choke himself on the wire.

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To our knowledge, no child has ever choked or injured himself with the enuresis alarm.

5- To some theory behind the enuresis alarm is illogical because it is believed that learning is supposed to happen by voiding the undesirable behavior or activity.

If the alarm sounds after the wetting happens, after it's too late, how can a child learn not to wet at night?

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Logic aside, alarm usage seem to work. Here's why we think it does, Because alarm sounding is not paired with voiding (that is the complete emptying of the bladder), rather because it is paired with the brief release of only a small volume of urine, the child does eventually learn dryness. The alarm sounds while there still time ether for her to be taken to the toilet to void or to inhibit a bladder contraction. Additionally, we believe that parental praise and reinforcement during the training assists in this learning process.

6- People may hear stories from neighbors or friends about unsuccessful treatment using the alarm. "It woke everyone in the house except Frank. He just slept right through it."

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These stories abound when families have not been taught the correct use of the alarm. Their child likely will sleep through the noise, but after repeated awakening by the parent, dryness will be attained. Although each of these concerns is legitimate, the effectiveness of the enuresis alarm is overwhelming. No single treatment when used properly, has as good a success rate in curing wetting as the enuresis alarm, particularly in the case of bedwetting. The likelihood of getting dry is even stronger when alarm use is coordinated with the use of reinforcements. Additionally, when the alarm is used consistently in conjunction with other treatments, the success occurs faster.