A mother brought her eight year old son to my clinic last year with a referral from an ENT specialist. The boy snored loudly every night and had recently been scheduled for a tonsillectomy. The ENT had mentioned, almost in passing, that fixing the snoring might also fix the bedwetting. The mother wanted to know if she should wait and see, or start bedwetting treatment now.
This question comes up more often than you might expect. Sleep apnea, especially the kind caused by enlarged tonsils and adenoids in young children, has been linked in the medical literature to bedwetting. But the way the connection is often described to parents oversimplifies a much more nuanced clinical picture.
When the two do happen together
In the great majority of bedwetting cases I see, sleep apnea is not part of the picture. The child sleeps quietly, breathes normally, and the bedwetting is its own problem with its own cause, which is the brain's failure to wake to a full bladder during sleep.
There is a smaller group of children where both conditions are present at the same time. These cases exist, and they deserve a careful answer. In those families, the real question is which problem to treat first.
Why people think sleep apnea causes bedwetting
The theory goes like this: obstructed breathing disrupts deep sleep architecture, increases pressure inside the chest and abdomen, and may influence the hormones that govern urine production at night. Each of those mechanisms is real on paper. The leap that some practitioners make is to conclude that solving the apnea will, by itself, solve the bedwetting.
In my experience, that conclusion is too clean. Some children whose tonsils are removed do see improvement in their bedwetting. Many do not. The brain's nighttime arousal mechanism, which is the actual underlying issue in primary bedwetting, does not automatically reset just because the airway has been opened.
Sleep apnea as a contributing factor, not the root cause
When sleep apnea coexists with bedwetting, I describe it to parents the same way I describe constipation. It is a contributing factor, not the underlying problem. It may make a difficult case slightly more difficult. But the deep sleep, the immature waking response, and the genetic component are the actual drivers of bedwetting, and they will not improve simply because the airway has.
This matters because some families wait months or years for a surgical fix to resolve the bedwetting on its own. It often does not. Meanwhile, the real treatment, the part that addresses the underlying sleep-waking mechanism, has been postponed.
What I tell parents
If your child has bedwetting and your pediatrician or ENT suspects sleep apnea, address both. Treating the apnea is the right call for sleep quality, growth, and daytime function, on its own merits. But do not let the apnea workup delay the bedwetting treatment, and do not assume one will solve the other.
Behavioral alarm therapy works on the actual cause of bedwetting. It is fully compatible with apnea treatment, and in our experience, the two can run in parallel without interfering with each other.