My child is motivated during the day and open and engaged in the process but at night when woken from the deep sleep by the alarm (or us whilst the alarm is still beeping) becomes really distressed and unhelpful. He just wants to go back to sleep and has always been like this when woken. My child is 7 so can’t be physically forced (and I don’t want to). I don’t think any other rewards, except going back to sleep, will work at this time. We will try again tonight. Any advice?
Deep sleep can be an issue for bedwetters and there are strategies you can use to help your child with this, but first we need to make sure that they actually want to respond to the alarm and cure their bedwetting….and this is where incentives can be used.
Children often get motivated when they have a sleepover, a holiday visit or a school camp coming up. They want to be just like their friends and not worry about the embarrassment of having to wear night nappies or take other precautions. If there are any overnight events coming up during the year it may be worth having a discussion with your child about how they would like to deal with these if they don’t want to use the alarm to help stop the bedwetting now. In having the discussion get them to imagine how much more they will look forward to and enjoy away-from-home nights if they don’t have the worry of bedwetting.
If they are motivated to stop bedwetting because it will enable them to participate more fully in things like school camps and sleepovers you could suggest a Reward Programme that, in the first instance, recognises their efforts to wake (or be woken) in response to the alarm. If you have to wake them it is important that they remember the routine of turning off the alarm, going to the toilet, cleaning and drying the sensor and then returning to bed and putting the alarm back on. This is part and parcel of the process of training the brain to recognise full-bladder signals by themselves. In order to do this we recommend a code word game: tell them that every night they get up when the alarm triggers you will give them a code word which you will ask them to repeat to you next morning. If they remember the code word 5 times correctly they get a reward that they would appreciate and you are comfortable with.
Once they are proficient in getting up to toilet during the night when the alarm triggers you could change the Reward Programme to incentivise them to respond to the alarm by themselves, i.e. they don’t need you to come and wake them up when the alarm triggers. Finally, you can incentivise them for waking up to go to the toilet before the alarm triggers, i.e. for dry nights.
For deep sleepers it is particularly important that they are primed for the alarm and the night time toilet routine. For this reason we recommend the Priming Strategy be implemented at bedtime:
Priming is based on a strategy called Prospective Memory which is setting something up in the brain that has to be remembered in the future. The classic example is telling yourself that you need to wake early and setting an alarm clock. Invariably you will wake before the alarm because the brain has been primed to wake at that time.
In order to prime your child’s brain to wake to the sound of the alarm, it is a matter of practising what they need to do when the alarm goes off. Before they settle down to sleep have them lie in bed pretending to be asleep. Turn on the alarm and trigger it by putting something metal (a stainless steel knife) across the black sensing strips on the Urosensor. Ask them to get up, turn the alarm off and go to the bathroom and pretend to pass urine, then go back to bed. Practice this three or four times a night over a few nights so that their brain is more ready to respond when they hear the alarm.
At the outset you may need to get up when the alarm triggers to wake your deep sleeper and ensure the procedure is followed (try using a cold damp cloth over their forehead and cheeks to waken them).
Another strategy which can help with the bedwetting training process is Visualisation:
At home when your child needs to go to the toilet, ask them first to go to their bedroom, shut the curtains as if it were night time, and lie down on the bed and close their eyes pretending to be asleep. Get them to describe out loud what they are feeling in their bladder and why this is a signal for them to wake up and go to the toilet. Some children get quite creative in describing the feeling –whatever it takes for the association to stick in their mind will help prime the brain to recognise the signals from the bladder.
Finally, good daily water intake is important. Make sure your child has sufficient hydration during the day. This can help stretch the bladder so it holds more and may not need to void so many times during the night. A 250ml glass of water taken 6 times a day (when they wake, before they leave for school, at morning tea, at lunchtime, at afternoon tea and at dinner) can help with this process.