2:1 = M:F
r/o: sleep disordered breathing, UTI, constipation, DM, diabetes insipidus, urethral valves, neurogenic bladder, seizures, meds (SSRIs, valproate), sexual abuse
Rx:
Patient education available at www.drynights.com
Only consider rx after age 6 yr; 15%/yr resolve after age 6 yr
Training: comprehensive approach including alarms, waking routines, bladder training, etc; main effect may come from alarm
Alarms 75% effective, most effective single rx (Cochrane Database Syst Rv 2003;[2]:CD002911); compliance tough, though improved w DDAVP given for 1st 3 wk; cost $60-75
Desmopressin (DDAVP) 10-20 µgm in each nostril hs, or 200-400 µgm po hs; may help a little, esp when combined with other rx, decreases sx by 1-2 nights/wk (Cochrane Database Syst Rv 2002;[3]:CD002112); adverse effects: hyponatremia, seizures, and rare sudden death (Med Let 1990;32:53); costs $3-6/night
Imipramine 25-50 mg (75 mg over age 12 yr); helps 25-35% or 1 fewer night/wk (Clin Evid 2004;[11]:468); check QT interval on EKG before starting; cheap but OD risk