To the Editor.—
In a recent letter (227:327, 1974), Martin suggests that imipramine's effect on nocturnal enuresis may be understood in terms of the drug's sleep effects.Evidence from adult human subjects indicates that the frequency of spontaneous shifts to stage I sleep from other sleep stages is actually increased, rather than decreased, consequent to administration of imipramine.1 This finding generates the prediction that far from decreasing the frequency of lightening of the electrocardiographic pattern and thereby making enuresis less likely, imipramine will increase the frequency of lightening of sleep constituting the enuretic episode.It is inviting to speculate that reductions in frequency of wetting may be attributed to a labile sleep pattern comprising frequent shifts to stage I sleep so that individual stage III and stage IV components are of short duration, although the total time spent in these latter (deep) sleep stages is unchanged. Thus, the likelihood
Cooper C. Imipramine, Sleep, And Enuresis. JAMA. 1974;228(5):569. doi:10.1001/jama.1974.03230300017018
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