Nocturia (nighttime urination) is so prevalent in sleep apnea patients it has become a screening tool as significant as snoring. A research study showed that over 84% of patients with sleep apnea reported frequent nighttime urination while 82% acknowledged snoring.
How many bathroom trips do you make during the night? It’s considered normal for one to be awakened once or twice during the night to urinate, but many patients with untreated sleep apnea report as many as 6 or more nightly trips. Often, people assume this disruption of sleep and having a small bladder causes treks to the bathroom.
“Sleep researchers know that nocturia is a sign of sleep apnea,” says Mary Umlauf, Ph.D., associate professor of nursing at UAB and lead investigator of the research study. “However, because the underlying mechanisms linking sleep apnea and nocturia had not been studied before, people with nocturia were more likely to report the problem to their gynecologist or urologist, not a sleep clinician. Doctors most often attribute nocturia to aging in women or to prostate problems in men.”
The study states that “nocturia can be defined as awakening from sleep to voluntarily urinate. It differs from enuresis or bed-wetting, where the person does not arouse from sleep, but the bladder empties anyway. Until recently, nocturia was thought to be caused by a full bladder, but it is also a symptom of obstructive sleep apnea. What actually causes nocturia is still being investigated. Some researchers believe that one event per night is within normal limits; two or more events per night may be associated with sleep deprivation.”
How does apnea cause nocturia? Umlauf explains that during episodes of sleep apnea, the soft structures in the throat relax and close off the airway, setting into motion a chain of physiological events. “Oxygen decreases, carbon dioxide increases, the blood become more acidic, the heart rate drops and blood vessels in the lung constrict,” says Umlauf. “The body is alerted that something is very wrong. The sleeper must wake enough to reopen the airway. By this time, the heart is racing and experiences a false signal of fluid overload. The heart excretes a hormone-like protein that tells the body to get rid of sodium and water, resulting in nocturia.”
The good news is that many people who have nocturia due to their untreated sleep apnea find that it totally resolves once they become cpap compliant. We are aware that the ravages of sleep apnea can and do cause a higher risk of heart problems and stroke. These present serious incentives for patients to strive for successful use of cpap. Nocturia is yet another motivation to become therapy compliant to achieve apnea free, quality, restorative sleep. There are other medical reasons to experience nocturia, so if you suffer with frequent nighttime urination, please discuss with your medical team.
Nocturia is one thing I definitely had as a symptom for my UARS too. I was up several times a night.
I had the same problem but mine turned out to be a diabetes issue. This is good information to know.
Kathy, do you have sleep apnea and use CPAP?
If so, I am wondering if you have noticed your morning blood sugar readings have lowered with successful CPAP therapy.
When I was diabetic, I was fortunate to have experienced that!
I am a dentist working in dental sleep medicine. We find that the symptom of excessive nighttime urination caused by obstructive sleep apnea will usually also be eliminated by successful OSA treatment via oral appliances. a.b.luisi,d.m.d.
This was certainly a symptom of mine during the period I was diagnosed but untreated from 2010 to 2015. At first it was 5 or 6 trips to the bathroom and I tried to never turn on the light so I would not totally awake… but, it got worse, and I ended up with a Big Gulp cup near my bed, and used it as many as 8 to 10 times a night. I claimed for years not to sleep… and this was just more evidence. Now, treated with a properly fitting mask, I may pee three times a night; but, I may also make it through the night without.
Prior to starting CPAP therapy (March 28, 2016) I would awake once a night between 2 and 3AM to go.
In the 30 days I’ve been on CPAP, I’ve only gotten up 1 night.
I consider this a major goal achieved with CPAP therapy.
Thanks for sharing the good news about your successful cpap therapy. Welcome to better sleep and health!
I have very severe sleep apnea and used a CPAP for several years. Even with a CPAP, I woke 2 to 3 times every night to use the bathroom. I have now used the Inspire Therapy for 5 years and have not woke up even one time to use the bathroom. Inspire is a new therapy that is very successful. Not only do I not wake for bathroom needs, I wake every morning rested and am rested all day. Check it our at inspiresleep.com
The reduction of nighttime bathroom visits is one of the under appreciated benefits of treating sleep apnea!
I have been on a bipap for about 15 years.
I have had diabetes (under control) for about 3 years
I get up to urinate at least 1 time per night, sometimes up to 3 times
I go right to sleep when I go to bed since I am usually exhausted
I usually go to bed early at 8 or 9
I usually get up early
I try not to get up too early since being “awake” does not mean fully rested.
I feel my best in the morning and can get my reading done if I am rested
throughout the day I get progressively tired and am very ready for bed early
I may go right to sleep but I usually wake up to urinate by 1am
after that I try to sleep but I am usually seeing the clock once per hour
by 4am I am thinking about getting up, sometimes earlier
I know better though and try not to get up until 5
I have found that I generally have to urinate again by around 6
and I am more rested by 6am so I usually get up, urinate, get coffee and read
That’s my experience. I hope it helps
I believe the combination of severe sleep apnea (even treated) and diabetes,
considering the difficult time I have getting my weight down seems to me
particularly bad. I do believe the symptoms of both would be reduced If I could
get my weight down. That is still a challenge.
That’s how I knew something had to be wrong with me, I was up using the bathroom too much. I immediately made an appointment with my doctor.
I wake up two or three times to pee each day i am not diagonsis sleep apena yet if it is sleep apena why it vary one day three times other day two times and sometimes one time is there any one explain to pls
I have the urination problem; Why does it effect sleep apnea patients?
This is what I told my patients in the sleep lab:
The bladder naturally fills by the time morning comes - this is how humans are “built.” You awaken in the morning, and you are fully aware that the bladder needs to void.
People that have disrupted breathing episodes - as in the case of sleep apnea - wake up often during the night because these episodes bring them out of a sleep stage sometimes just enough to realize there is the sensation to urinate. So they get up and use the restroom. Go back to sleep, wake up again, go again. Sometimes it is more than twice or three times per night for certain individuals.
The thing of it is, anyone who awakens before morning will have even a partially full bladder and have the sense of needing to urinate. If they were not having apnea, not waking up, they would not “know” their bladder is even slightly full.
So in essence, it’s not that people with sleep apnea have to urinate more - It is just that they are awake and can…
Hope this helps.
its a little more scientific than that. Sleep Disorders Breathing causes arousals in your sleep. A biological hormone is released signaling the need to evacuate, especially in pediatrics. Patients with apnea can have hundreds of arousals a night.
Thanks for your valuable information; I get to urinate seven or eight times a night. I do not know how much this effects my quality of sleep, or in what way.
I have only been on my machine and that was the first thing I noticed…I have had urination problems and just thought that going 2-3 times a nite was normal for me. I drink a lot of water…But I was going all nite, which is very rare, without going and some nites only once…I keep a hospital urine bottle next to the bed so I can just sit on the edge of bed and go…
I just wish I could get this darn mask to fit…Was going to give up but read about what could happen and this urine thing convinced me to keep trying