Sleep Apnea & Nocturia

What the number of bathroom trips you take in a night says about your respiratory health.

One of the first questions your physician might ask when screening for sleep apnea may, on its face, seem entirely unrelated: how many times do you get up during the night to urinate? This common symptom of obstructive sleep apnea (OSA) is called nocturia and is reported to be just as, if not more, prevalent than snoring in patients with untreated OSA. This article will explain why nocturia is so frequently associated with sleep apnea, and what you can do to ensure proper resolution of symptoms and decrease the number of bathroom trips you take in a night!

How is nighttime urination related to untreated sleep apnea?

To understand how getting up to pee is related to OSA, it is important to understand what happens during an apneic episode during sleep. When someone has obstructive sleep apnea, normal sleep is interrupted when the soft structures in the throat relax and cause the airway to close, producing that “gasping for breath” sensation that sufferers of OSA know all too well. This closing of the airway triggers different physiological reactions in the body, most notably, a decrease in blood oxygen level, subsequent increase in carbon dioxide in the blood, blood vessel constriction in the lungs, and increased heart rate. The increased heart triggers the release of hormones that activate the urge to urinate. At this point, the body is aware that something is wrong and will startle the sleeper awake. Much of the time (especially before a lot was known about the effects of OSA) frequent nighttime urination was often overlooked as a symptom of sleep apnea. It was a complaint more commonly reported to specialists such as gynecologists or urologists, instead of sleep or respiratory professionals. Now that there has been a clear link established between frequent bathroom trips and OSA, sufferers of nocturia are more likely to get the answers they need and finally find some relief.

But what does “Frequent” Mean?

Though nocturia is defined as “frequent” nighttime urination, sometimes it can be hard to tell the difference between regular habits and a sign of a larger problem, especially if you are used to these repeated bathroom trips. A long-term sufferer of nocturia may consider 3 or 4 bathroom trips a night “normal”. According to the National Sleep Foundation, some people even report getting up to use the bathroom upwards of 5-6 times in a night. Although getting up 1 or 2 times is generally considered to be within the “normal” range, the bottom line is this: if nighttime urination is consistently preventing you from attaining restorative and restful sleep, it is likely indicative of a larger problem and worth looking into. When the body is consistently awakened throughout the night due to nocturia, sleep cycles are interrupted and the sleeper is unable to attain proper REM sleep. This results in exhaustion, decreased concentration and memory function, mood swings, and an overall decline in physical and mental health. According to an article published by the American Sleep Apnea Association, 84% of patients with sleep apnea reported nocturia as a symptom – so this is without a doubt a prevalent problem among sufferers of OSA.

A better night’s sleep awaits…

If you are currently experiencing nocturia, don’t fret! There is good news for sufferers of this irritating problem. Patients diagnosed with OSA who become CPAP compliant typically see a reduction in these unwelcome middle of the night bathroom visits within the first few weeks of their CPAP trial period. CPAP keeps the airway open, and therefore prevents the physiological sequence of events that results in nocturia from ever occurring. The result is an uninterrupted, restorative night’s sleep. If you are concerned or frustrated about the number of bathroom trips you take in a night, and have eliminated other potential causes, consider speaking to your family doctor about initiating a sleep apnea consultation and free level three sleep study at Dream Sleep Respiratory. We are committed to providing superior customer service and medical advice to all of our patients. For more information on Dream Sleep’s patient referral program, what exactly CPAP is, and what the treatment process looks like from testing through a trial period, check out the following links:

 Patient Referral Form
 What is CPAP?
 The Secret to Getting Ahead is Getting Started: CPAP Trials at DSR