Help with nocturia

[Chairman Meow]

Prior to CPAP I was getting up 5+ times per night - my very first night on the machine was the first time in years that I didn't get up even a single time. It's been two weeks for me now and I have only had one instance were I had to get up - and even that one was more about getting up to check on noisy pets and just deciding that I might as well use the facilities, since I was up anyway.

I've also noticed that I no longer fear sneezing, coughing, or laughing. If you know what I mean.

[russatore]

Add me to the "immediate relief from nocturia"... I just assumed it was prostate related even though I wasn't having any problems... 3-4 times per night I was getting up to pee. None of my doctors discussed this in relation to apnea, it was just something I noticed when I started treatment... within a week I was down to 0-1 times. It was here in the forum that someone finally explained it to me.

Just new here and browsing around. Had the problem for a few years, tried to get diagnosed but an idiot doctor, in one of our most respected hospital suggested a tennis ball on my back while sleeping while another wanted to perform 5 different surgeries on me. This is the beauty of free medicals....

Had to go private and spend $600 to get a penumologist perform proper tests on me and prescribe a CPAP. Best thing that happened in my life.
I, like Scott assumed it was prostate related but from night one with a CPAP the problem went away to zero getting up. Same happened with redness in the right eye.

[SunnyBeBe]

Add me to the "immediate relief from nocturia"... I just assumed it was prostate related even though I wasn't having any problems... 3-4 times per night I was getting up to pee. None of my doctors discussed this in relation to apnea, it was just something I noticed when I started treatment... within a week I was down to 0-1 times. It was here in the forum that someone finally explained it to me.

Do you think that going down to zero trips to the bathroom at night is an indication your therapy is working well? I'm new and I also went from 3-4 times per night to zero almost immediately upon starting cpap.

[Julie]

It's certainly a sign that something has changed, and one that's almost expected with Cpap. If your numbers are otherwise good and you feel better, then obviously something is working.

[palerider]

Do you think that going down to zero trips to the bathroom at night is an indication your therapy is working well? I'm new and I also went from 3-4 times per night to zero almost immediately upon starting cpap.

when you stop breathing, your brain say "OH SHIT" and throws your heart into overdrive, which causes your blood pressure to go up, which makes your kidneys produce more urine, which causes you to have to get up and pee. (some steps and technical bits omitted).

what do you think?

[SunnyBeBe]

I certainly hope that's what it means. I have Type I diabetes, so that can also cause high urine output, but since my BS numbers are good and I'm faithful to my cpap, I really think it's a dream come true. Knock on wood and pray it continues.

[glowradar]

As the original poster, I realize I am overdue for an update.

My sequence of events (keeping it brief for the benefit of anyone who might find themselves in the same boat):

1. Nocturia
2. A visit with urologist reveals nothing alarming. Prostate big for my age, but shouldn't be big enough to cause nocturia.
3. I discover Apnea/nocturia link, and then discover I have severe apnea confirmed by test.
2. CPap (nasal mask)
3. Nocturia continues
4. I determine Cpap is not working due to enlarged turbinates (confirmed by ENT). Start steroids (Flonase) for my nose to try and reduce turbinate size.
5. Switch to full face mask (Which winds up being fine once I get used to it).
6. Nocturia continues.
7. I return to urologist, now deeply alarmed (compounded by lack of sleep). He notes my high anxiety level, and suggests that might actually be the cause.
8. I was on a tiny dosage of an SSRI called Celexa for about a year to treat PTSD. I stopped taking it several years ago. Anxiety is one of the hallmarks of PTSD. I decide to restart, and ask my dr. to renew the prescription. SSRI's take about 2 weeks to start working.
9. Two weeks later: I'm only getting up 1-2 times a night, which was my baseline before this started.
10. 6 weeks later: Still getting up once a night, but I've had a couple nights of not getting up at all. I've also had 2 nights which were relapses, but mild by comparison to what happened before. On both nights I was sleeping on my right side, and I noticed when I woke up that my right nostril was completely blocked. No air could escape whatsoever. The blockage was not snot, and I assume it is my turbinate swelling up from the blood rushing in and the turbinate not constricting as it should.

Working theory: I have turbinate blockage. (I'm wondering if that could be the primary source of my apnea? I don't meet any of the common risk factors) Once the anxiety kicked in I was in constant fight/flight mode. The stress went to my bladder. So the problem started with Apnea, but it was stress that kept it going.

[Julie]

I'm wondering if e.g. a full face mask might help if you have nasal issues and therefore might be losing lots of Cpap therapy out of your mouth when sleeping. Nocturia should go away on Cpap, but only if it's effective.

[Guest]

Add me up as well.
There were bed nights where I could take the trip 3-4 times.
Since day one on CPAP it stopped and I have no urges thru the whole night.

[SunnyBeBe]

Are you taking any medications and have you ruled them out as the cause of nocturia?

Have you ruled out diabetes?

Have you tried not drinking anything after 7 p.m, at night?

If your theory of blocked nasal passage is correct, then what is the cause of the nocturia on nights when you are not blocked?

[glowradar]

Are you taking any medications and have you ruled them out as the cause of nocturia?

No medications (until I started the Celexa).

Have you ruled out diabetes?

Yes. I also ruled out infection via urinalysis, and other possible causes.

Have you tried not drinking anything after 7 p.m, at night?

Yes.

If your theory of blocked nasal passage is correct, then what is the cause of the nocturia on nights when you are not blocked?

I'm not sure I've ever had a night with nocturia where the nasal pasagge wasn't blocked. It's kind of hard to tell because I'm asleep, but Sleepyhead shows every nocturia event is preceded by a large mask leak. And I think I've been able to establish the mask leaks are caused by nasal issues.
To explain:
I suspect the nocturia started with a combination of Apnea and stress/anxiety (many symptoms can have multiple causes, and I think that's the case here). It took me a LONG time to treat the Apnea. I was pretty sure that was my problem in November, but couldn't get confirmation until January, and didn't get my CPAP until March 1st. It took me a couple weeks after that before learning about Sleepyhead (on this board actually). Sleepyhead pointed out I was having a lot of large mask leaks, way above the machine's capabilities to compensate, and sometimes for up to 45 minutes. But when I experimented with mask fit during the day, I wasn't getting any leaks. It wasn't mask tightness or fit as far as I could tell. Furthermore I noticed that almost every time I got up to pee it was preceded by a large mask leak. This was happening 8 or 9 times a night. So obviously my first goal was to get rid of the leaks.
Initially I thought I might just be opening my mouth, so I tried a FFM, but my first couple times were a complete disaster. I had no idea what I was doing, and I thought it was the mask and I'm "just not a FFM person". I then tried getting an allergenic filter, and trying chin straps but that didn't work either. Eventually after some further web research I started zeroing in on turbinates as being a possible cause. Finally I booked an appointment with an ENT I trust and he looked in my nose:
"Your turbinates are HUGE!"
According to my ENT the nasal masks can actually irritate and inflame the turbinates, making a bad problem worse, or even making the problem in the first place.
Here's a way to tell if you have a possible problem: hold one nostril closed with your finger, and then inhale with the other nostril. If the nostril collapses completely shut that's not good, and it shouldn't do that. I could close both nostrils just by breathing in. That's really not good.
He prescribed me flo-nase with a nasal spray anti-histamine as a hopeful solution to bring the turbinate size down. It takes a long time to work (6-8 weeks), and I have a habit of forgetting to do it (I'm supposed to do it twice a day, and I sometimes don't remember at all). But I've seen some improvement: I can breathe in without my nostrils completely collapsing. My right nostril is definitely more clogged than the left though.

I no longer have significant mask leaks according to sleepyhead.

However I continued to have nocturia even after switching to the FFM and starting the Flo-nase, but my anxiety about the nocturia was also through the roof. My urologist said I was in a loop, and they were feeding each other. I already know I'm susceptible to health loops, so I went back on the Celexa (SSRI) and in about a week the nocturia went away. It could have been the FFM, it could have been the steroid, and it could have been the Celexa, but I think was the celexa because I was also starting to have a lot of urinary frequency during the day and while that can have other causes besides anxiety I had ruled out all those other causes. And my symptoms cleared up right around the time the anxiety went away.

In people with PTSD anxiety is phsyiological, not mental. Your receptors get flooded with an overdose of serotonin due to some terrible event (in my case it was confronting a life-threatening illness about five years ago). They then get "stuck" in a hyper-reactive state (like leaving the barn door open), and any amount of serotonin triggers fight-or-flight response. SSRI's work by reducing the ability of the receptors to receive serotonin (like shutting the barn door). After a year or so you can wean yourself off the SSRI, and your receptors will work properly. Fight-or-flight also triggers the bladder. So it's kind of a double-whammy if you have Apnea and explains why I couldn't dig my way out with CPAP alone.

Right now nocturia is not a problem for me. And that has definitely not been the case from November - April. It was an awful time of no sleep, and constant fear and anxiety about why I was suffering.

I am not a doctor, and this is just a theory. But I've seen a couple other people online elsewhere say that it was an SSRI that cured their nocturia. This may be useful information for someone in the future, so that's why I'm taking the time to post my thoughts here.