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.