OSA & Frequent urination during the night

This stuff is so amazing I want to run down my last PCP (who I had been with over 20 yrs)! I've been chasing several issues since last March - mostly daytime fatigue, neck stiffness, and multiple nightime awakenings (2-3 times to urinate). I finally got pissed enough last August and switched to a new practice and PCP. He chased down the usual suspects: blood work, prostate, MRIs of neck and brain, etc. Finally in December he says to me, "I'm baffled ... you are very healthy on paper. Do you snore?" Then, "has anyone ever told you that you stop breathing while asleep?" I answer yes to both. I could see the light go on in his eyes. Three months later I'm on CPAP. It hasn't resolved all my issues yet (3 weeks of chasing mask and leak issues), but the awakenings have diminished to 1 on good leak nights and no more getting up to pee.

This is my first post. I found this forum by searching for CPAP and frequent urination. It's been over a year now, probably 15 or 16 months, when my frequent urination started, and just like the OP, I made many trips to multiple physicians, with nary a one of them even mentioning the possibility that it may be related to sleep apnea. It was usually either written off to a bacterial infection, or my borderline diabetes. I actually mentioned back in June of this year, that I may have sleep apnea, and they sent me home with a device that was supposed to monitor me overnight. That first test came back positive, so I went in for two subsequent sleep studies, and three days ago started the therapy. The first night did not go very well at all, I felt claustrophobic, and felt like I was being suffocated at times. I think I got up to urinate at least three times. The second night started out the same way, but I did get used to it, and slept better. I only got up once to use the restroom the second night. And last night, it was much better, and I did not get up once. So off to the computer for some long past due research. That's when, among other articles and posts, I found this site, and specifically this thread. I also found Sleepyhead... is that what most y'all use to read you SD card, or is there something better? Thanks for posting this topic hbakar! Nice meeting y'all!

atarmiga, welcome to the forum! I think you will enjoy reading the posts here. I joined in June after I had been referred for a sleep study and before I actually went. This forum has helped me in so many ways, I highly recommend it. don't be afraid to ask questions. no question is too small. its best to start a new post when doing so. good luck! Oak

ps oh, yeah, i had frequent urination too and now sleep with only one trip to the bathroom per night, some nights none. i have been at this about two months.

in general, it seems way better with the machine but i still get nights where i have ridiculous nocturia and it doesn't seem tightly linked to ahi on my current machine. However, In general, the bad nights occur when my ahi number is above 1 on this machine. The difference in nights is truly bizarre. When i have the nocturia i'm up around 10 times with a huge urine volume, over 3 liters and the urine is clear and odorless, like water. There seems to be no connection to drinking liquids the day before. Last night was a good night - i was up once with extremely concentrated urine. I have no prostate problems at all and i just got the PSA results today and it is well below 1

In reading this thread from the beginning, I noticed that I posted two years ago that my frequent trips to the bathroom had become much less. Fast forward to two years later, that is not the case now. I did stop using CPAP for many months (long story), but have been using my machine every night for the last five weeks. I even purchased a CPAP bed pillow so that I would be more comfortable, and decided I'd do just about anything to help this therapy work for me.

The problem is that now I'm getting up at least two times a night to go, and sometimes three. A really good night was just once. My numbers appear to be okay so I'm not sure what's going on. I have an appointment with my sleep specialist next month but I wish I didn't have to wait so long to find out what's going on. If anyone has a suggestion as to what might be happening, it would be appreciated.

ems wrote:In reading this thread from the beginning, I noticed that I posted two years ago that my frequent trips to the bathroom had become much less. Fast forward to two years later, that is not the case now. I did stop using CPAP for many months (long story), but have been using my machine every night for the last five weeks. I even purchased a CPAP bed pillow so that I would be more comfortable, and decided I'd do just about anything to help this therapy work for me.

The problem is that now I'm getting up at least two times a night to go, and sometimes three. A really good night was just once. My numbers appear to be okay so I'm not sure what's going on. I have an appointment with my sleep specialist next month but I wish I didn't have to wait so long to find out what's going on. If anyone has a suggestion as to what might be happening, it would be appreciated.

Anything other than the need to "go" that could be waking you? It took me a long time to stop getting up once each night. Now it is an unusual occurrence. Five weeks is not long enough to sort out all of the hormonal issues that disturb your sleep - and may continue to do so.

atarmiga wrote: The first night did not go very well at all, I felt claustrophobic, and felt like I was being suffocated at times. I think I got up to urinate at least three times. The second night started out the same way, but I did get used to it, and slept better. I only got up once to use the restroom the second night. And last night, it was much better, and I did not get up once. So off to the computer for some long past due research. That's when, among other articles and posts, I found this site, and specifically this thread. I also found Sleepyhead... is that what most y'all use to read you SD card, or is there something better? Thanks for posting this topic hbakar! Nice meeting y'all!

Are you using ramp? If so, it often starts at a pressure that non-using doctors and DMEs seem to think it easier, but is actually suffocating to most people. You can either turn off the ramp, or have it start a little higher, like 6 or 7 instead of 4 or 5.

I suspect this is what is happening since it starts off suffocating and seems to improve (once the pressure gets up a little higher).

Also, if you have an auto machine, it may be set wide open, again starting at 4 or 5 instead of a more useful pressure closer to your actual needs. If you tell us your machine info and settings, we can help you figure this out and get it more effective and more comfortable for you.

Welcome to the group.

Amazing. I had no idea there was a connection. I've battled that condition for a few years. I'd be up at night 5-6 times. I was given medicine for it (two different kinds), sent to a specialist. No one mentioned apnea. I even told my doctor more than once (and the specialist) "I think this nocturia is disrupting my sleep!" No one thought to consider that it was the other way around.

I've been on my machine for 7 days, and already I have had two nights where I got up only once. I can't remember the last time I did that without a cpap machine. This is terrific motivation for sticking with the new cpap routine. Makes me wonder how many other conditions are related to SA and are not being properly attributed to it by PCPs.

Thanks for posting this!

For me, it was the bathroom trips, morning headaches, and high blood pressure.

Looking back, I am shocked that my doctor never suggested sleep apnea. She had been warning me for over a year that my high blood pressure was putting me at risk for a stroke (I was only 39 at the time. And it was not responding well to medication. She doubled the first medication, added a second, doubled the second, and added a third. It was better, but still not normal.

And here is what really makes it bad. I have the same doctor as my mom, and she was diagnosed with sleep apnea over 20 years ago! Duh. Why didn't it occur to the doctor that I might have it too?

Sadly, I knew I had sleep apnea for at least 10 years, but I always thought of it as sleep deprivation from waking up. I didn't know it was actual oxygen deprivation (I didn't realize the disturbances were frequent or long enough to cause oxygen problems). And I had no idea that the other issues were all related. I only got tested because I saw a report on the news that sleep apnea was one of the main causes of high blood pressure which leads to stroke and heart attack. I confessed and got tested. I wish I had done this 10 years ago.

Follow up question: So I'm now waking up 1-2 times per night. That's probably a bad night for most people, but compared to the 5-6 times I was getting up before, that's a major victory. I tend to get up once in the middle of the night, and once fairly close to my wake up time (I get out of bed at 5:15am, and have been waking up to go to the bathroom at 4am or so).

My question is whether this is likely to continue getting better. Is there usually some kind of period where your body/brain gets used to CPAP when it comes to this particular set of symptoms? I've been using my machine for 17 days. I could live with 1-2 times per night, but would throw a party if I could sleep all night and/or get up most nights only once. Anyone have experience with this?

Iowamv wrote:My question is whether this is likely to continue getting better. Is there usually some kind of period where your body/brain gets used to CPAP when it comes to this particular set of symptoms? I've been using my machine for 17 days. I could live with 1-2 times per night, but would throw a party if I could sleep all night and/or get up most nights only once. Anyone have experience with this?

You are male...I don't know your age or anything like that...I assume since you posted in a frequent urination thread that when you are getting up you are needing to urinate...remember that not all frequent urination needs are related to sleep apnea.
In the male of the species there is that potential for prostrate issues...if you have those issues then this may be as good as it gets but if you don't have those additional issues and the need to urinate is strictly from the sleep apnea events causing that overload of the stress hormone...then you may see less nighttime wake ups as time goes on.
Part of it may be habit...part of it may be what you drink at night... I went from getting up to pee every hour on the hour (with a full bladder to the point of hurting) to rarely having to get up to pee during the night and then it has always been related to drinking something right before bed that promotes urine production..like tea or a soda with caffeine.

Thanks Pugsy.

Well, that's a pretty personal question (just kidding). I'm 48. So yeah, it could be related to prostate. That's what my doctor thought when he tried putting me on medicine for it. He tried two different medicines, and my symptoms didn't respond to either one. That, coupled with the fact that I've already seen a major decrease in nightly visits to the bathroom, makes me hopeful that most of my issue is apnea related. I don't have any other symptoms that would suggest enlarged prostate either.

LIke I said, I think I can live with 1-2 times per night. But if I ever sleep for 8 hours without getting up you'll probably hear me shouting for joy.

And I still can't believe that I told both my GP and the specialist I saw that my trips to the bathroom each night were causing me to be exhausted-- and neither of them asked about apnea. I'm no doctor, but given what I've learned in the last couple of weeks, that'd seem like an obvious question to ask. "Do you snore at night? Wake up gasping for air?" I could have started on CPAP a few years ago!

get lots of these:







Nocturia is endemic to OSA. Since OSA is a lifetime disease, so is Nocturia in various levels. Get used to it!

Prevalence and predictors of nocturia in obstructive sleep apnea-hypopnea syndrome--a retrospective study.

Hajduk IA, Strollo PJ, Jasani RR, Atwood CW, Houck PR, Sanders MH



Abstract

OBJECTIVE: To determine the prevalence and predictors of pathological nocturia (PN) in patients with OSAHS. METHODS: Retrospective review of clinical and polysomnographic data obtained from patients evaluated at the Pulmonary Sleep Evaluation Center of the University of Pittsburgh Medical Center between November 1998 and September 1999. PN was defined as two or more urination events per night. OSAHS was defined as Apnea-Hypopnea Index (AHI) > or = 5. Group t-tests and Chi-square test were used to examine differences in subjects with and without PN. A multivariate approach utilizing logistic regression was performed to examine the relationships between polysomnographic variables [Arousal Index (ARI), AHI, Apnea-Hypopnea Time/Total Sleep Time x 100(%) (AHT/TST), % Total Sleep Time (TST)<90% Oxyhemoglobin Saturation (SPO2), nadir SPO2, Desaturation Event Frequency (average number of desaturations > 4% per hour sleep) (DEF)] and the presence of PN, while controlling for medical comorbidities. Data are expressed as mean + SD unless otherwise specified. Statistical significance was assessed at p < 0.05. RESULTS: Study population: n = 138 (50 females, 88 males), age: 49.7 +/- 12.3 years, BMI [Body Mass Index (kg/m2)]: 37.7 +/- 11.3. The overall prevalence of PN was 47.8%. The prevalence of PN was greater in females (60% vs. 40.9% in males). OSAHS patients with PN had a higher prevalence of peripheral edema, higher BMI, a greater %TST < 90% SPO2, lower nadir SPO2 and greater DEF. The logistic regression model indicated that age, ARI, AHI, AHT/TST, %TST < 90%, DEF were significant predictors of PN independent of BMI, neck circumference and medical comorbidities. CONCLUSIONS: Our data confirm that PN is common in OSAHS patients. The strongest predictors are age and selected polysomnographic variables reflecting OSAHS severity.

Iowamv wrote:And I still can't believe that I told both my GP and the specialist I saw that my trips to the bathroom each night were causing me to be exhausted-- and neither of them asked about apnea. I'm no doctor, but given what I've learned in the last couple of weeks, that'd seem like an obvious question to ask. "Do you snore at night? Wake up gasping for air?" I could have started on CPAP a few years ago!

As unbelievable as it seems not all doctor's are aware of the possible correlation between nocturia and OSA.
My own PCP picked up on the daytime fatigue and poor sleep in general and asked the "do you snore" question which landed me the cpap machine but totally didn't know about nocturia.
The reason I know this is because when we were discussing my successful OSA therapy in general at a subsequent general physical..I mentioned to him that the nocturia totally ceased and he said "what has that to do with it" and I went on to explain and he said "I had no idea...thanks for pointing that out and I will remember it for future patient discussions. I knew about the snore correlation and daytime fatigue but never thought about nocturia". Once the stress hormone thing was explained to him he understood totally how it could impact things but had never put 2 and 2 together.
Sometimes we expect our PCP or GPs to be a walking encyclopedia with total recall and know everything about everything and they are just human and can't be that encyclopedia.

They look for what is commonly perceived as the most obvious cause and with the male of the species then the first thing that jumps to their mind would be the prostrate especially for men pushing the age where the prostrate might be commonly starting to enlarge.

Now when I went to the sleep doctor for initial evaluation prior to any sleep studies...nighttime urination was on the little history sheet that I had to fill out. So then we discussed "do I pee a lot during the day too"...no I don't so... we then think that peeing a lot during the night might be an indication of OSA. If I had answered..yeah I pee every hour on the hour during the day too..then maybe I had other issues for excessive urination.

Sometimes the body just gets into a habit...wake up and go pee...the need to pee may not be the cause of the wake up but we just do it out of habit and not because the bladder is stretched to full capacity. If that is what is going on with you...then as you get more and more quality sleep with cpap therapy there's a good chance that the habit will get broken.

Update: I haven't gotten up more than once since Sept 17. So it DOES continue to get better. And I've had one occasion during that period when I didn't get up at all.