Urinary Incontinence, Nighttime Urination, Worse With Poor Sleep

May 16, 2011

It’s commonly accepted that suffering from urinary symptoms can prevent you from getting a good night’s sleep. However, a recent study confirms more recent findings that suggest that poor sleep itself can lead to lower urinary tract symptoms (LUTS), such as incontinence, and nighttime urination. This study prospectively followed over 1600 men and 2500  women and found that having poor sleep significantly predicted later development of LUTS.

For example, short sleep duration and poor sleep quality doubled the likelihood of LUTS in men and increased the risk by 66% in women. Poor sleep itself was associated with an 80-90% increased odds of developing urinary incontinence and nocturia.

This study’s results aren’t surprising, since there have been numerous studies in the past showing that most people who go to the bathroom at night do so not because they make too much urine, but because they stop breathing and then wake up to go to the bathroom. (Not breathing at night makes your kidneys make more urine).  Another recent study revealed that going to the bathroom two or more times per night  increases your risk of dying from any cause by over 50%! This makes sense, since most of these people will have some degree of untreated obstructive sleep apnea.

If you feel like to have to go to the bathroom too often or get up at night to go to the bathroom more than 1-2 times every night, it may be worthwhile to address your sleep problems first before seeing a urologist.

Those of you with known obstructive sleep apnea, how many of you had any of these urinary symptoms before being diagnosed with sleep apnea?


Too Many Bathroom Trips At Night? See A Sleep Doctor First

March 24, 2011

There have been numerous studies that show that a major reason why people go to the bathroom to urinate frequently are doing so not because of irritable bladders or enlarged prostates, but due to an underlying sleep-breathing problem. Here’s another study that showed that about 58% of men with nocturia had obstructive sleep apnea. When treated for sleep apnea, nocturia can be significantly improved, if not completely cured in many cases. Prescription medication for this problem can’t even come close to these results.

Another recent study showed that going to the bathroom 2 or more times per night increased the mortality rate by 50% in men and 30% in women.

It’s been shown in numerous studies that the reason why you wake up is not because your bladder is too full—it’s because you’ve stopped breathing and you think your bladder is full, but it’s not. Here’s what happens: Every time you stop breathing, blood flow to the heart diminishes, but once you start breathing again, blood rushes back in your heart which dilates the heart chambers, making your heart think that you’re fluid overloaded. The heart then makes a hormone called atrial natriuretic hormone (or peptide), which makes your kidneys make more urine. At a certain point, with even a small amount of urine, you’ll feel like you have to go but only after you’ve woken up after an apnea event. Notice too, that urine volumes are typically not that large.

The thing that get me upset about all this is that despite all that we know about urinary frequency and its’ connection to obstructive sleep apnea, PCPs and urologists haven’t changed their ways at all. They continue to place patients on medications that help to relax the bladder, shrink the prostate, or even do surgery, which is like placing a band-aid. Treating with medications may help people go to the bathroom less often, but it won’t prevent cardiovascular morbidity and mortality. Treating an underlying sleep-breathing problem will not only treat nocturia effectively, it’ll also significantly lower your chances of dying.

I’m not saying that all cases of nocturia is from sleep apnea but since it’s so common, why not rule it out before looking at the more traditional options that require medications? (The same argument can be made for ADHD, depression, anxiety, heart disease, diabetes, etc.) If you have sleep apnea, treat that first, and if you still have symptoms, get checked by a urologist. What do you think about this idea?


Can Going to the Bathroom Too Often at Night Be Dangerous To Your Health

June 1, 2010

Here's a not too surprising study presented at the American Urological Association meeting: That two or more bathroom trips at night increases your chances of dying by 50% in men and 30% in women. The researchers mentioned poor sleep as a possible link, but didn't mention anything about obstructive sleep apnea. Studies have recently shown that the main reason why you get up to go to the bathroom is because you stopped breathing, and not because you make too much urine. Actually, you do make some more urine, due to increased production of atrial natriuretic hormone (ANH), due to dilation of the heart's atria during breathing pauses. 

The surprising finding in this study was that even in young men (20 to 49), two or more trips to the bathroom more than doubled the risk of death. This is also the age then obstructive sleep apnea begins to take hold. 

Knowing what we know, I believe that anyone who has to go to the bathroom too often at night, or even those that have to go often during the day should at least be screened for undiagnosed obstructive sleep apnea. What do you think?

Do You Have To Go A Lot? Nocturia, Urinary Incontinence, And Sleep Apnea

February 7, 2009

If you’re one of the millions of men and women who have to go the the bathroom far too often, or have embarrassing leaks of urine once in a while, here’s some important information that you should know. The New York Times (Feb. 3) reported on an article from the New England Journal of Medicine which revealed that postmenopausal women with urinary incontinence issues had significant improvement after losing weight. They also benefitted in other areas such as improvements in their blood pressure, lipids, sleep and libido.


Another article in this month’s Journal SLEEP reported that OSA is associated with overactive bladder in men with or without urinary incontinence. The worse the severity of OSA, the worse the level of urinary problems. Not too surprisingly, nocturia (getting up at night to go to the bathroom frequently at night) is a known complication of obstructive sleep apnea. 


Most people with these issues end up seeing a urologist initially and are placed on various medications that work to various degrees. However, a recent study suggests why you should see a sleep doctor instead—people who wake up in the middle of the night to go to the bathroom do so not because their bladders were full, but rather because they stopped breathing and then realized that they had a full bladder. OSA has also been shown to increase atrial natriuretic peptide (ANP), which is produced by the heart when it gets too much blood due to the sudden rush of blood after a lack of blood flow during an apnea episode. ANP causes you to make more urine to get rid of the excess fluid.


Something new to think about for all our senior citizens (and young adults too).

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