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?