Nocturia and Sleep Apnea: What You Need to Know

It can be an all-too-familiar tale. You wake up during the night with the urge to urinate. It may happen more than once in the night. It can be frustrating as your sleep is disturbed -- and you may have trouble falling asleep again. In the morning, you’re tired and frustrated.  

Many of us consider these nocturnal bathroom trips to be increasing age or drinking too much in the lead-up to bedtime. However, a sleep disorder may also be causing your need to urinate during the night. Recent research points to a connection between nocturia and sleep apnea.

What Is Nocturia?

The urge to regularly urinate during the night is termed nocturia. Up to 50 million Americans experience nocturia, with 88% of regular nighttime urination caused by nocturnal polyuria – a condition where the bigger proportion of daily urine is produced during the night.

Nocturia can affect men and women, although the ratio can vary for different age groups. While more women between the ages of 18 to 49 can experience the urge to urinate during the night, this is typically a man’s problem from the age of 60.

The Link Between Nocturia and Sleep Apnea

Sleep apnea is another condition that affects the quality of your sleep. The more common form of this sleep disorder is obstructive sleep apnea, where a collapse of the airways causes frequent breathing pauses while you sleep. The brain reacts to the drop in oxygen levels by prompting the body to wake for air.

The arousal from sleep for air can be so short that someone with obstructive sleep apnea may not be aware of the issue. However, they can develop additional symptoms that include:

  • daytime fatigue
  • snoring
  • morning headaches
  • dry mouth
  • poor concentration
  • mood swings

One potential symptom that may be overlooked is nocturia, the regular urge to urinate through the night. Up to 50% of those with obstructive sleep apnea also experience issues with nighttime urination. This suggests a strong link between nocturia and sleep apnea and indicates that nighttime urination can be a sign of sleep apnea.

While the evidence points to a link between the two conditions, the precise nature of the connection is still a matter of debate. 

Low oxygen levels caused by breathing pauses may place additional stress on the bladder and increase the production of hormones that prompt urination – which may also result in an elevated heart rate. 

Multiple breathing pauses may result in the multiple urges to urinate associated with nocturia. 

Of course, in some cases there may simply be too much fluid which results in the urge to urinate.

Can Nocturia Cause Sleep Apnea?

Nocturia is not the cause of sleep apnea, but its presence can worsen the symptoms of your sleep disorder. Any co-existing condition that affects the quality of your sleep will negatively impact sleep apnea.

Regularly getting up through the night to empty your bladder will add to the sleep deprivation caused by sleep apnea. It is important to recognize this connection between nocturia and sleep apnea -- as addressing both conditions can improve the quality of your sleep. As sleep is such a vital restorative tool, improve your overall health too.

How Treating One Can Help Manage the Other

If you regularly feel the urge to urinate during the night, then you should discuss this with your health provider. Nocturia can be caused by the following:

  • drinking before bed
  • eating too many salty foods
  • pregnancy
  • diabetes
  • urinary tract infection
  • alcoholism
  • heart failure
  • enlarged prostate

However, if your health provider suspects obstructive sleep apnea may be a contributing factor, they may recommend a sleep study to aid diagnosis. 

Treating sleep apnea can help reduce nocturia while addressing nighttime urination issues can help better manage sleep apnea. 

As obesity is a major contributing factor to sleep apnea, lifestyle changes geared to weight loss may be recommended.

PAP therapy is also another leading treatment for obstructive sleep apnea. This involves a device that delivers pressurized air through a mask worn while you sleep. The air prevents the collapse of the upper airways and therefore prevents the breathing pauses and frequent awakenings for air associated with the disorder.

Medication, behavioral therapy, and in more severe cases, surgery can also be used to treat sleep apnea. It is important to work with your health provider or sleep specialist to reduce your sleep apnea symptoms. As well as potentially contributing to your increased nighttime urination, untreated sleep apnea increases your risk of heart disease, stroke, high blood pressure and diabetes. 

Tips on Reducing Nighttime Urination

Lifestyle changes that help reduce the symptoms of sleep apnea, including a balanced diet and exercise, can also benefit an overactive bladder. Similarly, behavioral therapies can be used to address nocturia and may involve bladder training to offer improved bladder control.

Some simple tips can help reduce your need to urinate overnight too. These include:

  • reducing the amount you drink in the couple of hours before you go to bed
  • avoiding alcohol and caffeine in the evening as these can contribute to the level of urine output
  • eating less salty foods and snacks
  • visiting the restroom right before bedtime to ensure your bladder is empty before sleeping

Medication could be prescribed if you continue to suffer from nocturia. The recommended medication will depend on any other underlying conditions and whether you are intolerant to alternative medications.

Final Thoughts

Although the reasons need further research, the statistics point to a link between nocturia and sleep apnea. If you suffer from a regular need to urinate at night, consult your healthcare provider. 

If sleep apnea is suspected of being a contributing risk factor, then treating both conditions will help you sleep better which in turn can help improve your quality of life.