In this video, Dr. Steven Park discusses a common medical condition that is often ignored as a cause of nighttime urination or nocturia. He explains that nocturia is not just a minor nuisance but can be strongly linked to various medical complications and even higher death rates. Dr. Park points out that almost all explanations for nocturia found online overlap and mentions common reasons such as drinking too much water before bedtime, diabetes, heart failure, and prostate enlargement. However, he emphasizes that the most common and often overlooked cause of nocturia is undiagnosed sleep apnea. Dr. Park provides seven steps to help alleviate nocturia, including treating sleep apnea if present. He concludes with a case study showing the improvement in nocturia and overall health after addressing sleep apnea and making lifestyle changes.
Key Insights:
- Nighttime urination, also known as nocturia, is a common problem that can be strongly linked to various medical complications and higher death rates.
- Common explanations for nocturia include drinking too much water close to bedtime, pre-diabetes or diabetes, congestive heart failure, liver problems, sleep problems, circadian rhythm problems, prostate enlargement, overactive bladder, kidney stones, and cancer.
- Of all the conditions mentioned, sleep apnea is often overlooked but should be a top consideration since it can lead to various health problems like high blood pressure, diabetes, heart disease, arthritis, and more.
- Upper airway resistance syndrome (UARS) is a condition related to sleep apnea where the upper airways and jaws slowly get smaller, leading to breathing cessation and frequent awakenings throughout the night.
- Waking up to urinate at around 3 a.m. is commonly associated with interrupted breathing during REM sleep, causing the bladder to fill up as a result of hormonal changes.
- Multiple wake-ups to urinate at night can significantly affect sleep quality and increase the risk of various health issues.
- To reduce nighttime urination, suggestions include avoiding eating and drinking late, maintaining a healthy sleep position, addressing nasal congestion, getting enough sleep, getting sunlight exposure during the day while avoiding lights at night, and losing weight. It is important to consult a sleep doctor to get tested for sleep apnea.
- Treatment for sleep apnea not only alleviates nighttime urination but also improves other health conditions like kidney stones, high blood pressure, pre-diabetes, arthritis, and headaches.
Transcript
Are you waking up once or more at night to urinate? In this video, I’ll reveal one very common medical condition that almost no one talks about as a cause of nighttime urination.
Hi, I’m Dr. Steven Park, ENT surgeon, and sleep doctor, helping you to breathe better and sleep better so that you can wake up refreshed and have energy to enjoy life again.
I’m going to cover what causes nighttime urination, why it’s potentially dangerous to your health, what one condition that causes it is often ignored by most experts on YouTube, and how you can get rid of it in seven easy steps. Stick to the end, and I’ll show you how you can sleep through the night for the first time in years.
Nighttime urination, or nocturia, is a very common problem, even happening in children and young adults. It’s not just a minor nuisance but can be strongly linked to various medical complications and even higher death rates.
I was wondering what the most common explanations are for nocturia on YouTube, so I recently spent many hours watching the top 25 videos about nocturia. All the explanations I saw online overlapped a lot between all the different videos. The most common reasons mentioned were drinking too much water close to bedtime, pre-diabetes or diabetes, congestive heart failure, liver problems, sleep problems or circadian rhythm problems, prostate enlargement, overactive bladder, kidney stones, and cancer. Only a few mentioned sleep apnea, and very briefly. When it did come up, it was mentioned alongside many other possible conditions as a somewhat rare condition.
It’s important to note here that with the exception of drinking too much water, all of the above conditions can be caused by untreated sleep apnea. Also, about half the videos were promoting various medications, telling you to see your doctor, or even being sponsored by a drug company or hospital. Honestly, you want to avoid medications since all have side effects and ultimately they don’t really treat the root cause of the problem.
I can’t emphasize enough here, if you do suffer from nocturia, sleep apnea should be the first condition you should be thinking about. Since sleep apnea is extremely common in our country, in fact, about 20 percent of the US population has sleep apnea, of which 80 to 90 percent are not diagnosed. Being obese or having various other medical conditions dramatically raises your risk of sleep apnea. In fact, 86 percent of obese diabetics were found to have sleep apnea.
We know that untreated sleep apnea can lead to any or most of the following: high blood pressure, diabetes, headache, heart disease, arthritis, skin problems, digestive problems, memory problems, heart attack and stroke, seizures, weight gain, kidney stones, sexual dysfunction including erectile dysfunction, anxiety, and depression. Believe it or not, this is a very abbreviated list.
We also know that sleep apnea can be seen in even young, thin women that don’t snore. You don’t even need to have sleep apnea to suffer from poor sleep. In fact, many young, thin, healthy-looking men and women will have what’s called UARS (Upper Airway Resistance Syndrome) who don’t quite meet the criteria for sleep apnea but still stop breathing a lot, which causes multiple brain micro arousals and sleep fragmentation. In my other videos, I describe why this is happening. It’s mainly due to our jaws and upper airways slowly getting smaller. Look for titles that include upper airway resistance syndrome or UARS.
What happens during apneas, whether for sleep apnea or UARS, is the following: what you see here is tracings of normal breathing. Here’s airflow from the nose, the mouth, and effort leads on the chest and abdomen. This is the tracing of a normal breath in and breath out. Up is in, and down is out, and the x-axis is seconds, with this interval being 10 seconds. This is an apnea where you have no flow at all in the nose and mouth channels, but you still have movement or respiratory effort in the chest and abdomen leads. Since the total time there’s no breathing is more than 10 seconds, it’s called an apnea. You can also have partial obstruction to breathing with more than 30% blocked airflow in the nose for more than 10 seconds. If you also have a drop in your oxygen level of more than 4%, then that’s scored as a hypopnea.
You need at least five total apneas or hypopneas per hour to say that you have obstructive sleep apnea, as long as you have other symptoms or medical complications such as high blood pressure, diabetes, or heart disease. However, if you stop breathing 20 times every hour, but only for eight to nine seconds each, then your score on the sleep side is zero, so you’re told you don’t have sleep apnea and there’s nothing wrong with you. This condition is what’s called upper airway resistance syndrome.
Here’s a tracing of breathing patterns from Dr. Christian Gimlino’s original 1993 article describing UARS. Here you take a deep breath in against a closed throat. This creates a very negative or vacuum pressure in your chest cavity, and this is measured by a pressure catheter in the chest cavity. When you take a deep breath in against a closed throat, the heart gets stretched out too much due to the negative pressure forces. The heart gets fooled into thinking there’s too much blood coming in, and it stretches the right atrial chamber. This leads to the creation of a hormone called atrial natriuretic peptide, which goes to the kidneys to create urine and pee out liquids when you shouldn’t be, since you’re sleeping.
This hormone is made in patients with both upper airway resistance syndrome and obstructive sleep apnea. Now, I’m willing to bet that a lot of you watching this have to urinate at night. If so, how many times every night do you go to the bathroom? And if you wake up only once, at what time usually does that happen? Please enter your answer below. It’s okay to wake up once in a while to pee as long as it doesn’t bother you. But if it happens three, four, or five times every night, it’s going to wreak havoc on your sleep as well as your health in general. And here’s why.
You most likely wake up around 3 a.m., plus or minus 15 to 30 minutes, depending on your regular sleep time. During the night, you cycle through four to five sleep cycles, with each cycle lasting about 90 to 120 minutes. In the beginning, you’ll have longer periods of deep sleep, but with each sleep cycle, it gets shorter and shorter. Your first REM sleep period, which is when you’re dreaming, happens at the end of the first cycle, but it’s very short. But with each cycle, it gets longer and longer, with the periods starting around 3 a.m. being the longest.
Now, REM sleep is when you’re dreaming, but it’s also when all your muscles are completely paralyzed, except for your eye muscles and diaphragm muscles to keep you breathing. If you have any apneas throughout the night, you’ll create more urine than normal due to the steps I described above. However, once you reach 3 a.m., you’re more likely to stop breathing during REM sleep, and when you wake up, your bladder is partially or completely filled, and you think you have to go to relieve yourself. If you have more severe apneas throughout the night, you’ll create more atrial natriuretic peptides throughout the night, making more urine, waking up at 90-minute intervals of REM sleep.
Another reason why you wake up at 3 a.m. is due to a lack of what’s called the sleep drive. Before you go to sleep, you’ll feel very sleepy due to the building neurotransmitter adenosine. But sleeping naturally lowers your sleep drive and adenosine, so you’re more arousable in the second half of the night. For most people, it’s been shown that what causes you to wake up is not from a full bladder but as a result of an apnea. This is confirmed by papers showing that in people with nocturia, the physiologic event that wakes them up isn’t a full bladder but obstructed breathing, but they’ve been making a bit more urine throughout the night.
So why is your risk of dying much higher overall if you wake up to pee at night? This study of over 15,000 men and women linked the number of times they went to the bathroom at night and all-cause mortality, meaning death for any reason. Overall, they found that going to the bathroom two or more times per night raised your risk of dying from any reason by over 50% in men and 30% in women. For women between 50 and 64, it was over 90%, for men between 20 and 46, it was 250% higher for two times per night, and almost 400% higher for three times or more.
This study didn’t come out to say that these increases were from sleep apnea, but I’m going to argue that a significant percentage, if not the vast majority, are due to untreated sleep apnea.
So what can you do to stop waking up at night to urinate? Some of these suggestions are on other people’s lists, but if you have undiagnosed sleep apnea, it can make many of the other conditions much worse. Here are the seven things to start with:
1. No eating late.
2. Don’t drink alcohol late, close to bedtime.
3. Watch your sleep position, especially staying off your back.
4. Address any nasal congestion.
5. Sleep seven to eight hours.
6. Get lots of sun exposure in the daytime and no lights at night.
7. Lose weight as much as possible.
If you don’t see any progress, go see a sleep doctor to get tested for sleep apnea before you see a urologist or an OBGYN. If you see a sleep doctor and are found not to have sleep apnea, then go down the list of other conditions.
What I saw happening all the time is that once patients are treated for sleep apnea, not only does the nighttime urination get much better or go away completely, but many of their other problems get better as well, such as their kidney stones, high blood pressure, pre-diabetes, arthritis, headaches, and heart rhythm problems.
Ultimately, Vivian gained about 15 pounds over the past two years, on top of her being a bit overweight, and the husband had mentioned that she’s been starting to snore more. Of note, she started a new job 12 months earlier and was getting home later, so she was eating closer to bedtime. She made some adjustments to her dinner time, eating much earlier and cutting down on carbohydrates and eating much healthier fats. She also took early morning walks and went outside to have lunch in the sun. In five months, she lost 25 pounds and now feels and sleeps like she’s 30 years old again.
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