Sleep Apnea And Overactive Bladder

International Journal Of Clinical Pediatrics

Volume 4, Number 2-3, October 2015, pages 145-148

Sleep Disorder in Children With Overactive Bladder

Parsa Yousefichaijana, Ali Khosrobeigib, d, Shima Zargarb, Bahman Salehic

aPediatric Nephrology, Department of Pediatrics, Arak University of Medical Sciences, Arak, IranbDepartment of Student Research Committee, Arak University of Medical Sciences, Arak, IrancDepartment of Psychiatry, Arak University of Medical Sciences, Arak, IrandCorresponding Author: Ali Khosrobeigi, Students Research Committee of Arak University of Medical Sciences, Arak, Iran

Manuscript accepted for publication August 18, 2015Short title: Sleep Disorder in Childrendoi: http://dx.doi.org/10.14740/ijcp212w

Background: Children with an overactive bladder typically exhibit urinary frequency, urgency and urge incontinence. The present investigation was conducted to evaluate the relationship between sleep disorders and hyperactive bladders in children.

Results: The mean score of nine different sleep disorders was 0.38 ± 0.87 for control subjects and 2.24 ± 1.73 among case patients. Obtained data show significant differences between the two groups in terms of sleep disorders .

Thoughts On Sleep Apnea And Nighttime Urination

Frequent Nightime Urination And Sleep Apnea

Waking to urinate throughout the night is known as nocturnia. Many people who suffer from nocturnia believe this condition is caused by a urological disorder or feel it is simply a part of aging. Recent studies show the problem could be caused by something elsesleep apnea. Heres what you need to know about nocturnia and sleep apnea.

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Alternative Treatments For Nocturia

Many people turn to complementary and alternative medicine before seeking medical help. You may also be interested in alternative medications or treatments for nocturia, but there are few studies to support their use. These treatments may work for nocturia, but only if OAB is the cause.

For example, research has found that:

• herbal medications have a positive impact on symptoms of OAB and quality of life
• acupuncture provides short-term relief for OAB symptoms
• homeopathic remedies may have benefits, but need more studies
• alternative treatments have fewer side effects than medications
• saw palmetto berry extract has no benefit for nocturia

But more research is needed to confirm if CAM works for OAB.

Always talk to your doctor before trying a supplement or alternative treatment. Certain CAM treatments can cause unintended side effects, especially if youre already taking medication.

Medical Treatments For Nocturia

Your doctor may prescribe medications when preventive measures and lifestyle changes fail to reduce the frequency of your nighttime urination. Doctors prescribe a class of drugs called anticholinergics to treat symptoms of OAB, if thats the cause of your nocturia. They reduce bladder spasms that create the urge to go.

Your doctor may suggest you take a diuretic for regular urine production. A diuretic can itself cause nocturia. But if you take it early enough in the day, it may help you get rid of excess fluid while youre awake. This should decrease your urine production at night.

Other drugs that may help are:

• desmopression in cases of diabetes insipidus to cause the kidneys to produce less urine
• tamsulosin , finasteride , or dutasteride to treat prostate enlargement
• antibiotics if you have a urinary tract infection

Your doctor may also adjust your diabetic medications to lower your blood sugar if theyre causing nocturia.

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Can You Prevent Having To Pee At Night

There are several things that you can do to help prevent having to pee at night due to OAB. These include:

• Reduce fluids in the evening. While its important to stay hydrated during the day, limit your intake of fluids, especially ones that contain alcohol and caffeine, in the 2 to 4 hours before you go to bed.
• Double void before bed. Some people with OAB have trouble fully emptying their bladder. Double voiding, or emptying your bladder twice, can help. Before going to bed, empty your bladder once, wait several minutes, and then try again.
• Avoid triggers. Some foods and drinks can irritate the bladder and may increase your need to urinate. Some that you may want to avoid, especially later in the day, are:
• alcohol

• acidic foods, like citrus fruits and tomatoes

• spicy foods

Since coping with nocturia due to OAB can be stressful, its also a good idea to make sure your bedroom is an environment that promotes sleep. A few things to consider include:

• setting up a sleep schedule and a relaxing bedtime routine that you can stick to
• making sure that your bedroom is dark, quiet, and a comfortable temperature
• limiting or avoiding the use of TVs, cell phones, and computers or tablets in your bedroom
• making sure the path to the bathroom is clear, in case you need to get up to urinate

How Is Nocturia Diagnosed

To help your healthcare provider diagnose nocturia, you can keep a fluid and voiding diary. This is a two-day record of how much you drink, how often you have to go the bathroom and how much you urinated . You should also record any medications you are taking, any urinary tract infections and any related symptoms. Your healthcare provider will review the diary in order to determine the possible cause of and treatment for the nocturia.

Your provider may ask you the following questions:

• When did this condition start?
• How many times do you need to urinate each night?
• Is there a large or small volume of urine when you void at night?
• Has there been a change in urination output ?
• How much caffeine do you drink each day, if any?
• Does frequent urination during the night keep you from getting enough sleep?
• Do you drink alcoholic beverages? If so, how much each day?
• Has your diet changed recently?

In addition to reviewing your voiding diary, your doctor may order a urinalysis to examine your urine for infection.

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How Common Is Nocturia

Nocturia is quite common among both men and women. Studies and surveys have found that 69% of men and 76% of women over age 40 report getting up to go to the bathroom at least once per night. About one-third of adults over age 30 make two or more nightly bathroom trips.

Nocturia can affect younger people, but it becomes more common with age, especially in older men. It is estimated that nearly 50% of men in their seventies have to wake up at least twice per night to urinate. Overall, nocturia may affect up to 80% of elderly people.

Rates of nocturia have been found to be higher in people who are black and Hispanic than in white people even when controlling for gender and age. The reason for this disparity is not well understood.

Nocturia frequently occurs during pregnancy but usually goes away within three months after giving birth.

Side Sleep For Sleep Apnea

Sleep apnea has been linked to OAB symptoms in both men and women. This may be due to the effects of apnea events, which can cause low tissue oxygen in the body, including in the urinary system. However, more research is still needed.

If you have sleep apnea and OAB, sleeping on your side may help. Its estimated that moving from sleeping on the back to sleeping on the side can eliminate sleep apnea symptoms in about 20 percent of people.

Managing sleep apnea can also help with your OAB symptoms. A 2021 study found that participants who used continuous positive airway pressure or surgery for sleep apnea had a significant reduction in OAB symptoms.

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What We Know Now About Oab & Osa

Even though both of the above studies secured similar results about the relationship between overactive bladder and sleep apnea, researchers still do not know how overactive bladder and OSA are related or which one might influence the other. However, scientists say that the studies have clinical implications: when a patient is diagnosed with OSA, he or she should be screened by a doctor to look for signs of OAB so that that health condition can also be treated.

When To See A Provider

Because enuresis can be the result of another underlying medical condition, experts recommend that all adults experiencing nighttime bedwetting see a healthcare provider as soon as possible. They’ll be able to review your medical history, discuss symptoms, and perform any tests needed to get an accurate diagnosis, and they can rule out any other serious medical conditions. From there, you’ll be on the road to the best treatment option.

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Best Sleeping Positions For An Overactive Bladder

Theres not currently much specific research into whats the best sleeping position for OAB. A general rule of thumb is to select one thats both comfortable to you, leads to restful sleep, and doesnt contribute to pain upon waking.

There are a few points about OAB, sleep, and body position that are important to know. Lets examine these now.

Overactive Bladder Linked To Sleep Apnea In Women: Study

Overactive bladder is linked to sleep apnea in women, according to research. Overactive bladder is characterized by a higher frequency and urgency to urinate, along with incontinence and frequent awakenings throughout the night to urinate . The need to urinate throughout the night is also a common symptom of sleep apnea, but little research looking at the two conditions together has been conducted.

The findings come from researchers at the Hospital del Mar in Barcelona, Spain. Seventy-two female participants completed questionnaires about their symptoms related to bladder control, urgency and frequency of urination, incontinence, and nocturia. The women were also asked to rate their discomfort with each of the symptoms.

The sixty-two women diagnosed with sleep apnea also had significantly higher scores on the prevalence of bladder symptoms.

Lead author Núria Grau said, Overactive bladder has a prevalence of 16 percent among people over 40 years in Europe, and it is a difficult condition to live with, affecting a persons quality of life. The findings of this study provide evidence that bladder control could be linked to sleep apnea, although we do not know whether one of the conditions causes the other. The next step in our research is to investigate the role of continuous positive airway pressure therapy in these patients and its impact on the symptoms of overactive bladder.

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Strengthen Your Pelvic Floor

As part of treatment, your health provider or specialist may recommend pelvic floor exercises, says Dr. Firoozi. These can strengthen the muscles around the bladder, which helps to control urine flow and may reduce incidence of bladder signals at night. One study showed that regular training sessions of these exercises provided significant improvement for participants, including overnight. Dr. Firoozi suggests getting a referral to a pelvic floor therapist, who can teach you how to engage these muscles properly and develop a tailored at-home training plan.

What Are The Causes Of Nocturia

There are many possible causes of nocturia, depending on the type. The types of nocturia include:

• Polyuria.
• Nocturnal urinary frequency.

Polyuria

People with polyuria urinate > 3,000mL in 24 hours. This is usually caused by there being too much water filtered by the kidneys. It can also happen if something is in the urine, pulling the extra water out, such as sugar .

The causes of polyuria can include:

• High fluid intake.
• Untreated diabetes .
• Diabetes insipidus, gestational diabetes .

Nocturnal polyuria

Those with nocturnal polyuria experience a high urine volume only at night. Their urine volume during the day is normal or reduced. This is usually due to fluid retention during the day that often accumulated in the feet or legs. Once you lie down to sleep, gravity no longer holds the fluid in your legs. It can re-enter your veins and be filtered by your kidneys, producing urine.

The causes of nocturnal polyuria can include:

• Congestive heart failure.
• Edema of lower extremities .
• Sleeping disorders, such as obstructive sleep apnea .
• Certain drugs, including diuretics , cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D.
• Drinking too much fluid before bedtime, especially coffee, caffeinated beverages or alcohol.
• Having a diet thats high in sodium.

Nocturnal urinary frequency

The causes of an inability to fully empty your bladder can include:

The causes of an inability of the bladder to fully fill can include:

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Sleep Apnea And Erectile Dysfunction

Although, it might be surprising the stress of sleep apnea can contribute to a lot of issues with your internal plumbing, including erectile dysfunction and a decreased sex drive.

“Yes, sleep apnea is linked with erectile dysfunction and a lowered sex drive. Although we still don’t know the exact cause, we do know that having sleep apnea usually leads to a decrease in testosterone, which is important for having a healthy erection. Also, it is suggested that the sleep deprivation from sleep apnea causes fatigue, which also plays a role in the lowered sex drive in people,” explained Dr. Haissam Dahan, DMD, MSc, Ph.D., lecturer at Harvard and McGill University.

When the feeling is right, it can be ruined by the stress and fatigue brought on by sleep deprivation can quickly put the fire out. Plus, as well as decreased testosterone, sleep apnea can also lead to decreased oxygen, which is needed for a healthy erection.

Nocturia And Nocturnal Polyuria Are Symptoms Of Obstructive Sleep Apnoea

Greenstone and Hack comprehensively reviewed the diagnosis and management of obstructive sleep apnoea .1 From a urological standpoint, another important symptom of OSA is nocturia, particularly nocturnal polyuria. Nocturia is often the primary reason for urological referral and rated by patients as their most bothersome lower urinary tract symptom.

Nocturnal polyuria is defined as more than one third of the total daily voided volume being passed between 12 pm and 8 am, whereas nocturia alone indicates waking to void one or more times during sleep. Nocturnal polyuria is diagnosed after patient self assessment of voiding patterns using a frequency volume chart. Bladder outflow obstruction , overactive bladder, intravesical disease, diabetes, and fluid overload should also be considered.

Possible pathophysiological mechanisms include large negative swings in intrathoracic pressure that result in cardiac mediated diuresis.

Healthcare professionals, mainly primary care doctors, should consider OSA and sleep patterns in patients presenting with nocturnal polyuria and nocturia.

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Sleep Apnea And Nighttime Urination

Weve know for many years that frequent bathroom trips at night are not due to bladder or prostate problems, but mostly due to breathing pauses that make you wake up and and think that you have to go. Numerous studies have shown that most men and women who have to go to the bathroom often at night or have overactive bladders during the day actually have sleep apnea.

A new study confirms these findings again, but points out that the presence of frequent trips to the bathroom is as sensitive in predicting obstructive sleep apnea as snoring!

Sleep apnea also makes the body produce more urine, and because you wake up every few hours, youll want to go, but you wont have a completely full bladder. Sudden shifts in blood flow into the heart after an obstructive event increases production of atrial natriuretic peptide, which makes you produce more urine. One study found that diluted levels of urine during these episodes is also predictive of having obstructive sleep apnea.

I often see complete or near total resolution of these sort of problems after definitive sleep apnea treatment.

Do you suffer from frequent nighttime urination, or have an “irritable” or overactive bladder during the day? Please enter your responses in the box below.