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February 4, 2019

Why do I get up frequently to pee at night?

By the time you’re an adult, your body has trained itself to send the bladder into a form of hibernation while you’re asleep. Ideally, this natural action allows us to enjoy the full benefits of a long night of restful sleep, sometimes accompanied by the need to pee in the morning. But in reality, this isn’t always how the evening plays out.


The frequent need to urinate during the night, so much so that multiple bathroom trips are part of your nightly routine, are likely symptoms of a greater health concern. Many patients reporting these issues are sent to urologists or gynecologists, but there’s another kind of doctor that should be at the top of this list: a physician specializing in sleep apnea.


The need to get out of bed at night to urinate is called nocturia. A recent research study reported that over 84% of patients known to have sleep apnea reported a frequent need to urinate at night. This especially high instance of nocturia has prompted many sleep doctors to use it as a question to bring up with their patients when screening for sleep apnea.


It’s not unusual for nocturia to bring someone out of a sleeping state one or twice every few nights. But when those nighttime trips to the bathroom are frequent and often, it isn’t normal, and could be a signal that something more is happening to interrupt your sleep in this way.


Some people think that a full bladder is what wakes us up. This isn’t always true. In fact, the act of waking up is the inciting action that wakes up your bladder, and sleep apnea can sometimes trigger this action.


So why does sleep apnea happen? When we’re awake, we’re usually sitting or standing upright, and this position helps to support the muscles around our throat to keep our airway open. But when we lie down, gravity works against us, pulling the tongue and soft palate into the back of the throat. Sometimes, the jaw and tongue can shift so much that they end up partially or wholly blocking the throat.

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This blockage causes the flow of oxygen to become obstructed or outright halted for short periods of time. When these interruptions occur frequently enough, it could mean that you have sleep apnea.


When the brain is made aware of a blockage in oxygen within the body, it gets an alert that something isn’t right. At the same time, the heart rate rapidly speeds up, and can receive a false signal of fluid overload. To combat this, a special protein is excreted. This protein tells the body to get rid of water and sodium, which results in nocturia. Due to the need to urinate, this awakening also causes the airway to reopen and begin regular breathing again. But by this time, you’re probably already up and headed for the bathroom.


To be sure, frequent episodes of nocturia can also point to other health conditions, like an enlarged prostate or issues with the bladder or kidneys. Your doctor will be able to assess your situation and help you determine what’s going on. Additionally, if a diagnosis of sleep apnea results from you visit, a physician specializing in sleep health will be able to work with you to figure out a treatment program.


There is some good news regarding the link between urinating at night and sleep apnea: when proper treatment is received, incidents can be greatly reduced. You can work with your sleep physician to see if treatments like positional therapy, weight loss, CPAP, or a custom mouth guard from a sleep dentist can get you on track to healthier sleep and less midnight trips to the bathroom.