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Post-Polio Health (ISSN 1066-5331)
Vol. 14, No. 4, Fall 1998
Sleep-Disordered Breathing and Nocturia
Mary Umlauf, RN, PhD, Associate Professor, University of Alabama School of Nursing, Birmingham, Alabama
This article is a follow-up of the survey of symptoms regarding sleep and bladder function that appeared in Polio Network News (Volume 14, Number 3). At a later date, Polio Network News will summarize a formal report of this study as well as list an Internet address for the same. Dr. Umlauf is still accepting the Sleep and Bladder Health Among Polio Survivors survey. The purpose is to explore the magnitude of obstructive sleep apnea (OSA) symptoms and nocturia in persons who had polio.
Having a good night’s sleep is not an optional part of our lives; it is absolutely necessary to our health and well-being. Physically, sleep provides the body with time to rest and to recover from daily activities. All of us require a certain amount of dream sleep (rapid eye movement, or REM sleep) and deep sleep (slow wave, or delta, sleep) every night to function mentally. Any condition, whether it is pain, snoring, sleep-disordered breathing, restless legs, insomnia or nocturia (excessive urinating at night), can fragment our sleep and result in daytime sleepiness.
One of the most serious types of sleep problems is obstructive sleep apnea (OSA), which can cause hypertension (high blood pressure) and lead to heart failure. OSA, a reversible condition, is associated with both snoring and nocturia. OSA occurs when the soft upper airway over-relaxes and closes off or obstructs the passage for air when the person goes to sleep. The sleeper may snore loudly and then suddenly stop. An observer, usually a spouse, may note that the sleeping person is trying to breathe but is unable to. After a number of tense seconds, sometimes 20 or 30, the sleeper will wake up, take a big breath and resume snoring.
Often, the sleeper will not remember how many times these arousals occurred even though they may number in the hundreds. Here is the danger of sleep-disordered breathing: the sleeper may be unable to convey to a physician the exact nature and severity of the sleep problem.
Not surprisingly, nocturia is also frequently associated with poor quality of sleep. Getting up to void more than twice at night is considered abnormal because of sleep disruptions. For persons with mobility problems, having to urinate at night may also lead to falls or add to the difficulty of maintaining independence.
Although nocturia is usually assumed to be caused by either bladder instability or an enlarged prostate, it may also be a sign of OSA. In fact, recent studies have found a mechanical and hormonal relationship between OSA and increased urine production at night. The mechanics of obstructed breathing characteristics of OSA cause the heart to perceive false signals of fluid overload. In turn, the heart produces a hormone-like protein that causes the kidneys to increase their output. However, because this relationship between sleep-disordered breathing and nocturia is not generally understood among health care providers or the public, persons who have both nocturia and signs of sleep-disordered breathing may not seek help for these symptoms or may not receive appropriate treatment when they do report them.