Waking Up To Pee at Night? A Common Sleep Disorder Could Be the Culprit

Did you know that sleep apnea and peeing during the night can be related? Two or more instances of nighttime urination (nocturia) are observed in approximately 80 percent of people with obstructive sleep apnea, says Carleara Weiss, PhD, MSH, RN a sleep science advisor for Aeroflow Sleep. However, not everyone who wakes up to use the restroom has sleep apnea. This is just one clue you can use to figure out what's going on with your health.

What is sleep apnea?

As mentioned above, sleep apnea is a breathing disorder that causes short, frequent pauses in breathing during sleep, says Dr. Smith. These pauses only last seconds at a time but can occur hundreds of times throughout the night, reducing oxygen flow and impacting both sleep quality and overall health, he adds.

There are a few different types of sleep apnea, Dr. Smith says. One of the most common types of sleep apnea is obstructive sleep apnea, which is when your throat muscles relax so much while you're sleeping that it narrows or blocks your airway. Central sleep apnea (which is less common), is caused by your brain sending mixed signals to your lungs and diaphragm—which essentially results in skipping a breath while you sleep. According to the Mayo Clinic, there's also complex sleep apnea syndrome, a combination type that features both sources of the disorder.

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"Sleep apnea is a very serious condition," says Angela Holliday-Bell, MD, CCSH, who spoke to us on behalf of Helight Sleep. Research shows that sleep apnea negatively impacts our quantity and quality of sleep and puts us at a higher risk of experiencing negative events like a car crash. "If it goes untreated, it can lead to things like high blood pressure, pulmonary hypertension—elevated blood pressure in the lungs—abnormal heart rhythms, cardiovascular disease, and stroke," she adds.

"I would consider [sleep apnea] more of a disorder than a disability. Sleep apnea is treatable and in some cases reversible, depending on the cause," says Dr. Holliday-Bell. How much deep sleep you need varies by person, but chances are if you have sleep apnea, you aren't getting enough. Insufficient sleep, and in particular, the oxygen starvation to the cardiovascular system as a result of sleep apnea, can lead to other health issues.

What are the symptoms of sleep apnea?

According to the National Institutes of Health (NIH), some of the most common symptoms of sleep apnea are: regular, super loud snoring, gasping for air while you're sleeping, irregular breathing while you're sleeping, daytime drowsiness, dry mouth, headaches, and waking up at night to pee.

Snoring is the most stereotypical symptom of sleep apnea. However, many women with sleep apnea don't snore. According to the NIH, female symptoms of sleep apnea more commonly involve anxiety, depression, daytime drowsiness, morning headaches, insomnia, and waking up in the night.

Sidenote: If you're feeling short of breath while lying down at night, and you're still awake, you could have something called orthopnea, which should also be checked out by your doc.

When waking up to pee every night is a sign of sleep apnea

Peeing at night is a condition known as nocturia. It's estimated that 50 million American adults suffer from the condition, with only 10 million of those diagnosed. "Individuals with nocturia often wake up multiple times during the night to urinate," says Dr. Lanna Cheuck, DO, a urologic surgeon based in New York City.

Nocturia is often its own thing. (More on that in a minute.) However, Dr. Smith says getting up to use the bathroom frequently throughout the night can be a sign of sleep apnea if accompanied by the other sleep apnea symptoms mentioned earlier (like snoring, gasping for air during sleep, dry mouth, etc.).

"Although the exact mechanism is not fully understood, the thought is that during sleep apnea episodes, the body gets less oxygen which makes the heart pump more blood faster, which can cause an increased volume of blood filtering through the kidneys, which makes more urine," says Aleece Fosnight MSPAS, PA-C, CSCS, CSE, NCMP, a board-certified physician assistant who specializes in sexual medicine and urology. (More urine equals a fuller bladder which equals more peeing during the night.)

Both Fosnight and Dr. Weiss recommend patients track their urinations throughout the night in a log, along with other symptoms like snoring, waking up with a dry mouth or dry throat, headaches, daytime sleepiness, dehydration, and mood swings.

What are other causes of peeing in the middle of the night?

There are many other reasons someone might wake up frequently to pee, says Fosnight. As we age, we don't get enough deep sleep which leaves us more susceptible to easy wakening. Waking up is a biological trigger for the bladder to signal that it's time to pee; however, if you're not sleeping deeply, it can result in waking you up to pee.

"Certain conditions such as diabetes and sleep apnea can lead to an increase in overnight urination due to hormonal changes," adds Dr. Holliday-Bell. "Certain medications can also cause frequent urination, like some diuretics used to manage high blood pressure, and drinking too much too close to bedtime can be a cause as well."

"Consuming large amounts of fluids, especially caffeinated or alcoholic beverages, close to bedtime can lead to increased urine production and the need to wake up to pee during the night," agrees Dr. Cheuck.

Many adults associate nighttime urination a "normal" part of aging and don't bring it up to their doctor, says Dr. Smith. However, it is important to discuss bladder health at your next check-up—along with any other observed symptoms.

Can sleep apnea cause bed wetting?

Although sleep apnea does wake you frequently, and can trigger an urge to urinate, you may not always catch yourself. "More frequent wakings to urinate can disrupt your sleep quality, leading to less restful sleep overall," says Dr. Holliday-Bell. If you have urinary incontinence (meaning you struggle to control your bladder), you may unknowingly wet the bed as well.

How to get treatment for sleep apnea

If you or your partner notice signs of sleep apnea, including waking up often to pee during the night, it's time to see a doctor to figure out what's going on. Diagnosis is super important for sleep apnea, says Dr. Smith. (This typically involves some kind of sleep study or overnight evaluation of your breathing and other sleep habits, per the Mayo Clinic.)

Treatments are largely based on the type of disorder you have, the severity, and your symptoms. One popular form of treatment is called continuous positive airway pressure (CPAP). This therapy involves wearing a mask connected to a machine that pumps a constant stream of air to ensure your airways remain open. Surgery is an option for curbing some symptoms, and you can talk to your doctor about mouthpieces you can wear to support your airways so you can sleep like a baby.

How can I manage peeing during the night?

If you wake up on the reg to pee during the night—but don't have any other symptoms of sleep apnea—you likely are just dealing with nocturia. Trying to limit the intake of liquids to 90 minutes before sleep can prevent you from getting up to pee at night. Dr. Cheuk specifically recommends cutting back on the 4Cs, aka beverages that are considered bladder irritants: Colas, Coffee, Citrus, Chocolate-based drinks.You might also want to try sleep apps to calm your mind and body before bed.

If you adhere to these rules and continue to experience nocturia, consider talking to a provider about your symptoms. 

"There’s a medication called DDAVP [desmopressin] that can be taken prior to sleep that helps to decrease the amount of urine you make at night," says Dr. Cheuck. "For women who have hormonal imbalances, such as perimenopausal or postmenopausal, hormone replacement therapy can help with overactive bladder symptoms and nocturia."

For people with penises, a medication like tamsulosin can help treat an enlarged prostate and reduce the need to pee at night. "If you truly have an overactive bladder that’s not based on volume of urine, then a medication to relax the bladder can be appropriate in certain patients," adds Dr. Cheuck.

Any tips for helping me sleep better?

There are a variety of calming and sleeping apps that will help ready your body for nighttime. "I love the app Better Sleep, which includes a number of bedtime stories, meditations, and sleep sounds that you can customize to help ease you into sleep," says Dr. Holliday-Bell.

Dr. Holliday-Bell also recommends soothing activities like taking a hot shower and reading a book. "Magnesium for sleep is also thought to be helpful. More research is needed but it is thought to possibly play a role in the production of melatonin." (And melatonin, ICYMI, is the stuff that primes your body for sleep.)

No matter what's going on, here's hoping you get a super restful night of sleep ASAP. And in the meantime, check out these ways to help you feel more awake to get you through the workday.

—reviewed by Jennifer Logan, MD, MPH