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Not needing to urinate (pee) at night.
I have seen several other posts about this topic, but there seemed to be no good consensus on whether the phenomenom is real or the cause.

I can definitely say that since only being on APAP for several weeks (and my AHI still isn't even optimal yet) my need to get up at night and urinate (pee) has stopped. I used to get up 1 (and sometimes 2) times a night to pee. I don't have any prostate problems, and I'm not taking diuretics, and just blamed it on too much fluids in the evening and plain "getting older."

Other posts on here and other sleep apnea boards eluded to the reason for sleep apnea suffers getting up was overactive bladder or being awakened easily, so using that as a chance to urinate before fallening back asleep.

I can say that those two reasons are definitely not the case. I used to need to get up 1-2 times and pee a large amount (sorry if that is TMI) each time. There is no way I could have waited for morning.

After starting APAP for a while, I have awakened to pee only once in the past 7 days, even with an AHI hovering around 9.

It is like magic - now I know it is just not too much fluid or "getting older".

So after this "discovery," I definitely believe that the amount of urine my kidneys was making was way too high at night (probably because I wasn't really sleeping). Probably more like daytime - having a full bladder every 3-4 hours. Now that I am sleeping more normally, I am rarely getting up.

Anyone else experiencing this? Is it men only or the same for women? Can anyone else confirm that it appears to be reduced flow from the kidneys, and not just going because they happened to be awake as others have believed?

Just curious.
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I have noticed exactly the same thing.
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It's not just men.....I used to wake up every 2 hours before using Cpap therapy.

But once I started therapy, I noticed the very first night that I didn't need to get up, and I rarely wake up now for that reason or any other.

Just one of the many benefits of Cpap therapy. Smile
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Do you believe it is due to less urine production or simply you just don't wake up as often while on XPAP therapy? (Were you going small or large amounts during the night?).
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I asked my sleep doctor about not having to get up at night and he did say something about kidney function being improved. If you do a search on the net there have been a few studies on cpap and kidneys
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I read someplace recently that your body produces less urine during deep sleep. Which makes sense as otherwise you would wake or wet yourself. Without CPAP you won't get as much deep sleep and your body could continue on your daytime schedule. I still get up to pee a couple times a night, but that is just because I am awake not because I really need to.
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You can google this and find many informative articles on this subject.

Stanford Center for Sleep Sciences and Medicine
By Brandon R. Peters, M.D.

Just like clockwork, it’s time to get up and pee again. If it seems like the bane of getting a continuous night of sleep in middle age and beyond, it may not have to be. Learn a surprising reason why you may have to wake to urinate at night and how improvement can occur without seeing a urologist, but a sleep specialist instead.

It is considered abnormal if you wake more than once at night to urinate. Ideally, you wouldn’t wake at all. These awakenings can disturb sleep and contribute to insomnia, especially when they occur frequently or towards morning. What causes frequent urination at night, a condition known as nocturia, and what can be done about it?

In both women and men, nightly awakenings to urinate appear to be associated with poor sleep, even when other factors such as pain and other medical conditions are taken into account. In fact, nocturia may be the single most common factor associated with poor sleep among the elderly (1).

Many people, including doctors, have the wrong idea about the cause of nocturia. Too often men of a certain age are told it is due to an enlarged prostate. Women might blame excessive fluid intake in the evening, a hyperactive bladder, loss of bladder control, or even menopause. Prescription medications are paraded out to mixed effect. Men may have painful procedures to reduce the prostate’s constriction of the urethra. What if something else entirely is to blame?

With aging, there is another phenomenon that often becomes apparent in sleep: obstructive sleep apnea. In fact, the risk increases 10-fold in women at the time of menopause (2). This condition is characterized by repeated pauses in breathing that lead to awakenings, sleep fragmentation, drops in blood oxygen levels, and - nocturia (3). Sleep apnea is associated with other classic symptoms, including:

Excessive daytime sleepiness
Insomnia (Frequent nighttime awakenings)
Witnessed pauses in breathing
Gasping or choking in sleep
Dry mouth at night
Night sweats
Teeth grinding (Bruxism)
Morning headaches
Concentration and memory problems
Mood problems
If any of these other symptoms are present, it may be necessary to investigate sleep apnea as a potential cause of nocturia. As an aside, in an important pairing alcohol often causes people to wake to urinate more at night because it also contributes to both snoring and sleep apnea.

Many people say that they get up to urinate because they are awake, their bladder feels somewhat full, and they aren’t sure that they’ll get back to sleep unless they do. As discussed, sleep-disordered breathing may trigger these awakenings, yet why is the bladder full?

The body normally releases anti-diuretic hormone (ADH) in sleep to prevent needing to wake to urinate. It works to shut down the kidneys, preventing movement of fluids from the blood vessels to the bladder. The bladder is like a storage balloon, and there is no need to wake to empty it if the fluid isn’t there to start. No matter how well or poorly the bladder may function, or whether an enlarged prostate obstructs or not, without urine filling the bladder from overactive kidneys, these other issues should not matter.

Research and clinical experience demonstrates that sleep apnea changes the release of ADH (4). More severe sleep apnea may lead to pulmonary hypertension and right-sided heart failure. The body responds to this strain by stopping the release of ADH, which causes more urine to be produced, filling the bladder and triggering awakenings to pee during sleep.

When sleep apnea is effectively treated, most often with the use of continuous positive airway pressure (CPAP), these effects are quickly reversed (5). CPAP delivers a constant flow of air through a face mask that keeps the airway open and prevents the associated changes. Both men and women wake less to pee at night. Sleep quality substantially improves as fragmented sleep is relieved.

CPAP doesn’t treat the bladder. It doesn’t shrink the prostate. It doesn’t make you less thirsty or dry you out. It doesn’t put you in a deep sleep so you can’t wake to pee. It simply treats one of the most common and often overlooked causes of nighttime urination. In so doing, those trips to the bathroom abate and often are fully eliminated.

For those who are convinced that getting up to pee is because of how much fluid was consumed in the evening, your age, an enlarged prostate or a weak bladder, think again. If you have some of the other symptoms associated with sleep apnea, meet with your doctor and get the evaluation and treatment you need to once again sleep through the night.

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This link on the Respironics blog gives a general explanation: The Link Between Bathroom Trips and Sleep Apnea

I'm still not sure I fully understand the reason. It has to do with obstructed breathing, lower-than-normal pressure in the chest cavity, and increased secretion by heart muscle of a hormone called ANP (Atrial natriuretic peptide).

So when you start CPAP treatment, ANP levels apparently go back to normal.

ANP isn't the only factor that can cause nocturia, according to Wikipedia. It just seems to be the one most often associated with sleep apnea.

I find all this fluid balance stuff to be hugely complex. Oh-jeez
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Same here. I used to get up 1 to 2 times per night. Now rarely. I just usually sleep through the night now.

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Post from Imgur

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I'm not a doc. And it has been several years since I stayed at a Holiday Inn Express, so take with a grain of salt. I'm just prattering and supposing, so feel free to quit reading if you're not interested.

I suspect that the apnea is putting a lot of stress on all the body's systems. I know heart has to work harder. It beats harder (higher blood pressure) and it beats more frequently as a reaction to stress. Now I don't know if the kidneys "ramp up" or produce more as a result of the stress, or if their function is more passive (ie, they just take out at a constant rate whatever the blood stream sends them), but even if they are passive, it would make sense to me that the more blood a stressed system passes through them, the more pee they would throw off.

That is just a very vague hypothenuse with no research or experimentation to bear it out. But I do believe it happens as enough first hand stories have been passed around on this forum. Me, personally, I've never had a regular pattern of night urination in over 50 years. But it is always the last thing I do befoer bed and generally the second thing I do when I get up, whenever that is. Maybe 03:00 or 08:30.
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