Ask the Pharmacist

Q) I have been having difficulties with having to ‘pee’ frequently during the night. I had assumed it was my prostate but my urologist suggested it might possibly be related to sleep apnea and has suggested I get referred to a sleeping clinic. Does this make sense?

A) By now, given the high incidence of sleep apnea in the Canadian population, many of us are aware of this condition and are somewhat cognizant that it is at least somewhat associated with snoring, obesity and an increased risk of poor cardiovascular outcomes. But ongoing research is bringing to light an array of symptoms that we hadn’t traditionally associated with sleep apnea that are extremely common in both sexes as we traverse through our 40’s and beyond.

Sleep apnea is quite common but yet a serious disorder. In 2017, 6.4% of Canadians reported they have been diagnosed with this by a health care professional. Of course, there are probably many more who go undiagnosed, as is the same with just about any other common medical condition. In sleep apnea, your breathing essentially starts and stops throughout your slumber depriving your vital organs of the necessary levels of oxygen they require to function properly. While many self-diagnose themselves to be just “regular” snoring, sleep apnea is a different and a more serious condition.

In apnea, the snoring tends to be louder (no small deal for your roommates), there are longer pauses (sometimes for over 10 seconds) between breaths, the breaths tend to be shallow and of a gasping or choking nature and the affected individual appears to be restless. The symptoms of sleep apnea vary but often include snoring (although it is possible to have this condition and not exhibit snoring), daytime fatigue, a dry mouth or sore throat upon awakening, depression/ anxiety, nighttime restlessness, headaches and sexual dysfunction.

However, there are a number of symptoms that have more recently come to light that many of us would not typically associate with this. One such atypical symptom of sleep apnea is nocturia, which is a condition that is loosely defined as an increased rate of urination during the night. For many with noctura, we seek traditional therapy that might involve drug therapy, physio-therapy aimed at strengthening and stretching the muscles in our pelvic region, lifestyle alterations such as decreased caffeine, alcohol, evening fluid intake and when all else fails, possibly surgery. Some patients however fail to respond to these treatments which leaves them, and their doctors, in a conundrum.

One possible answer for this nocturia that is unresponsive to usual treatments is sleep apnea. An analysis of 13 studies found that patients with apnea indeed had a very high incidence of nocturia. Another study looking at the impact of CPAP therapy on nocturia noted that nighttime voiding incidents decreased by almost half when therapy was initiated. It turns out that nighttime sweating/ hot flashes is another possible symptom of undiagnosed sleep apnea as well. 31% of men and 33% of females with apnea complained of being bothered with night sweats which is usually only seen in about 10% in the general population. Treatment of these patients with positive airway pressure eliminated this condition in many of them and as such, sleep studies should be considered in those patients suffering from hot flashes who’s condition cannot be explained by traditional causes (e.g. menopause, hormone blocking drugs….).

Sleep apnea has also been found to be the culprit, at times, behind the challenges some of us may be having with our memory and our ability to think clearly. A review of 42 studies that looked at this subject found that there is widespread acknowledgement that untreated sleep apnea impairs several of our so-called executive functions. These include our ability to immediately recall things we have just been told (such as names), our abilities to learn and recognize as well elements of our visuospatial memory (which leads to problems with driving or bumping into things as distances are not judged correctly).

Once again, there can be many other contributing factors (including ageing of course) but in people who otherwise do not appear to have mild cognitive impairment or dementia, a sleep study to rule out apnea might be a worthwhile expenditure of time. Stay tuned for future columns (barring some important COVID-19 updates) as we discuss the different types of sleep apnea, how the condition is diagnosed and the different ways of treating it which traditionally have relied upon the ‘not always beloved CPAP machine’ but has now expanded to include other possible solutions that some may find less cumbersome to use. For more information about this or any other health related questions, please contact your pharmacist.