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Fri, Dec. 13

Nighttime restroom visits may be due to sleep apnea

Dear Dr. Rosenberg:

My husband is 72 years old. He is up repeatedly to urinate at night - usually four to five times a night. We have been to see a urologist who ran several tests and found nothing wrong. When my husband told the doctor that he snores, a sleep test was recommended. What could snoring have to do with his problem?

A: We have been bombarded with advertisements from pharmaceutical companies about prostate problems and getting up at night to urinate. Unfortunately, that is not always the case. Sleep apnea is one of the leading causes of excessive nighttime urination. When the person stops breathing, the right side of the heart is stretched. The upper chamber of the heart called the atrium, when stretched during an apnea, releases a hormone called atrial natriuretic protein. This hormone induces diuresis resulting in the urge to void. The frequent urination at night increases the incidence of falls, daytime fatigue, sleepiness and even depression. If the cause is sleep apnea, it can be easily treated.

Dear Dr. Rosenberg:

I am 32 years old and sleepwalk almost every night. I have been placed on several different medications, but I continue to sleepwalk. Since the medications are not working, do you have any recommendations for me?

A: First of all, if you have not had a sleep study, you should. Many adult sleepwalkers have an underlying sleep disorder such as sleep apnea or leg movements during sleep that precipitate the episodes. If you do not have a sleep disorder, then hypnosis has been shown to be an effective treatment in many patients who sleepwalk. However, you would need to find a professional who is certified and skilled in the use of hypnotherapy.

Dear Dr. Rosenberg:

I feel as if I don't sleep. The slightest noise wakes me up. I always wake up feeling fatigued. I was diagnosed with fibromyalgia several years ago, but am not being treated for it. Could my sleep problem be related?

A: Yes, it could. There are two schools of thought. One that feels fibromyalgia is a sleep disturbance that causes chronic pain. The other feels that pain causes the sleep disturbance. However, we do know that most patients with fibromyalgia are poor sleepers. They have trouble falling and staying asleep. When studied in a sleep lab, the majority show an awake pattern of brain waves called alpha superimposed on their sleep. We believe this is one of the major reasons that patients with fibromyalgia describe their sleep as non-restorative. The good news is that there are many new treatments available for fibromyalgia, some of which target the pain and the sleep disturbance at the same time. I would discuss your symptoms with your health care provider.

Dear Dr. Rosenberg:

I am an overweight diabetic. I snore and have heard that might be linked to my diabetes. My health care provider has been having a hard time controlling my blood sugar. Is there a possible relationship?

A: We are learning more and more about the relationship of sleep and diabetes. We know that insufficient sleep can contribute to diabetes. The incidence of sleep apnea is 23 percent in diabetics and 75 percent in overweight diabetics. These findings are substantially higher than found in the non-diabetic population. It would appear that lack of sleep or fragmentation of sleep, due to repetitive arousals as occur in sleep apnea, causes insulin resistance and poor diabetic control. I would mention this to your health care provider and get a sleep study. The test would show if you are just snoring or are actually having apneas.

Dr. Robert Rosenberg, board-certified sleep medicine specialist, will answer readers' questions by incorporating them in future columns. Contact him at askthesleepdoc@yahoo.com

or via mail at the Sleep Disorders Center of Prescott Valley, 3259 N. Windsong Dr., Prescott Valley, AZ 86314.

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