Tuesday, November 30, 2021

5347 - Over active bladder? Not really

I saw this online. I'd never heard this explanation before. And I don't have a problem getting up a few times a night and going right back to bed and falling back asleep.


Dear Dr. Roach • I am a 69-year-old woman in good health. For a couple of years, I have had increasing trouble sleeping because of having to get up during the night to urinate. It is now four to eight times per night. I am careful not to drink much after early afternoon. I have a healthy diet and get plenty of exercise. My primary physician treated me for overactive bladder, which did not work. I have seen two urogynecologists. They both told me that I am producing way too much urine at night because my antidiuretic hormone levels are very low. They also told me that the medication normally given for that cannot be given to people over 65 due to cardiac side effects. Do you have any ideas? Should I see a kidney specialist? This is seriously affecting my quality of life. I feel that if I have to live with this for the rest of my life, it may be a short one. — A.E.S.

Answer • The body has several systems in place to allow people to sleep through the night without having to get up to urinate. One of these is a hormone called arginine vasopressin, also called antidiuretic hormone. It is usually at a high level at night. Unfortunately, this system doesn’t work so well in many older people, and can sometimes invert entirely so that the levels are low at night, and people need to urinate more. One treatment for this is to give the hormone in a form called desmopressin, often abbreviated DDAVP. It is given by injection, or via nasal spray or oral tablet.

The side effect your urogynecologists are concerned about is low sodium levels (hyponatremia), which is extremely common in people over age 65 when taking this medication, and most experts will not prescribe it for older people. Women are at even higher risk than men. The Food and Drug Administration has a black box warning, the highest level of concern, that DDAVP is recognized to “cause hyponatremia” and that “severe hyponatremia can be life-threatening, leading to seizures, coma, respiratory arrest, or death.” Even in studies with people who were carefully monitored and where lower doses were tried, participants still developed serious hyponatremia at a rate that was concerning (up to 30%).

Other options include using a dose of a diuretic in the afternoon, so your body is as “dry” as it can be before bed; sleeping medications; and a newer treatment called posterior tibial nerve stimulation.


10 comments:

Elephant's Child said...

Oh joy, oh bliss. Something else to look forward to.
And yes, I get up several times a night.

jenny_o said...

I'm not at all sure I'd want to take a sleeping medication if I was getting up four to eight times a night to use the bathroom. There could be an unintended, different problem created.

I do feel for the lady in question. That's a lot of sleep disruption.

Mike said...

Sue - The golden years may have a different meaning.

Jenny - They make pills to take at night to keep you from peeing. And if those don't work there are always paper underpants.

Bilbo said...

I used to have to get up a gazillion times a night to go to the bathroom. When I was diagnosed with sleep apnea, the doctor told me that most of those visits to the bathroom weren't because I actually had to pee, but because my body thought "well, since I'm up anyhow, I may as well go to the bathroom." Since I started using my CPAP machine years ago, I almost never have to get up and pee during the night. Problem solved!

Margaret (Peggy or Peg too) said...

So I need a CPAP machine? Aging, such fun.

Mike said...

Bill - I'd never heard that before. I've been tested for sleep apnea but don't have it even though I snore.

Peg - You need to have Rick watch you while you sleep for an hour and check your breathing. You shouldn't stop breathing at all.

Lady M said...

Ah the joys of getting older.

Mike said...

Lady - One of the many!

Margaret (Peggy or Peg too) said...

I made the mistake of telling this to Rick. Got in bed last night and he was staring at me and I said I can't sleep like this. Sure you can he tells me. I can 'feel' him making faces at me. He's now 8 years old and teasing me like a child. So much for seeing if I stop breathing but if he does this shit again, he may stop breathing!!

Mike said...

Peg - He's going to have to wait in another room until you are asleep. Or you can record yourself with your phone and listen the next day.