When You Gotta Go
When talking to my patients about their sleep, I frequently ask if they wake up throughout the night. “Well doc, when you gotta go, you gotta go”. Nighttime urination (nocturia) is something patients commonly blame their disrupted sleep on. They think that it is normal to wake up because you feel like you have to go to the bathroom. What most people do not realize is that the reason you awoke is NOT that you had to go to the bathroom, but something much more serious.
In many people, nocturia is not simply a result of a small or overactive bladder. It is usually associated with obstructive sleep apnea (OSA), a condition where you stop breathing throughout the night. With nearly 25 million people suffering from this condition, it is interesting to note that over 80% of the people report frequent nighttime urination.
Most people think nothing of going to the bathroom multiple times a night. “It’s just part of getting older.” Or many men say “It’s that darn prostate.” However, our bodies are built to allow us to sleep, even with a full bladder. We can ignore the signals of a filling bladder (within reason of course) to allow us to sleep through the night and get a full night of reparative sleep. The awakening at night is not because of the need “to go”. We wake up because of our OSA and then become aware that we could go to the bathroom.
How does your breathing ability relate to your bladder? Well, when we stop breathing, negative pressure increases in us, which results in more blood being returned to the heart. This tricks us into thinking our bodies are in fluid overload, sending off a cascade of signals in our body to pull fluids out of our body, filling the bladder. Not only can OSA cause more urine production, but it also can also physiologically change your bladder. The stress placed on your bladder by the lack of oxygen can damage it on a cellular level, causing an “up-regulation of excitatory sensory receptors and smooth muscle instability”. Or in laments terms, it makes your bladder, hypersensitive, over-reactive, and muscularly unstable. So not only does OSA make you bladder fill faster, but it also makes it harder to ignore those signals.
So what does a dentist have to do with your nighttime bathroom trips? Well, your dentist may be the first to start asking how well you sleep. An American Academy of Dental Sleep Medicine qualified dentist will be able to look not just in your mouth, but at your airway and review your medical history to see if you are at risk for OSA. Once tested, your dentist can guide you towards the best way to treat your OSA.
While CPAP is the gold standard for treatment, many patients cannot tolerate the masks you need to wear. Your dentist can then work with your physician on managing your OSA with an oral appliance. By wearing these custom-fit retainers while you sleep, you can keep your airway open, helping to stop your snoring and keep you breathing all night. Studies support that when a patient treats their OSA, they are also able to treat their nocturia. By breathing well, you decrease the oxidative stress on your bladder and can make it through the night with less (or no) bathroom visits. That way, the only thing you will have “to go” each night is “to sleep”.
Q&A: How Can Your Dentist Treat Your Obstructive Sleep Apnea?
What is obstructive sleep apnea (OSA)?
OSA is a very common sleep disorder affecting nearly 29 million Americans. Of that population, 80 percent are unaware that they have the condition. When asleep, a patient suffering from OSA tries to breathe but is unable to get oxygen into their lungs due to a blockage of their airway. This can cause the patient to snore, gasp for breath, and even suddenly wake up.
Why should I care about OSA?
Hold your breath for as long as you can — now hold it for a few more seconds. Did you feel what happened when you finally allowed yourself to breathe? Your body jumped at the chance to take in oxygen because it knew something was wrong. Something similar happens to you during an obstructive event: your heart rate shoots up, your blood pressure rises, and your body goes into a “fight or flight” response. Over time this pattern can take a toll on your health. If left untreated, OSA can increase your chances of contracting other diseases, and if you already have them, OSA worsens your symptoms. These include diabetes, obesity, hypertension, dementia, depression, ADHD, and even heart failure. The good news is that when patients seek treatment for their OSA, many patients see improvements in these other medical conditions.
What are the ways I can treat OSA? How can my dentist help?
The gold standard for treating OSA is Positive Airway Pressure (PAP therapy). While PAP is effective, the problem is that most people do not use it as prescribed. Some studies show that more than four in five people don’t even use their PAP machine!
The good news is that your dentist can offer you a PAP alternative. An oral appliance can be used to hold the jaw forward while you sleep, opening up your airway and allowing you to breathe. Most patients prefer these to PAP therapy because they are comfortable, easy to sleep with, and effective in treating their OSA. Only a skilled dentist can make a custom-fit appliance and monitor your use of it.
Does my medical insurance cover an oral appliance? Does Medicare?
The good news is that most medical insurances, including Medicare, cover oral appliance therapy. Our office, for example, is trained in billing medical insurance to maximize your benefits. We are one of the only offices in the state who are allowed to bill Medicare for oral appliance therapy.
It is important to note that there is no dental insurance coverage for sleep apnea appliances. Be wary of any dentist who says they can get your dental insurance to pay for one.
What should I look for in a sleep dentist?
The most important thing is that you go to an American Academy of Dental Sleep Medicine Qualified Dentist. A dentist with that designation has gone through rigorous training to provide you with the highest level of care. He or she will know that treatment is not as simple as popping in a couple of retainers. In fact, regular follow-up and adjustments will be necessary and it’s important that they’re included in your OSA treatment. Your sleep dentist should know A better night’s sleep can be yours when you find a dentist who has the skill, expertise, and cares to successfully manage your OSA.