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Ask Dr G

Published: Sunday September 14, 2014 MYT 8:40:00 AM
Updated: Monday September 15, 2014 MYT 4:55:45 PM

Sleepless nights

Sleep deprivation can result in exhaustion, fatigue, cognitive dysfunction and depression. 

“He would lie in the bed and finally, with daylight, he would go to sleep. After all, he said to himself, it is probably only insomnia. Many must have it!” - An extract from Ernest Hemingway’s Classic, A Clean, Well-Lighted Place, arguably my favourite from his collection Winner Takes Nothing. 

Some had interpreted Hemingway contrasts light and shadow to differentiate the old man and the young people around him. 

Apparently he also uses the deafness of the old man as a symbol that separates him from the rest of the world. Indeed, the trouble of sleepless nights can be a lonely affair, highlighted by the late Heath Ledger: “I think the most common cause of insomnia is simple; it is loneliness.” 

In reality, sleepless nights can also be caused by other medical conditions. It is often thought to be both a medical sign and symptom, characterised by persistent difficulty in staying asleep. 

Although such disorder can occur at any age, it is particularly prevalent with men with advancing age and enlarged prostate. On that note, let’s deal with Alwin’s predicament. 

Hi Dr G,

I have been suffering from insomnia for quite some years now. This is because of the troubles of having sleepless nights due to frequent urinations.

I have to wake up at night frequently for about 4-6 times to urinate. Often times, I find it difficult to get back to sleep. Sadly, I am also disturbing my wife’s sweet dreams.

I am 62 years old and have not been having peaceful sleep for some time now. I am feeling tired and fed up!

I have consulted many doctors and they said my prostrate is not emptying the urine completely.

They had prescribed me numerous medicines for prostate. I did not see any effect of the medication and am still losing sleep.

Do you have any advice for me?

Please help.

Alwin

The necessity of waking up at night to urinate is called nocturia. Such troublesome symptoms often worsen with age.

Studies revealed the habit of nocturia affects 5-15% of those under 50 years old, and the prevalence can increase to 20-30% among the 50 to 70 years old age group.

Half of the men and women above the age of 70 have to wake up twice a night to urine according to some studies. Most of the studies demonstrated same rates of nocturia for both genders.

Prostate enlargement is one of the major causes of nocturia. It is believed the enlargement (both benign and malignant) can impair the emptying of the bladder and result in the retained urine to be expelled on regular basis.

Many men had been prescribed medicines such as alpha-blockers to improve the urinary flow and reduce the urine retention. However, such therapeutic intervention may not benefit all men, and definitely not improving the symptoms for ladies.

Although prostatic obstruction is a major cause of nocturia, two other primary causes of nighttime urinations are hormonal imbalances and bladder over-activity.

The over-production of urine at night is called nocturnal polyuria and it may be related to advancing age.

This is believed to be associated with the disruption of fluid controlling hormones, AVP.

Other causes of such disorder can be congestive heart failure, liver failure, obstructive sleep apnea or simply the habit of excessive nighttime drinking.

Small capacity bladder or overactive bladder can also result in frequent voiding at night.

In reality, the majority of the sufferers of nighttime urination have multifactorial mixed etiology. Lifestyle changes are advocated, which include prohibiting bedtime fluid consumption and reduce intake of caffeine and alcohol.

Several pharmaceutical interventions had also been used in the treatment of nocturia.

Anti-muscarinic is particularly useful in the reduction of the contractility of bladder. However, many sufferers may have to put up with the side effects of constipation such as dry eyes and dry mouth.

Another medication that may be efficacious in treating nocturia is desmopressin. This medication is actually a synthetic replacement of hormone, AVP.

Believe it or not, this is the exact medication that is used in children with the problems of bedwetting. Clinical trials had shown good response in both men and women treated for nocturia with desmopressin.

In recent years, clinical trials had also revealed the injection of Botox (yes, the same Botox for wrinkles!!) into the bladder have superior effects on reducing contractility of bladder muscles. (What I am interested to find out is who on earth came up with such idea?)

The efficacy of Botox in the treatment of nocturia is very encouraging and the popularity is gaining momentum in recent years.

Although the “simple” bothersome of nighttime urination is affecting many, the true negative impact of such inconvenience and the consequence of insomnia cannot be underestimated.

Sleep deprivation can result in exhaustion, fatigue, cognitive dysfunction and depression. Most of the time, the sufferers cope with such disability in loneliness. Needless to say, it is also doing no good to your love life!

“O sleep, O gentle sleep, Nature’s soft nurse, How I frightened thee. That thou no more will weigh my eyelids down, and sleep my senses in forgetfulness?”- William Shakespeare, Henry IV

> The views expressed are entirely the writer’s own.

 

Tags / Keywords: Nocturia, AVP, insomnia, sleepness nights, medical

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