Why those frequent nighttime toilet trips
could be hidden sign
of a dangerous disorder that puts you at risk of a heart attack

For three years, Vicki Maylan was treated for bladder problems that she did not have.

The then-66-year-old had developed a strange symptom soon after the menopause. Previously a relatively good sleeper, she suddenly found herself waking up needing the loo – sometimes up to seven times a night.

‘It was very disruptive,’ says the former NHS worker from Devon. ‘I would wake up exhausted and with a headache every morning. The GP diagnosed me with nocturia – or the frequent need to wee in the night – but couldn’t tell me why I’d developed it.’

Medications she was prescribed for the condition had no impact – but caused debilitating side-effects in the day, such as nausea and splitting headaches.

After three years, Vicki was finally referred to a urologist who performed a series of tests. But they came back normal. Then, during a multidisciplinary panel where Vicki’s case was being discussed, one doctor wondered if her nighttime symptoms might be caused not by her bladder but by her sleep.

Nocturia, the doctor explained, could also be caused by obstructive sleep apnoea (OSA) – a condition that occurs when throat muscles relax too much during sleep, cutting off breathing for seconds at a time and temporarily starving the brain of oxygen.

Though patients may not realise it, these sudden pauses in breathing cause the body to stay awake – leading to very disrupted sleep. It can also impact the kidneys, which usually shut down during sleep – causing them to continue producing urine throughout the night.

Vicki’s breathing and blood oxygen level were observed overnight. The results were astounding – Vicki was suffering nearly 70 apnoea events every hour.

After being officially diagnosed by a respiratory consultant, she was put on continuous positive airway pressure treatment – a machine that pumps air through a mask worn over the nose and mouth to hold the airway open at night.

Within a week, Vicki was waking just once in the night to use the loo. Today, she regularly sleeps through without having to get up at all.

‘The machine has been amazing,’ she says. ‘I finally feel refreshed in the morning, and my headaches and fatigue are much better. I was even struggling with high blood pressure before, which has gone right down. I just wish I was diagnosed sooner.’

Experts say tens of thousands more women may be suffering with undiagnosed OSA. If left untreated, the condition can cause lasting health impacts – including weight gain, high blood pressure and even increased risk of heart disease and stroke.

Yet women are far less likely to have their symptoms picked up because of misconceptions about OSA being primarily a male condition, and the fact that symptoms such as fatigue, disrupted sleep and mood changes are also commonly associated with the menopause. 

Dr Zoe Schaedel, a Brighton-based GP who specialises in sleep and menopause, said: ‘Research shows that women are less likely to have their symptoms picked up by routine assessments used by GP to refer them for further testing.

‘They have different, less recognisable symptoms than men, which often don’t meet the exact criteria. As a result, recent studies suggest as many as 85 per cent of women with sleep apnoea may be living undiagnosed. It’s a huge problem.’

More than eight million Britons are estimated to suffer from OSA – a number that has risen nearly sixfold since 2000.

Studies have shown women’s risk of OSA roughly doubles after menopause because of sharp drops in levels of oestrogen and progesterone – hormones that help protect and maintain upper airway and muscle tone.

Yet because women can present with different symptoms than men, many cases are still missed, says Dr Christopher Turnbull, respiratory consultant and medical adviser for the Sleep Apnoea Trust Association. 

‘The typical symptoms of OSA are loud snoring, that can be heard through a closed door, disturbed sleep and excessive sleepiness in the day – falling asleep accidentally despite getting a good amount of hours in bed,’ he adds.

‘Yet these are more likely to be reported by men than women. Women, meanwhile, are more likely to have general tiredness or fatigue in the day without the overwhelming need to sleep, as well as to experience headaches and mood changes.’

Dr Schaedel says: ‘The fact that women refer to tiredness, but don’t necessarily report falling asleep in the day, is enough to make them less likely to be referred by GPs.’

Dr Turnbull adds: ‘Many of the commonest symptoms of OSA, such as sleepiness, disrupted sleep and waking up in the night have overlap with menopause symptoms.’

Luckily, there are some signs of OSA that should be brought up with one’s GP.

‘Morning headaches are always worth investigating – and are much more common in women,’ says Dr Schaedel.

‘New nightmares when you haven’t them in ages and fragmented sleep more generally are also concerning.’