Case Study: Is Sleep Apnea related to Urinary Frequency/Urgency
Pelvic Floor PT Case Study
Condition Focus: Nocturia & Sleep Apnea
Client Overview
Age & Life Stage: 64-year-old active female, part-time job, long walks
Primary Complaint: Frequent nighttime urination (nocturia), worsening dramatically when not using CPAP
Relevant Background: 10+ year history of nocturia, intensified when CPAP is not worn. Medical history includes sleep apnea, arthritis, hypothyroidism. Active lifestyle and no major other health concerns.
Initial Challenges
Symptoms & Daily Impact:
Severe fatigue, low energy, difficulty concentrating at work
Mood changes and emotional volatility
Moved to guest room for sleep to avoid disturbing spouse
Avoided travel and family visits due to fear of waking others
Emotional Toll:
Embarrassment and reluctance to share with prior providers
Feeling isolated and discouraged
Frustration with lack of results from previous treatments
What Was Tried Before:
Myrbetriq (no relief), Ambien (side effects), fluid restriction (caused dehydration)
No previous pelvic floor PT recommendation until new PCP referral
Treatment Approach
Findings:
Internal exam: normal tone with mild bilateral obturator internus tenderness
Plan of Care:
Deep breathing with rib cage and thoracic spine mobility work
Hydration education to prevent bladder irritation from concentrated urine
Urge management techniques for night use
Referral to sleep medicine for improved CPAP attachments
Initial Response:
Felt encouraged and empowered after first session with actionable strategies
Results Achieved
Physical Outcomes:
Decreased nighttime urination from up to 6x/night to 1-2x on nights without CPAP
CPAP use returned to baseline (1x or none per night)
Improved daytime energy, focus, and emotional well-being
Quality of Life Gains:
Comfortable planning travel again
Restored sense of control and normalcy
Client Quote:
"I finally feel like I have options — like this isn’t just something I have to live with."
Clinical Insight
This case highlights the physiological connection between obstructive sleep apnea and nocturia. In a hypoxic state (decreased oxygen), peptide secretion increases sodium and therefore water excretion. Additionally, deep sleep stages—disrupted by apnea—are necessary for antidiuretic hormone (ADH) release from the hypothalmus, which suppresses nighttime urination. Without deep sleep, this mechanism fails. Combining pelvic PT with sleep optimization (via CPAP adherence) offers a synergistic path to symptom relief.
https://kellyelevatewellnesspt.com
Kelly McCall Knott PT, DPT
📞 719‑416‑4039 • 📠 719‑622‑3326
