Since my surgery 15 years ago, I regularly visit the bathroom twice each night to void the bladder.
Disturbed sleep (& shortened duration of sleep) have sometimes been associated with increased mortality. In a paper published in September, Steve Freedland & team looked at data from the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) trial, "to test the association between baseline nocturia (voiding ≥3 times per night) and all-cause mortality" [1].
"Nocturia was associated with increased mortality risk (hazard ratio [HR] = 1.72 ...) independent from demographics and medical comorbidities. Inclusion of disturbed sleep in the model reduced the magnitude of the association (HR = 1.43 ...)"
In a response from November [2]:
"In their manuscript recently published in Prostate Cancer and Prostatic Disease Journal Bliwise et al. [1] explored, as several previous studies [2], the impact of nocturia on all-cause mortality and found an increased mortality risk in men presenting with ≥3 nocturia episodes/night. They concluded that nocturia was an independent predictive factor of mortality.
"Although the authors have to be congratulated for the quality of their work, we would like to underscore several concerns that may question the reliability of their conclusion.
"Firstly, the REDUCE trial was designed to determine whether dutasteride reduced the risk of incident prostate cancer among men who are at increased risk for the disease and the analysis of the effect of nocturia on mortality in men complaining from LUTS was not planned.
"Secondly, the threshold they chose to define nocturia (≥3 episodes per night) is not very much justified and might be called into question as it is not in line with the one from the International Continence Society (≥1/night) nor with the most widely accepted to define clinically meaningful nocturia (≥2/night) [3]. One may then wonder if the definition chosen could have been data-driven.
"Another significant drawback is that nocturia was not documented with bladder diaries. Self-estimation by patients has been shown to be poorly reliable and commonly overestimating the number of nocturia episodes [4]. It is then also impossible to determine the proportion of patients with nocturnal polyuria (NP) as an underlying cause of nocturia in this cohort.
"The Medical Outcomes Study (MOS) sleep questionnaire has several limitations that Branche et al. [5] clearly acknowledged in their manuscript. One of the main shortcomings of the MOS questionnaire is that it is a poor tool to screen patients with obstructive sleep apnea (OSAS), a condition that can cause nocturnal polyuria by increasing atrial natriuretic peptide release secondary to hypoxia during apneic episodes. OSAS has been reported to be a common underlying etiology of nocturia [6]. Untreated/undiagnosed OSAS can result in the occurrence of cardiovascular diseases, including coronary artery disease, hypertension, left ventricular dysfunction, and arrhythmias. Hence, OSAS may well be a significant driver of the relationship between nocturia and mortality. The lack of adjustment for this important confounder can be regarded as a significant limitation of the present report.
"The pathophysiology of nocturia is far from being completely elucidated. Several cofactors such as nocturnal hypertension or primary sleep disorders have recently been suggested as possible contributors to nocturia pathogenesis and have just started being explored as such [7]. Even though the authors could not be blamed for lacking to adjust their analysis for these cofactors as their definitions and implications is not well defined nor standardized yet, these conditions may well play a significant role in the relationship between nocturia and mortality that will require to be further explored.
"In conclusion, in addition to several other limitations, this study, as the previous ones exploring the impact of nocturia on overall mortality, may have missed important confounders, especially OSAS. The relationship between nocturia and mortality might not be that straightforward and we might be missing the forest for the trees. Further studies are needed to elucidate the comorbidities that may underpinned the relationship between nocturia and mortality."
***
The subject came up some years ago. We had just taken in a stray cat & he insisted on going out in the middle of the night. He would stir when I went to the bathroom, but wait until I was falling back to sleep before making it clear that he wanted to be out. And if I happened sleep past my normal toilet break, he would wake me up. He was driving me crazy. One man had a helpful solution: "Put him on Lupron"
I just started reading "Why We Sleep" by Matthew Walker. The association between any kind of sleep deprivation and a host of health conditions (dementia, mortality, etc) is fairly evident, and is not limited to PCa patients. Nocturia is one of such shocks to the system, and based on the findings of this paper, it conveys a consistent message.
My MO @ Sloan Kettering recommended a sleep study when I had an uptick in my nocturnal polyuria . The mechanism , as I understand it , is that with OSA oxygen levels decrease , carbon dioxide levels increase , the blood becomes more acidic ( temporarily ) , blood vessels in the lungs constrict , heart rate increased , where the heart senses a false fluid overload and secretes a hormone- like protein substance which signals the kidneys to dump fluid and sodium . Often consistent CPAP use reduces nocturnal to 1-2 times a night which was the result in my cases . Post 45 IMRT treatment my prostate is no loner enlarged so that was ruled out as etiology . But - we all know that Lupron impacts the nervous system resulting in insomnia and muscle weakness impacts the bladder detrusor muscle resulting in increased nocturnal and sleep disturbance .
I did not know that Lupron affected the detrusor muscle. When doing the uroflow test at the urologist's office my stream was very weak and I told Dr. that I fell like I am on gravity flow. He agreed but never mentioned that it was HT causing the problem.
As I'm sure you are well aware, there is much evidence of the negative impact of sleep disruption on health in general and cancer specifically. My readings indicate the issues seem to be related to:
1. exposure to bright light within several hours of bedtime.
2. exposure to blue light spectrum light in general, esp. in evening hours. (Ever proliferating use of LEDs is a primary source for this.)
3. shifting of sleep hours typical of shift workers.
4. disruption of sleep pattern during the night.
Some of this seems to be related to melatonin production being reduced or stopped as a result of sleep interruption. A contributing factor in this interruption is exposure to light during sleep from undarkened rooms, exposure to light when waking to go to the bathroom, night lights, etc.
As a result, I have been wearing a sleep mask to bed and avoiding turning on lights when I occasionally get up to pee during the night. (Depending on how much fluids I drink in the evening, I range from 0 to 2 urinary events per night.) I also use room-darkening shades and do not use night lights where I sleep. Since I also wear eye glasses full time, my most recent pair have a blue-light filter lens coating. Has all this made a difference? Well, for the last year I've been taking 20mg of melatonin at bedtime, so I sleep like a rock for my normal 8 hours regardless of any minor interruptions during the night. In other words, I'm not sure I would have noticed.
Here are a few links to articles/research I've saved that relate to sleep disruption/circadian cycles:
Cancer has a biological clock and this drug may keep it from ticking
Watch the late night beverages, turn off the electronic devices, turn down the lights, and keep it dark till morning - i.e., Sleep Well to Be Well - cujoe
Could be more visits to urinate increases one’s risk of tripping over the cat,,,or dog, therefore increasing mortality. Studies can be very deceptive when all imponderables are not considered.
Funny you should say that. I have developed a bit of a balance problem. Afraid to turn on a light (see Cujoe's post), I lurch to the bathroom in the dark like a drunken sailor. All the while wondering where cat is. -Patrick
You guys sound like you've been taking humor classes from resident stand up comedian, j-o-h-n.
Taking a leak in the total/semi- darkness is an acquired skill with at least some potential hazards involved. As for sleeping cats, try strapping a low-output night light on that feline.
I do keep a very small single AA battery, LED flashlight on nightstand. No more tripping over dog or stubbing toes on furniture or walls. Nor turning on lights disturbing spouse. Particularly helpful on moonless nights.
One important contributor to nocturnal awakenings, in my case anyway, is pain. I spend a good part of the night twisting and turning trying to alleviate pain in my shoulders, especially the right one. I seldom feel any pain during the day when I am moving about but at night it is a constant search to change sleeping positions trying to find a "sweet spot" that will give me at least temporary relief. Although I am not in a deep sleep, I am in that light sleep just below full consciousness and there's the problem: the mechanism that controls our bladder is still functioning so that we are aware when we have to urinate. If it were a deeper sleep, the problem would be reduced. And then there is the issue of when to stop drinking liquids. I guess if we are getting enough liquids during the day, we shouldn't need any liquids at night including herbal teas.
In 2013 before diagnosis I was bench pressing, flat bench, real steel, a bar, 335 lbs. I used 165 lbs. overhead for sets and reps. I also cleaned the 165 lbs. I didn't take it off a rack. I have witnesses. I had athletic injuries to both shoulders that were long forgotten and a back injury in 2010 that was just about resolved. Six 500 mg Cipro and the intramuscular shot of Levaquin for the TRUS in July of 2013, same for an Artemis in September of 2013. Again for an ablation in October of 2013 and a week's (?) course of Levaquin orally 6 days after the ablation. In April of 2014 a right triceps tenderness occurred. In May my right hip became sore, an old injury. I worked around these and things settled down mostly. In mid August when I had just unracked my warm weight for incline bench presses, just unracked mind you, my right shoulder audibly shredded. I allowed the weight to fall on my chest. I went to an experienced chiropractor. She told me that she has had quite a few patients harmed in this way by the fluoroquinolones. I did my own therapy and had ultrasound treatments for my shoulder, hip and triceps concentrating on my shoulder. When the chiropractor diagnosed what had happened to me she plainly stated that she had seen this before. That the fluoros will go for old injuries. I called my uro and reported what had happened. In December 2014 he scheduled me for a 1 year post ablation Artemis biopsy. Guess what? He used fluoros! He told me that he had had a shoulder injury that affected his golf game and to do therapy exercises which he briefly demonstrated. Okay--guess what? The progress on my shoulder regressed. In February a ligament tear in my back that happened in 1988, an injury I hadn't thought about much tore again while just getting out of bed. I was extremely reluctant to ever have fluoros in my body again. In January of 2017 after quite a bit of back and forth, me not wishing another biopsy and asking for a 3.0 rather than the 1.5 he uses for the Artemis. I was told no, that the contrast is the important thing. Rather than December, because of the back and forth communications I traveled to him again, had the 1.5 in the AM and showed up in his office in the early afternoon. He saw me and with maybe just a hello told the nurse to get me ready for biopsy. I told the nurse I didn't want a biopsy. I had been the results of a free and total PSA test from November of 2016 that indicated that I had a 12% chance of prostate cancer. The week before the results of the simple test that my uro ordered that my PSA had dropped 0.63 from November lowering the 12% chance even farther. I felt that 0.63 in about 6 weeks wasn't bad and it was also a continuing a downward trend. I told my uro I would fly back if my PSA destabilized but as it had been going down and what had happened to me in the past with the fluoros that I feared for my quality of life as much as the cancer. This time he hadn't prescribed the 6 Cipro pills to be taken, 2 the day before, the day of and day after the procedure. He told me that he would only use the intramuscular shot of Levaquin. I unfortunately agreed. Uh huh! I lost my left shoulder! I still don't have a full range of motion in that shoulder and it will not bear weight. My back is worse. If I am lucky I will sleep for a few hours until the pain in my shoulders and back wake me.
Now! This is interesting. Last July I asked my oncologist if he had seen fluoro damage before. I am one of a few patients that has had ablations that Brown Urology has had therefore there is some interest in me and I believe I have been a topic. My oncologist started using the keyboard and told me to look at my the results of my bone scans when I got home. The report on the August 2013 scan noted some inflammation in my lower back. The February 28, 2017 bone scan report stated that there was degradation in both shoulders and my lower back. That is from repeated use of the fluoros I would say. That is why my oncologist loaded the results of my bone scans and told me to read them. I wouldn't have thought that bone scans would show that. I was surprised. It isn't likely I will ever repair the damage which may well be permanent. As my shoulders and back have degraded, so has the quality of life that I might expect. The sad thing is that many of the side effects of the fluoros are permanent.
Rocephin and Cefdinir are drugs that can be substituted for the fluoros. I have had conversations with men whose uros used these two drugs rather than the fluoros without side effects. Had one these drugs been used I might have been able to rehab but when tissue is repeatedly under assault from a drug that literally eats the tissue how can one rehab that?
I am still desperately trying to rehab these old injuries that the fluoros have brought back. I seem to be having some small success. That has happened in the past and then it is lost. I have to keep trying in order to have some sort quality of life.
Kuanyin, I certainly understand what you go through with your shoulders. Leaning forward a bit to type this causes the ligament in my back to send the wrong signals. It is a 24 hour a day way of life. Stay away from the fluoros if at all possible. You never know which time might be too many exposures for you.
I try to use the pain that wakes to my advantage. I often take a supplement or a drink of Green Vibrance at least once in the middle of the night.
Wow. Why so many Cipro (fluoro's) ??? I took one for my TRUS biopsy and I was very alarmed by the side-effects printout for this stuff -- at least three pages worth of dire warnings. The oddest one was that one could experience achilles tendon rupture after taking this crap. I did take one more -- when I got HIFU surgery. I was lucky to suffer no ill effects. Wonder if you have a case for malpractice. Six 500 mg Cipro's -- really?
Six 500 mg Cipro pills and immediately before an intramuscular shot of Levaquin in the buttocks. I asked how much Levaquin was in the syringe as I felt the very long needle enter. The nurse told that me it was a "massive shot'".
Standard procedure for prescribing for this doc and most I would think is 6 Cipro, 2 the day before, 2 the day of and 2 the day after. Just before the biopsy the "massive shot" of Levaquin. This is to prevent sepsis.
Both Levaquin and Cipro are fluoros but maybe mixing the two creates more side effects, a greater chance of side effects and more dangerous side effects than either one separately.
I do know this. If I were a doctor and my patient called my office to report side effects from a drug I used on him I wouldn't use it again! That was the first time. The second time I was face to face with him and stated plainly that I didn't want any fluoros because twice I had had adverse reactions and was concerned about being crippled. He hadn't ordered a prescription for Cipro as in the past. He told me that he wouldn't use Cipro, just Levaquin --which is a fluoro! I got another maybe even bigger, intramuscular, "massive shot" because only Levaquin was being used. I wonder how strong a dose it was? He scared me. I relented to the biopsy. I lost my left shoulder and my back is worse now too.
Thank you Currumpaw for that "cautionary tale" you just sent. Do you know I often refer to this site, HealthUnlocked, as "Fatal Attraction." At times what I read frightens me ( 'There but for the grace of God go I'). Yet, it is a place for education. All of us are"Internet Doctors" madly combing the Net for the Holy Grail. I have learned much here that I send to my onco who has never seen much of the stuff. How much can he read each week? Anyway, about fluoroquinolone antibiotics: I guess I am lucky because I am allergic to Cipro. Praise be to G-D! This is what WebMD has to say: "However, some people who take these medicines may develop disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and central nervous system. These can occur in someone all at the same time." Well, I hope Patrick's post on Nocturia is not correct--I don't even bother to count how many times I get up in the middle of the night anymore.
You should copy and post your above history for a topic so the community can see and be made aware of --- and add my post with the video below :
I had the same thing happen to me. In 2006 I was given massive doses of corticosteroids because my GP could not determine why I was developing a severe rash in patches all around my body - on my face -- neck - midsection - legs etc. then about a month later I developed a sinus polyp -- to which I was put on high dose prednisone (another massive dose of corticosteroids) then I was given a massive dose of Cipro by my ENT doctor for sinus infection caused by the polyp. Within days my back and all my joints were killing me -- I could hardly walk --- So after about 3 weeks I go to my dermatologist who immediately diagnosed the rash as caused from poison ivy. Within a month I was unable to walk or stand without help for 6 months and it took almost 2 years to recover -- 90%. There was permanent damage to ligaments, tendons and some nephropathy. No one could explain it -- I went to half a dozen doctors -- they had no clue --- . So one evening we were watching the TV show 60 minutes. and there was an episode that was about the devastating effects of combining Cipro with corticosteroids ! they interviewed some of the survivors -- people permanently crippled some on crutches and others in wheelchairs.
About 3 years ago I was speaking with a RO --- who had had an Achilles tendon rupture from taking Cipro and sued and recovered $35,000. It now has a black box warning about possible tendon ruptures. SO, like you, when my Dr. did the biopsy I told him I was not taking Cipro -- he said just take 3 / 500mg pills one the morning of and one each day for 2 days after. Which I did.
Omg, now I am scared to death. I am scheduled to do a cystoscopy to check my bladder and the doctor said he will give me antibiotics, should I be scared about it? Thanks
I would ask for something other than Cipro or fluoroquinolone antibiotics -- there are many others that have less chance of bad side effects.
Ask about Doxycycline fif you have to take antibiotic it has actually been shown to kill PCa stem cells.
My dermotologist has prescribed Doxycycline for patients that he said take them daily for years for skin condition -- acne - rosacea etc.
"As Doxycycline and Vitamin C are both relatively non-toxic, this could dramatically reduce the possible side-effects of anti-cancer therapy."
"A third study, published in the journal OncoTarget in 2017, found that IV vitamin C was able to kill CSCs in those cancers that were found to be resistance to the antibiotic doxycycline. This well known and commonly prescribed antibiotic has been shown to be an effective therapy against CSCs in breast, ovarian, prostate, lung, pancreatic, melanoma, and glioblastoma cancers. Interestingly, doxycycline increases the sensitivity of CSCs to radiation and chemotherapy. Some cancers, however, can escape and become resistant to the effects of doxycycline. The use of IV vitamin C in these doxycycline resistant cancers has been shown to be highly effective."
"Through this analysis, it became apparent that tetracycline antibiotics, such as Doxycycline, could be re-purposed to eradicate CSCs, in multiple cancer types [14, 20, 21]. These eight distinct cancer types included: DCIS, breast (ER(+) and ER(−)), ovarian, prostate, lung, and pancreatic carcinomas, as well as melanoma and glioblastoma. Doxycycline was also effective in halting the propagation of primary cultures of CSCs from breast cancer patients, with advanced metastatic disease (isolated from ascites fluid and/or pleural effusions) [20].
Remarkably, Doxycycline behaves as a strong radio-sensitizer, successfully overcoming radio-resistance in breast CSCs [20]. This has important clinical implications, as the majority of ER(+) breast cancer patients are currently treated with breast-conserving surgery (lumpectomy) plus radiation therapy and hormonal therapy with an anti-estrogen.
Doxycycline is an FDA-approved drug, which first became available in 1967, ∼50 years ago now. It has excellent pharmacokinetic properties, with absorption of nearly 100% and a half-life of 18 to 24 hours. However, as with any new potential therapy, there is always a concern regarding the possible development of drug-resistance.
Here, we show that cancer cells can indeed escape the effects of Doxycycline, by reverting to a purely glycolytic phenotype. Fortunately, the metabolic inflexibility conferred by this escape mechanism allows Doxycycline-resistant (DoxyR) CSCs to be more effectively targeted with many other metabolic inhibitors, including Vitamin C, which functionally blocks aerobic glycolysis.
Interestingly, previous studies have shown that Vitamin C inhibits GAPDH (a glycolytic enzyme) and depletes the cellular pool of glutathione, resulting in high ROS production and oxidative stress [22]. We show here that DoxyR CSCs are between 4- to 10-fold more susceptible to the effects of Vitamin C, inhibiting their propagation in the range of 100 to 250 μM. Therefore, Doxycycline and Vitamin C may represent a new synthetic lethal drug combination for eradicating CSCs, by ultimately targeting both mitochondrial and glycolytic metabolism."
"Now we know that Doxycycline, a tetracycline antibiotic drug commonly used to treat infection, has specific anti-Myc, anti-tumor activity which applies to cancer which spread to bone. Numerous studies have shown that doxycycline induces apoptosis (programmed cell death) and reduces cancer cell proliferation by down-regulating these Myc genes in cancer cells including metastatic disease in bone."
Thank you very much, George but I am only concerned at this point with my cystoscopy procedure not the pc, that you s a different story. they found microscopic red blood cells in my urine , that is why I need to the procedure and I know they will prescribe antibiotics right after to avoid possible infection
I have a couple of interesting issues sleeping. I have bursitis in my left hip which only hurts when I try to sleep on my left side. I can't sleep on my back -- sleep apnea (self-diagnosed, but when I wake up with a start feeling that I've forgotten to breath seems like a good conclusion). There's only so much time I can sleep on my right side until I have to roll onto my left. Apart from the attendant hip pain I have to deal with the phenomenon that sleeping fully on my left side can trigger an a-fib episode (doctors skeptical but I'll attest to it) causes me to attempt a twisted left side sleeping position.
Hi Patrick,
This is somewhat what I'm challenged daily, but not symptoms of need to urinate, instead it's mental health, having an extended period of acceptance denial, my mind at rest will race, cannot sleep because of anxiety.
I know this is off-topic with this post, but replace "Nocturia" with "Anxiety" and it hits home for me...
I think the symptoms you described are a quite natural reaction to the situation we find ourselves in. Its important to talk to your regular doc. We have depression and anxiety. As my doc said "why wouldn't you". There are many drugs that mitigate that racing mind. Its a matter of finding out which ones work for you. Cannabis in moderation is OK for me but there are molecules. My doc came up with this: its a drug for depression and bipolar. Its "off label" use is as a sleeping tablet that has no nasty side effects like addiction. It is called quetapine. Works a treat.
The other thing you should consider is taking a 5-10mg metformin before bed and taking one when you get up in the night (helps you get back to sleep).
There have been times when I get up 6+ times at night. Surgery 08, radiation '13, on ADT 1 year.
Myrbetriq (?sp) no help at all. Toviaz helping a lot FYI. I do have a weak stream and may need to be scoped again - did have a partial obstruction at the anastomosis several years ago that was ballooned.
I take 20 mg of Melatonin which is a potent antioxidant but it doesn't do much for my sleep. The usual recommendations darkening your room, not looking at anything bright before bed, etc., do not work for me neither do standard sleep medications. Unfortunately, in my case, it is both physical and psychological: the moment I hit the bed, even though sleepy, a combination of pain and Monkey Thoughts work to keep me up, although my wife claims that I do sleep and she can hear me snoring!
Had a lamp in bedroom hooked up to smart plug so I wouldn't trip over cats. All I had to say was "Alexa lamp on". It no longer works. Alexa is such a bitch. Have not slept for 8 hours in 2 years. Rare 5 hour stretches are precious. Had no issues with depression until I read today's posts.
In the run up to my PCA diagnosis, I noticed that I was experiencing many plumbing problems, including weak stream, urgency, increased frequency both day and night. For me, THC has a profound positive effect! If i take THC oil at night I am pretty much guaranteed that I will sleep through the night, and a toke in the evening makes me pee like a 10 year old. Never thought I would ever enjoy peeing so much.
I used to have the problem of waking up from my sleep and walking to the bathroom to leave a leak....(remember you don't want to take one, you wanna leave one) ... Not a problem for me anymore,.. I sleep in my bathtub.....
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 02/14/2019 5:58 PM EST
I'm no longer on ADT but I get up at least once a night, usually twice. I suffered from BPH for years so maybe my bladder capacity is compromised? Anyway, if I find myself awake in the middle of the night -- I get up to pee, whether it is a compelling need or not. Habit. Here's a weird thing and I wonder why I am not wetting the bed -- almost every night I dream that I am urinating. I often wake up at that point and guess what -- I go take a pee. It doesn't seem like I void much in these nocturnal trips. Maybe my 'alarm level' that should indicate a full bladder goes off with only a slightly full bladder? Is the urine acidic and setting off the alarm for that reason? I don't have any problem, after TURP surgery years ago, completely voiding.
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Antidepressant medication use and prostate cancer recurrence in men with depressive disorders. 
