Brilliant, thank you. I understand now 
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KarlT
#22
@sluggerT80 you’re still assuming that the Fournier’s is a side effect of the SGLT2. We don’t know if it was causation or correlation. List of Medication side effects are fraught with errors.
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Yes - I definitely experience increased urination when on SGLT2 inhibitors. And yes - it might be worth trying a break to see how sleep improves.
Or perhaps try the lowest dose. The half life is about 12 hours, so you’re still going to be getting some effect even in the evening.
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With all due respect, the FDA has known about this with SGLT2 inhibitors for years. No other class of diabetes medication has this warning. It is a class effect.
That said, I understand it is rare. I wasn’t telling OP to stop the medication due to the risk of Fornier’s. It was for the possibility of him getting better sleep without having to wake up multiple times a night with a urine glucose > 1000.
Do you agree that that level of glycosuria would cause poliura as a result?
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KarlT
#25
Probably. I couldn’t tell if the op had nocturnal before starting the SGLT2.
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KarlT
#26
Another side effect of SGLT2’s:
Sodium-glucose cotransporter 2 (SGLT2) inhibitors and non-small cell lung cancer survival
https://www.nature.com/articles/s41416-023-02177-2
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Thank you all for your input. I have stopped the Empagliflozin and will monitor the urine glucose but to answer KarlT’s question, yes I have had this issue for close to 20 years and have not solved the problem. Been to four urologists, had cystoscopy twice (camera sent up urethra… fun), prostate is normal for someone my age, tried multiple medications, botox injections in the bladder, electrical stimulation, etc. When this doc found the glucose in the urine test he said “we have to eliminate this before we go any further”. So I am but I have no belief that this is the issue because I just started taking the Empag a few months ago.
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Bicep
#28
Sleep apnea makes you get up and pee frequently. When your heart gets stressed it puts out a diuretic that then makes it feel like your bladder is full. You have to get up and pee. This is the main symptom.
The other thing is to not drink anything after about 6:00pm
I don’t have sleep apnea. A little about me… I’m 67, very fit for my age (resistance train 6 days a week plus zone 2 cardio), eat a healthy diet (mostly mediterranean, low carb). I do enjoy a drink with dinner (which I’m sure exacerbates the issue, but even when I don’t drink alcohol I have the problem). We eat dinner early and are usually done by 6.
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It’s a bother for sure. I’ve heard and tried various things. Eat a little salt before bed. Don’t drink fluids after 1pm. Exercise to lose a lot of sweat late in day. I only don’t wake up to pee if I’m dehydrated which I don’t recommend. I do it if I need a good nights sleep. I think the key is figuring out how to go back to sleep after peeing. Good luck.
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Bicep
#31
I know it is normally associated with obesity. I’m 5’11 155lb and have it anyway. It runs in the family.
If you get one of those oxygen saturation things that you wear all night and it tells your phone the next morning what your O2 was continuously, that will tell you:
https://www.amazon.com/Bluetooth-Health-Tracker-Overnight-Saturation/dp/B094JG4JD7/ref=sr_1_9
Much more expensive than I remembered.
No need for that, my wife sleeps next to me!
Oura ring tracks breathing rate (estimated via HR) and O2 saturation, in case $350 is a better value (it also does other stuff).
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The one solid piece of advice is after peeing don’t look at your phone.
It seems like I can never go back to sleep if I do that!
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Don’t, worry about going back to sleep, you will. If you worry about it, it will just prolong the time to go back to sleep. Michael Lustgarten in one of his videos suggested taking another melatonin tablet. I do this sometimes, but I have found that if you don’t worry about it you will go back to sleep. It’s no big deal if it takes a little while. I have posted before that bi-biphasic sleep may be the norm and that we are still adapting to one long sleep period.
“Before the 15th century, people used to sleep in two shorter periods over 12 hours. They would go to bed at dusk for around four hours, wake in the middle of the night, and then sleep again until dawn. The ancient Egyptians are often credited with being the first civilization to adopt this biphasic sleep pattern.
The two periods of night sleep were called “first sleep” and “second sleep”. The period between the two sleeps was used for a range of activities, such as having sex, praying, eating, chatting, and taking medicine. The night-time wakefulness usually lasted from around 23:00 to about 01:00.
The ancient Egyptians are often credited with being the first civilization to adopt this biphasic sleep pattern. The Roman sleeping culture was also biphasic, consisting of two main divisions: the midday rest and one period of sleep at night.”
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Well mine would be probably be categorized as quadrant sleep because I’m usually up five times 
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I find that I have to pee because I’m awake vs I wake up to pee. If your mind goes right to “do I have to pee”, that can keep you from falling back to sleep.
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