Is Frequent Urination Keeping You Up at Night?

A common problem that interrupts sleep is the need to go to the bathroom. Nighttime frequent urination is very troublesome but also treatable.

By Sheryl Grassie

Frequent urination at night is a common medical condition called nocturia or nocturnal polyuria. If you need to go frequently both during the day and at night, it is generally considered overactive bladder (OAB), which is not the same as nocturia. If you wake from something other than the need to urinate, like frequent snoring from a spouse, and then you need to go because you are already awake, that is not nocturia either. Nocturia can further be differentiated from bedwetting or enuresis, where you don’t wake up to void; with nocturia the urge to go is what wakes you.

Nocturia, or frequent nighttime urination, can happen daily or only a couple of times a week. Sources differ as to how many times a night you need to be getting up, but conservatively if you wake 2 or more times per night, you may have nocturia. Serious cases involve getting up between 4 to 6 times or more. Some people report that it feels like they are getting up all night long. Normally, most people can comfortably hold their bladder for 6 to 8 hours or more at night.

How Common Is Frequent Urination or Nocturia?

The National Sleep Foundation did a survey in 2003 and found that 65% of adults between the ages of 55 and 84 reported getting up to use the restroom numerous times per night at least several times per week. Frequent nighttime urination is most common in older adults. This is due to a natural decrease in ADH, antidiuretic hormone, which lessens as we age. This hormone promotes urine storage overnight. With less of it, we have a greater urge to void.

How Does It Affect Sleep?

If you are waking frequently during the night and getting up to use the bathroom, you are likely having some level of sleep deprivation or deficit. Of major concern is the ability to get enough time in the deeper levels of REM sleep, where repair and regeneration occur. This vital stage of sleep is the time that reboots the immune system and is critical to good health.

The flip side of this coin is that waking frequently at night and not getting enough deep sleep (when it is caused by a sleep disorder like sleep apnea, snoring, or lack of sleep hormones) can have an effect on nocturia.

During the deep stages of REM sleep, the body makes ADH. Without enough time in REM, we don’t make enough hormones, and we won’t retain fluids well overnight. This can cause the need to get up and go more frequently. So in short, sleep and frequent urination are intimately intertwined.

Symptoms

The symptoms of frequent urination or nocturia are waking and getting up numerous times throughout the night to go, with either a perceived excess of urine when you go, or frequent waking with the urge to go, but not much urine is voided.

Causes

So, what causes nocturia? There are a significant number of possible factors that can contribute to this disorder. There are two primary categories: lifestyle choices and medical conditions. These categories are not mutually exclusive.

Lifestyle Choices

  • Drinking alcoholic beverages and consuming things with caffeine like coffee and chocolate, which are diuretics, can cause frequent urination at night.
  • Drinking liquids too close to bedtime can be the cause of frequent getting up.
  • Some medications, for certain medical conditions, can cause excess urination.

Medical Conditions

  • Urinary infection or bladder infections have frequent urination as part of their symptomatology
  • Enlargement of the prostate gland
  • Bladder prolapse can put pressure on the bladder and increase urination
  • Early Pregnancy has frequent urination as a symptom
  • Tumors can pressure the bladder into more activity
  • Diabetes
  • Hypertension and high salt intake
  • Kidney disease causes frequent urination
  • Diseases like MS and Parkinson’s can be accompanied by the need to go more frequently. Heart or liver disease can also have frequent urgency as a part of their etiology.

Treatment

Treatment depends on the diagnosis and generally requires a visit to the doctor. The doctor may run a series of tests to determine what is causing the problem, and may prescribe medication to treat it. If it appears that poor sleep is the cause, they may suggest a sleep study at a clinic to look at treating the underlying cause of your nocturia. If there is no specific medical problem diagnosed, there are alternative therapies that can help. Acupuncture, hypnosis, and homeopathics can be explored at integrative health clinics.

Tips

Consider a few things to try at home before visiting the doctor and see if they make a difference.

Keep Data

It is recommended that you keep a journal or record in some form the number of times you get up each night and how much you void. You can keep it simple by having a pad of paper and a pen in the bathroom for a quick notation in the middle of the night. This data is very helpful in looking at exactly how much you are getting up, and your doctor will appreciate the information if you do end up seeking a medical diagnosis.

Drink Liquids Earlier In The Day

Try to have the majority of your liquids earlier in the day. This serves two purposes: it keeps you hydrated during the day, and you will have voided out most of your liquid well before bed. The suggestion is to stop drinking at least 2 hours before bed.

Elevate Your Legs After Work

After you get home from work is a great time to put your feet up. If you do this literally, with your legs above your heart, it can encourage urination that might otherwise be stored and voided overnight.


Summary

Is frequent urination keeping you up at night? Nocturia is common, especially in older adults. It is characterized by getting up numerous times during the night and is likely compromising your sleep. It can be caused by many different lifestyle choices or a number of medical conditions. Keep data, try some home interventions, and seek medical expertise if needed.


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