Nocturia Facts and Treatments

Do you wake up more than once every night to go to the bathroom? If yes, you may have nocturia, which is a frequent need to relieve yourself during the night.

Ideally, you should be able to sleep for six to eight hours at a stretch without feeling the need to go to the bathroom. Your body is designed to control this urge when you sleep, but when you can’t control it, it’s time to listen to your body’s signals and search for answers.

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Some researchers believe going to the bathroom once during your nighttime sleep is normal, but more than that calls for attention.

What Is Nocturia?

Nocturia is a condition in which you wake up more than once at night due to an urgent need to go to the bathroom.

Urine forms when your kidney cleanses your blood. Normally the amount of urine an average adult produces is 1.5 to 2 quarts every day. This liquid waste flows out from the kidney to the bladder through the ureter. When your bladder is full, your brain sends signals to the body, telling it it’s time to go.

The muscles in the lower part of the pelvic floor hold the bladder in place, and when your body feels the urge your bladder muscles contract, pushing out urine through the urethra. This is kept closed by the sphincter muscles, at all other times.

During sleep, the body produces a hormone called antidiuretic hormone (ADH), also known as vasopressin. ADH Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source acts on the kidneys to reduce the production of urine and helps the body retain water. This hormone signals the kidneys to reabsorb more water from the urine and produce less urine overall. As a result, the bladder doesn’t fill up as quickly, and the need to urinate is reduced while sleeping to prevent sleep interruptions.

If for some reason, any of these organs don’t perform their function properly, it could lead to nocturia.

Prevalence of Nocturia

Nocturia is quite common. About 1 in 3 adults over the age of 30 experience nocturia, which may increase with age. According to a National Sleep Foundation poll, 65 percent Verified Source National Sleep Foundation Nonprofit focused on educating about sleep health. View source of adults between the ages of 55 and 84 reported experiencing the need to go to the bathroom several times a night, at least a few nights per week.

And over half Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source of them (53%) reported that the need to urinate ‘every night or almost every night.’ This frequency of nocturia causing sleep disturbance was four times higher than the proportion of respondents (12%) who identified pain as the next most common reason for their sleep problems.

Clinically relevant nocturia–cases of having to go twice or more at night–affects 2 percent to 18 percent in the 20 to 40-year age group. It increases to 28% to 62% Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source in the 70 to 80-year age group. A common cause of nocturia among older adults is due to decreased nocturnal secretion of an antidiuretic hormone.

Dr. Joshua Tal, an NYC sleep psychologist, says “nocturia can have major effects on a person’s psychological and physical health, including insomnia, falls and fractures, depression and even increased incidence of death in older adults.”

Symptoms of Nocturia

The urge to go to the bathroom more than once during sleep is a symptom of nocturia. By itself, nocturia is not a disease, but it is an indication of something wrong in the body. Nocturia may affect your quality of sleep, which has a direct impact on your daytime productivity. Getting up during sleep to go to the bathroom leads to sleep disruptions, causing problems like poor concentration and daytime drowsiness the next day.

Causes of Nocturia

Nocturia can occur for various reasons—lifestyle habits, a side effect of medications, or a manifestation of an underlying health condition.

Drinking Too Much Before Sleep

You should drink plenty of water throughout the day, but limit its consumption a couple of hours before bedtime. Excess consumption of water or caffeine close to bedtime affects your sleep and gives you the urge to go to the bathroom more frequently, disrupting the time you should be resting. Extra fluids add to the pressure on your bladder, pushing you towards the need to relieve yourself.

Behavioral Pattern

If you make a habit of going to the bathroom at the slightest urge, those small sensations may wake you up from sleep. Because your body is used to the habit of waking to use the restroom, your body expects to need to pee in the middle of the night and wakes you up to do so. Dr. Tal says, “It can become a snowball, the more you experience it, the more it happens.”

Side Effect of Medicines

The timing and dose of certain medicines such as diuretics (also known as water pills), expel excess amounts of salt and water from the body. They are usually given for hypertension. Common examples include Aldactone (spironolactone), Bumex (bumetanide), Demadex (torsemide), Esidrix (hydrochlorothiazide), Lasix (furosemide), Zaroxolyn (metolazone). Other medicines like cardiac glycosides, lithium, methoxyflurane, phenytoin, and excessive vitamin D may lead to nocturia.

Polyuria

Polyuria is a urological condition in which your body engages in the overproduction of urine throughout the day. This may lead to the increasing urge to go to the bathroom even during sleep.

Nocturnal Polyuria

Nocturnal polyuria is when your body makes excess urine at night. This condition makes you feel the need to go to the bathroom frequently during sleep.

Bladder Storage Problem

When it is difficult for your bladder to store urine for a long time, it leads to nocturia. The inability of the bladder to contain urine compels you to go to the bathroom even during sleep. Sometimes your body produces excess urine, exceeding the bladder storage capacity and leading to nocturia.

Mixed Nocturia

Mixed nocturia is when an individual has nocturnal polyuria and a low bladder storage capacity, leading to frequent urges to relieve yourself.

Global Polyuria

Global polyuria is a urological condition of overactivity in the kidney as it produces urine in excess of 40 ml/kg body weight in a period of 24 hours.

Sleep Disorders

Some sleep disorders like chronic insomnia cause or are associated with nocturia. The inability to sleep makes you feel an urge to go to the bathroom frequently through the night. Dr. Tal says this is a common issue he sees when treating insomnia. Sometimes other sleep disorders like obstructive sleep apnea (OSA) may also trigger nocturia.

In cases of untreated obstructive sleep apnea, your body struggles to breathe against a closed airway while sleeping, causing a large amount of pressure on your chest cavity. This negative pressure leads to the production of a hormone called atrial natriuretic peptide, which induces the frequent urge to relieve yourself.

Diabetes

Both diabetes insipidus and diabetes mellitus may lead to frequent bathroom trips at night. In diabetes insipidus, your body can’t properly balance fluids leading to increased urine production. The antidiuretic hormone (ADH), also known as vasopressin, controls the speed at which these fluids are excreted. This hormone is made in the hypothalamus part of the brain and stored in the pituitary gland.

Any damage to the hypothalamus impacts fluid regulation, or sometimes the kidney doesn’t respond to this hormone for some reason leading to nocturia.

In diabetes mellitus, the high blood glucose level in your body triggers the need to excrete it, expelling glucose through urine. Even when you sleep, your body regulates glucose levels, giving you urges to relieve yourself. If you have high blood glucose levels, then you may be vulnerable to picking up a urinary tract infection (UTI), which in turn leads to nocturia.

High Blood Pressure

Nocturia may be a manifestation of high blood pressure. When your body has excess salt, it needs to expel it. The only way for salt to get out of your body is by dissolving into a liquid. Frequent needs to go to the bathroom at night may be an indication of your body struggling to deal with high blood pressure.

Enlarged Prostate 

An enlarged prostate is also known as benign prostatic hyperplasia (BPH). An enlarged prostate presses against the urethra, narrowing it and leading to urine retention. The inability to completely relieve yourself when you go to the bathroom leads to feeling repeated urges even as you sleep.

Heart Disease, Vascular Disease, and Congestive Heart Failure

Heart conditions, like heart disease, vascular disease, and congestive heart failure, often lead to disturbed sleep, which in turn makes you feel the urge to go to the bathroom frequently. In some instances, decreased REM makes you feel the urge to relieve yourself frequently, leading to sleep disruptions.

Bladder Problems

Problems like bladder pain syndrome (BPS), obstructions or tumor in the bladder, or overactive bladder (OAB) which leads to improper functioning of the bladder, cause nocturia. Any dysfunctions in the bladder may cause nocturia. Some bladder problems may affect the nocturnal bladder capacity leading to nocturia.

Urinary Incontinence

Urinary incontinence is a condition in which your body leaks urine accidentally when involved in activities like coughing, sneezing, laughing, or exercising. Sometimes this condition leads to frequent and repeated urges to relieve yourself at night.

Ways to Deal with Nocturia

There are different ways to deal with nocturia, depending on what causes it.

• If it is due to lifestyle habits, then simple practices like reducing fluid intake a couple of hours before sleep may help.
• Avoiding caffeine after noon is important, because not only does it increase fluid levels in your body leading to the urge to relieve yourself, but caffeine also causes sleep disruptions.
• If you have to take diuretic medication, then try to avoid taking it six hours prior to bedtime.
• Some people tend to have a fluid build-up in their legs—elevation pushes liquid back to the bloodstream preventing nocturia.
• Using elastic compression socks helps put pressure on your legs, preventing fluid build-up which may lead to nocturia.

Treatment of Nocturia

Nocturia may be a manifestation of an underlying health condition. To properly diagnose and provide treatment options, your doctor may ask you to keep a bladder diary, detailing when and what you eat and drink. They may also recommend a urinalysis, or urine culture, to understand the cause and better treat your problem.

FAQs

Is nocturia a disease?

Nocturia is not a disease by itself, but it may be a manifestation of an underlying medical condition. It’s a common occurrence affecting the quality of sleep, especially in the elderly.

Can nocturia be cured?

Managing certain lifestyle habits often helps in dealing with nocturia. But if the underlying causes are certain health conditions, then those need to be treated first. Sometimes, despite treatment, you may still feel the impact of nocturia. Your doctor may prescribe medication for treatment.

Conclusion

While it is normal to wake up once during sleep to use the bathroom, waking up multiple times may indicate a problem. Nocturia can have a significant impact on a person’s physical and psychological health, including sleep disruptions, poor concentration, and daytime drowsiness. And if it is not taken care of, it can have a bigger impact on your lifestyle.

The repeated urge to relieve yourself at night leads to poor sleep, affecting your productivity and quality of life. It’s better to take steps towards curbing this problem at the first sign.