Frequent Urination at Night (Nocturia)

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Nocturia occurs when a person must wake up at night to urinate. Normally, hormones decrease urine production so we can sleep through the night. A number of factors can interfere with this process, leading to nocturia.

Nocturia is very common, affecting 50 million Americans. However, since many people assume it is a natural consequence of aging, nocturia often goes underdiagnosed and untreated. We explore common causes of nocturia and how to stop frequent urination at night.

What Is Nocturia?

Technically, nocturia describes waking up at least once per night with a need to urinate. Some physicians and researchers define it as waking up twice per night, since this is the point when sleep interruptions typically start affecting quality of life.

To be classified as nocturia, the person must originally be sleeping, and they must return to sleep after going to the bathroom. Waking up for a different reason and visiting the bathroom along the way does not qualify as nocturia, nor does waking up early with the need to urinate and not being able to fall back asleep.

Nocturia is different from polyuria, which describes excessive urine production. However, it is common for a person to experience both nocturia and polyuria, called nocturnal polyuria. One study found that up to 88% of people with nocturia also have nocturnal polyuria. Nocturia is also distinct from nocturnal enuresis, or wetting the bed. People with nocturnal enuresis urinate without waking up.

How Common Is Nocturia?

Nocturia becomes more common with age. While only 2% to 18% of people aged 20 to 40 wake up to urinate twice or more per night, 28% to 62% of people aged 70 to 80 do the same.

Among young adults, women are more likely to experience nocturia than men. For example, among 20- to 30-year olds, 44% of women may have nocturia, compared with 35% of men. In older adulthood these numbers reverse, with 93% of men in their 70s and 80s reporting nocturia compared to 77% of women. Nocturia is also common during pregnancy, but pregnancy-related nocturia normally goes away on its own a few months after childbirth.

Consequences of Nocturia

Nocturia contributes to sleep disruption and deprivation, which can cause daytime sleepiness and a host of other side effects. Repeatedly waking up throughout the night disrupts the progression of sleep stages and can lead to less restorative deep sleep.

People with nocturia may experience impaired work productivity, lower quality of life, health problems, moodiness, fatigue, and problems with concentration and memory. Almost half of the people who wake up to use the bathroom at night find it difficult to fall asleep afterwards. Bed partners of people with nocturia may also experience disturbed sleep.

In the long term, sleep deprivation from excessive urination at night is linked to chronic health problems including depression, obesity, diabetes, and heart disease. Older adults with nocturia also have an increased risk of falling or sustaining other injuries on their way to the bathroom.

What Causes Frequent Urination at Night?

Nocturia may be caused by reduced bladder capacity or increased urine production. Drinking too many fluids at night, especially alcohol or caffeine, can increase your urine production and cause nocturia. Many health conditions can also contribute to nocturia, including but not limited to:

  • Benign prostatic hyperplasia (enlarged prostate gland)
  • Chronic kidney disease
  • Congestive heart failure
  • Diabetes
  • Liver failure
  • Medications, especially diuretics (water pills)
  • Obesity
  • Obstructive sleep apnea
  • Overactive bladder
  • Peripheral edema (swelling in the lower legs or hands)
  • Urinary tract infections (UTIs)

Standing still for long periods of time or eating a diet high in sodium may cause fluid to collect in the legs, which can stimulate urine production after lying down in bed. People with insomnia may also experience nocturia as a side effect of poor sleep.

Tips for Reducing Frequent Urination at Night

Depending on the cause of your nocturia, you may find that implementing simple lifestyle changes can help reduce urination at night so you can wake up less frequently.

Reduce Your Fluid Intake

While it is important to stay well hydrated, you may want to consider limiting your daily fluid intake to a maximum of two liters based on the guidance of your physician. If you experience nocturia, it is especially important to avoid caffeine and alcohol and drink less in the evening, particularly in the two hours before bedtime. Use the restroom one last time just before you go to bed.

Adjust Your Diet and Exercise

If you are overweight, your doctor may recommend that you adopt a lower-salt diet and exercise more often. In addition to regular exercise, some people may benefit from specifically training the muscles involved in urination. One study found that pelvic floor exercises significantly reduced nighttime bathroom trips for women with incontinence.

Elevate Your Legs

For people with conditions such as chronic heart failure or peripheral edema, wearing compression stockings and elevating the legs a few hours before bedtime may help reduce the fluid buildup that can trigger nocturia.

Ask About Medication

Though certain medications can help treat the conditions that cause nocturia, others may increase urinary production at night. If you are taking diuretics, ask your doctor if you can take them earlier in the day, around the mid-afternoon. Instead of drinking a full glass of water with your medications, consider limiting it to just a sip or two if your physician permits.

When to Talk to Your Doctor

If nocturia interferes with your sleep or if nighttime urination occurs alongside other symptoms, schedule an appointment with your doctor. They will ask you about your diet and fluid intake, your sleep habits, whether you are taking medications, when you first noticed symptoms, and how much and how frequently you urinate at night. They may perform a physical exam or order additional testing to determine the underlying cause of your nocturia.

To provide your doctor with a full picture of your symptoms, it is helpful to keep a diary in the days before your appointment where you track how much you drink and how frequently you go to the restroom.

Treatment for nocturia usually focuses on improving lifestyle habits, addressing underlying health conditions, and sometimes using medications as prescribed by your doctor. If you are currently experiencing nocturia, you can minimize your risk of injuries by ensuring you have clear and easy access to a bathroom at night.

References

+ 4 Sources
  1. 1. Accessed on October 20, 2021.https://pubmed.ncbi.nlm.nih.gov/28984060/
  2. 2. Accessed on October 20, 2021.https://pubmed.ncbi.nlm.nih.gov/30085529/
  3. 3. Accessed on October 20, 2021.https://pubmed.ncbi.nlm.nih.gov/31586470/
  4. 4. Accessed on October 20, 2021.https://pubmed.ncbi.nlm.nih.gov/26967265/

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