Is Using the Bathroom in the Middle of the Night Normal?
The term nocturia means waking up in the middle of the night to pee. Nocturia is the most common (1) lower urinary tract symptom. Many people consider nocturia a normal sign of aging, but getting up multiple times during the night can have a negative impact (2) on your sleep quality and could be a sign of an underlying medical condition (3).
What Is Nocturia?
Most people urinate around four to six times a day (4). Nocturia refers to getting up one or more times during the night to pee.
Your circadian rhythm, the internal clock that regulates the timing of bodily processes, may play a role in your urine output (5). The urge to urinate usually happens during the waking hours of the day and decreases significantly at night as you sleep. However, those with nocturia find themselves waking up in the middle of the night, often multiple times, with a strong urge to use the bathroom.
Who Is Most Likely to Experience Nocturia?
Nocturia is the most common lower urinary tract symptom and affects men and women of all ages. About 69% of men and 76% of women over age 40 report having to urinate at least once during the night. Waking up to pee in the middle of the night can also affect those under the age of 40, although nocturia is less common in young adults (6).
The need to urinate at night tends to increase sharply with age, especially for men. Between 70% and 90% of men over the age of 70 experience nocturia.
How Does Nocturia Affect Your Sleep?
Occasionally getting up to use the bathroom at night is usually not a cause for concern. However, consistent and frequent awakenings to use the bathroom every night fragments your sleep. Those who experience multiple awakenings may also find it hard to fall back asleep after they use the bathroom, leading to less time spent in deep, restorative sleep.
Missing out on high-quality sleep every night affects almost every aspect of life (7). Sleep loss due to nocturia is associated with a wide array of negative outcomes including:
- Reduced quality of life (8)
- Higher risk of depression
- Increased risk of falling (9)
- Poorer overall health (10)
Why Do You Have to Pee So Much at Night?
Medical professionals consider nocturia to be a symptom and not a condition in itself. In many cases, increased trips to the bathroom at night are due to drinking too many liquids in the evening. By consuming large amounts of fluid right before bed, especially caffeine or alcohol, your body is forced to increase urine production as you sleep.
In some cases, waking up to pee at night might be a sign of an undiagnosed medical issue, such as:
Type 2 Diabetes
Type 2 diabetes is marked by an increase in thirst and need to urinate (11). More than 34 million Americans (12) live with type 2 diabetes, but the Centers for Disease Control and Prevention estimates that over 7 million more could be undiagnosed.
Urinary Tract Infections
Urinary tract infections can cause increased urinary frequency. They are the most common cause of frequent urination in women and children.
For older men, the most common cause of needing to urinate more frequently is an enlarged prostate. Known as benign prostatic hyperplasia or BPH, an enlarged prostate affects over half of men in their 60s (13) and results in a greater urination frequency and urgency (14).
Nocturia is also associated with sleep disorders. Those with sleep-disordered breathing conditions such as obstructive sleep apnea often need to urinate more (15) in the middle of the night. Researchers aren’t certain what causes the link between sleep apnea and nocturia. One theory is that people with sleep apnea may produce more urine (16) and have elevated levels of hormones important for urine production.
People experiencing nocturia are also more likely to have insomnia. However, it's not clear whether the need to use the bathroom frequently throughout the night is the cause of insomnia and sleeplessness or if insomnia causes frequent urination.
How Can You Stop Frequent Urination at Night?
Lifestyle changes are typically the first point of intervention for successfully managing nocturia. If you experience only occasional or mild symptoms of nocturia, you can modify your daily routine to help stop the urge to urinate in the middle of the night including:
- Reducing fluid intake, especially caffeine and alcohol, at least 2 hours before bed
- Emptying your bladder before going to sleep
- Reducing salt intake
- Losing weight, for those who are overweight or obese
- Strengthening the muscles around your bladder with pelvic floor exercises
When to Seek Medical Treatment
If you experience nocturia, consider discussing your symptoms with your primary care physician. Nocturia is notoriously underreported (17), and talking to your doctor can help you identify any underlying medical conditions.
Ultimately, the best treatment will depend on the cause of your nocturia. If your symptoms are severe or don’t respond to simple behavioral modifications, your doctor may prescribe medication. One common pharmaceutical treatment for nocturia is desmopressin, a drug that concentrates urine overnight and is effective in both men (18) and women (19).
Many people think waking up in the middle of the night to urinate is just a part of aging. While nocturia is incredibly common, you don’t have to let it dictate your sleep quality. If you’re waking up frequently every night, talk with your doctor to identify the underlying cause and discuss an individual treatment plan so that you can return to restful nights of high-quality sleep.
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