A frequent need to get up and go to the bathroom to urinate at night is called nocturia. It differs from enuresis, or bedwetting, in which the person does not arouse from sleep, but the bladder empties anyway. Nocturia is a common cause of sleep loss, especially among older adults. In fact, nearly two-thirds (65%) of those responding to NSF’s 2003 Sleep in America poll of adults between the ages of 55 and 84 reported this disturbance at least a few nights per week.
Most people without nocturia can sleep for 6 to 8 hours without having to urinate. Some researchers believe that one event per night is within normal limits; two or more events per night may be associated with daytime tiredness. Patients with severe nocturia may get up five or six times during the night to go to the bathroom.
Nocturia is often a symptom of other medical conditions including urological infection, a tumor of the bladder or prostate, a condition called bladder prolapse, or disorders affecting sphincter control. It is also common in people with heart failure, liver failure, poorly controlled diabetes mellitus, or diabetes insipidus. Diabetes, pregnancy and diuretic medications are also associated with nocturia.
Until recently, nocturia was thought to be caused by a full bladder, but it is also a symptom of sleep apnea. According to Michael J. Thorpy, MD, and Jan Yager, PhD, authors of The Encyclopedia of Sleep and Sleep Disorders, relief of the sleep apnea syndrome will alleviate the nocturia.
Nocturia becomes more common as we age. As we get older, our bodies produce less of an anti-diuretic hormone that enables us to retain fluid. With decreased concentrations of this hormone, we produce more urine at night. Another reason for nocturia among the elderly is that the bladder tends to lose holding capacity as we age. Finally, older people are more likely to suffer from medical problems that may have an effect on the bladder.
Nocturia or frequent nighttime urination may occur only occasionally or nightly. Symptoms of nocturia include excessive urination (need to urinate too much fluid), frequent urination (too many visits to the bathroom for various reasons), urinary urgency (need to urinate sometimes without much result), or reduced urine. Nocturia may result when a person’s normal “body clock” allows for daytime urination pattern to occur at night. Sometimes, nocturia may simply be the result of drinking too many fluids, especially caffeine, before going to bed.
If you are experiencing nocturia, consult your doctor as soon as possible and follow his or her recommended therapy. It may be helpful to keep a diary of times and amounts of urine voided to bring with you to the doctor. Also, bring a record of your sleep habits as well as any daytime fatigue you may be experiencing. After an initial evaluation, your doctor may prescribe medications, diagnostic testing such as urinalysis, cystometry (a measurement of the pressure within the bladder), neurological tests (for some urgency problems), or ultrasound, or refer you to a sleep center for testing.
Drink your normal amount of liquid but do so earlier in the day. Cut down on any drinks in the last two hours before you go to bed – especially alcohol, coffee or tea as these stimulate urine production. Keep a diary of how much you drink, what you drink, and when. This may be helpful in identifying situations which may make the nocturia worse. While there is limited scientific research and no proof of their effectiveness, some people believe that homeopathic medicines, hypnosis or acupuncture can be beneficial. Be sure to seek advice from a trained practitioner.
In the 2003 Sleep in America poll, 65% of adults age 55-84 report the need to get up to go to the bathroom a few nights a week or more (53% every or almost every night).
Donald L. Bliwise, PhD
Professor of Neurology at Emory University Medical School in Atlanta, Georgia. He serves as Director of the Program in Sleep, Aging and Chronobiology in the Department of Neurology and as a Professor at the Nell Hodgson Woodruff School of Nursing at Emory University. His specific area of interest has been the description, elucidation of pathophysiology, and treatment of sleep disorders in the aged, with special interest in sleep in neurodegenerative conditions such as Alzheimer’s disease and Parkinson’s disease.