Millions of Americans are affected by a frequent need to urinate during the night. This is known as nocturia, and it is often cited as a cause of sleep disruptions. Though frequently thought of as a problem in elderly people, it can impact people of all ages.
Trips to the bathroom can cause fragmented sleep, excessive daytime sleepiness, and an elevated risk of dangerous falls. Nocturia has numerous potential causes and can be connected to a range of serious health issues.
Although nocturia is common, it shouldn’t be accepted as inevitable. In many cases, steps can be taken to reduce bathroom trips and improve sleep. Understanding the basics about frequent nighttime urination, including its causes, consequences, and treatments, can be a first step for people of any age to sleep better and with less bothersome nocturia.
What Is Nocturia?
Nocturia describes needing to wake up at night in order to urinate. It is a symptom of other conditions, not a disease itself.
According to technical definitions, a person has nocturia if they get out of bed to urinate one or more times per night. By this standard, nocturia is widespread; however, many people may not find one awakening to be problematic. Nocturia tends to be more bothersome when a person awakens two or more times and/or if they have difficulty getting back to sleep.
Nocturia is not the same thing as bedwetting, which is also known as nocturnal enuresis. Unlike nocturia, which involves waking up and recognizing the need to urinate, bedwetting typically occurs involuntarily and without the sensation of having a full bladder.
How Common is Nocturia?
Nocturia is quite common among both men and women. Studies and surveys have found that 69% of men and 76% of women over age 40 report getting up to go to the bathroom at least once per night. About one-third of adults over age 30 make two or more nightly bathroom trips.
Nocturia can affect younger people, but it becomes more common with age, especially in older men. It is estimated that nearly 50% of men in their seventies have to wake up at least twice per night to urinate. Overall, nocturia may affect up to 80% of elderly people.
Rates of nocturia have been found to be higher in people who are black and Hispanic than in white people even when controlling for gender and age. The reason for this disparity is not well understood.
Nocturia frequently occurs during pregnancy but usually goes away within three months after giving birth.
What Are the Impacts of Nocturia?
Nocturia can have significant health consequences. It may be connected to serious underlying problems, and nighttime bathroom trips can both disrupt sleep and create additional health concerns.
Does Frequent Urination Disrupt Sleep?
Multiple research studies, including a Sleep in America Poll by the National Sleep Foundation, have consistently found that nocturia is one of the most commonly reported causes of sleep disruptions. Especially in older adults, it is frequently listed as a cause of poor sleep and insomnia.
Many people, perhaps over 40%, have trouble quickly getting back to bed, which can mean reduced sleep time and more fragmented, lower-quality sleep. Not surprisingly, nocturia is commonly associated with excessive daytime sleepiness which can translate to impaired physical and mention function, irritability, and a higher risk of accidents.
What Are Other Health Risks Related to Nocturia?
The consequences of frequent urination at night go beyond just poor sleep. For older adults, nocturia creates a higher risk of falls, especially if they are rushing to get to the bathroom. Studies indicate that fall and fracture risks increase by 50% or more for people with two or more nighttime bathroom trips.
Nocturia has been associated with reduced scores on quality of life measurements as well as negative health conditions including depression. Beyond specific negative impacts, nocturia has also been connected to higher overall mortality although further research is necessary to fully understand this correlation.
What Causes Nocturia?
Three main issues provoke nocturia: producing excess urine at night, decreased bladder capacity, and sleep disruptions. Each of these issues can be caused by a variety of underlying health conditions.
Producing Excess Urine at Night
Producing excess urine at night is known as nocturnal polyuria, and it is estimated to be a contributing cause for up to 88% of cases of nocturia.
For some people, excess urine production occurs throughout the day and night. This condition, called global polyuria, is most often tied to excess fluid intake, diabetes, and/or poor kidney function. Diuretics, including medications (“water pills”) and substances like alcohol and caffeine, can cause enhanced urine production as well.
Elevated amounts of urine production that occurs only at night can occur when fluid intake goes up at night. It can also occur when peripheral edema — swelling or fluid accumulation in the legs — relocates after a person moves into a lying position. Coexisting medical problems can contribute to peripheral edema and thus raise the risk of nocturnal polyuria.
Some research indicates that changes to the body’s circadian rhythm cause older adults to have a greater proportion of their daily urine production occur at night, which may be a contributing factor to their higher rates of nocturia.
Decreased Bladder Capacity and Increased Urinary Frequency
Even without increased nighttime urine production, reduced bladder capacity and increased urinary frequency can give rise to nocturia.
Urinary tract infections (UTIs) are one of the most common causes of changes to bladder capacity. They can also occur among people who have enlarged prostate, benign prostatic hyperplasia (BPH), or overactive bladder.
A heightened urge to urinate, inflammation of the urinary tract, and bladder stones can all be risk factors for diminished bladder capacity and increased urinary frequency that can lead to nocturia.
Some people experience increased urinary frequency and urgency throughout the day while others find them to occur primarily at night.
Though we tend to focus on nighttime urination as disrupting sleep, there is compelling evidence that sleeping problems are also a major factor in provoking cases of nocturia.
One of the clearest examples is obstructive sleep apnea (OSA), which causes repeated pauses in breathing during the night. Nocturia occurs in around 50% of people with OSA. OSA repeatedly reduces airflow and oxygen levels during sleep and influences hormones in a way that increases urine production. On top of that, people with OSA have frequent sleep interruptions, so they are more inclined to notice the need to urinate.
Beyond OSA, there is debate among experts about whether nocturia causes sleep disturbances or the other way around. It is more likely that sleeping problems, including insomnia, are the root cause if a person struggles to get back to sleep after going to the bathroom.
Research in older adults indicates that lighter sleep may increase susceptibility to nocturia. Older people spend less time in deep sleep stages, which means they are more easily awoken. Once awake, they may take note of an urge to urinate, leading to nocturia.
As previously described, older adults have been found to produce more of their daily urine at night, which can combine with lighter sleep to increase the prevalence of nocturia in the elderly. This also demonstrates how multiple factors, including sleep difficulties, can work simultaneously to cause frequent nighttime urination.
Reducing Nocturia and Getting Better Sleep
Because it can have significant health consequences and connections to other illnesses, it is important to talk to your doctor about bothersome nocturia. A doctor can help identify the most likely cause and appropriate therapy for any specific individual.
When an underlying condition is causing nocturia, treating that condition may reduce the nighttime trips to the bathroom. Many patients with nocturia are treated with medications or have adjustments to their existing medications (such as diuretics).
A number of lifestyle changes can help reduce problematic nocturia. These changes are designed to reduce nocturnal urine production and include:
- Reducing evening fluid intake, especially before bed.
- Decreasing consumption of alcohol and caffeine, especially in the afternoon and evening.
- Elevating the legs an hour or more before bed in order to reduce the resorption and conversion of peripheral edema to urine during sleep.
Focusing on sleep hygiene, which includes your bedroom environment and sleep habits, can reduce awakenings during which you notice a need to go to the bathroom. Examples of healthy sleep tips include:
- Keeping a consistent sleep schedule, including waking up at the same time on weekdays and weekends.
- Having a steady routine that gets you ready for bed each night.
- Learning relaxation techniques that can put your mind at ease when you go to bed and when you want to fall back asleep after going to the bathroom.
- Getting daily exercise that can help you have deeper sleep.
- Setting up your bed with a comfortable mattress, pillows, and bedding.
- Customizing your bedroom to have a minimal light and noise, a cool temperature, and a pleasant smell.
- Limiting the use of electronic devices, including cell phones, which can activate the brain and reduce the production of the sleep-promoting hormone melatonin.
Working with a doctor and making lifestyle changes can reduce the number of bathroom trips you take each night, but they often may not eliminate them completely. For that reason, it’s important to take steps to make those trips as safe as possible, especially for older people.
Motion-activated, low-wattage lighting can make it easier to walk safely to and from the bathroom. The path should be cleared of common trip hazards like cords or rugs. People with mobility issues or who have high urgency to urinate upon awakening may find that a bedside urinal or commode improves safety and reduces sleep disruption.
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