Nothing is more frustrating than waking up repeatedly for trips to the bathroom when you’d rather be sleeping, but that’s the reality for those living with nocturia. It’s a condition that means you’re losing out on an uninterrupted, restful night’s sleep, which can make you feel drowsy, irritable and out of sorts. Not being able to sleep enough is also linked to undesirable outcomes like exhaustion, mood disturbances, poor work performance, accidents, injuries, illness, and lower life expectancy.

In America, 50 million people live with nocturia, with about 10 million receiving treatment. Sometimes, the condition is lifestyle-related, but it could also be a symptom of an underlying disease. Determining the cause and finding treatments could be tricky, but help is available.

Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t take the place of medical advice and supervision from your healthcare provider. If you feel you, your child, or partner may be suffering from any sleep disorder or medical condition, please see a trained professional immediately.

What Is Nocturia? 

“Nocturia is a condition in which people need to wake up to urinate in the night,” says Daniel A. Barone, MD, an associate professor of Clinical Neurology and Associate Medical Director at Weill Cornell Center for Sleep Medicine, New York. It’s not necessarily an illness, but it certainly acts as an annoyance, disrupts sleep, and could be a sign of underlying disease. 

Alex Shteynshlyuger, MD, Director of Urology at New York Urology Specialists says “it’s a common problem men and women experience as they grow older.” He emphasizes that “it’s important to understand the ‘danger’ of nocturia’’ and seek medical attention early.  

Men and women are equally affected, and as Shteynshlyuger pointed out, it’s more common as people grow older — one in three adults over 30 years old experience nocturia, while up to half of those aged 60 and above can be afflicted with this pesky condition. 

How Does Nocturia Affect Sleep?

Adults are meant to sleep for 7-9 hours every night — if you’re regularly falling below that threshold, you know how exhausting it can be. People with nocturia wake up at night to urinate, which disrupts their normal sleep cycle and shortens the amount of time spent sleeping. Often, after waking up to urinate, they find it difficult to fall asleep again — and even if they do fall back to sleep, their slumber may not be as deep and restful as it should be. Ultimately, nocturia significantly reduces your ability to sleep well and prevents you from getting the benefits of proper sleep. 

Over time, this leads to the dreaded sleep deprivation, which negatively affects emotional well-being, work performance, and overall health. People who don’t sleep enough also have a higher risk of falls and fractures, injuries, accidents, and death from any cause.

Symptoms Of Nocturia

Nocturia itself is often a symptom. However, it can show up as: 

• Waking two or more times at night to pee
• Sleepiness and tiredness during the day

Causes Of Nocturia 

“There are many situations, conditions, and diseases that cause nocturia,’ says Kelly Casperson, MD, board-certified urologist with Pacific Northwest Urology Specialists in Washington. “It could happen because you drank too much or have sleep difficulties or even cardiac, metabolic, or kidney disease. That’s one of the reasons nocturia is challenging — it’s not always the bladder’s fault. There are many [possible culprits],’ she adds. 

Generally, nocturia is caused by changes in how you sleep or your body makes and stores urine. Sometimes, more than one change happens at once; for example, if you are pregnant and drink too much water or have diabetes and prostate disease—this combined effect could lead to nocturia.

The common root causes of nocturia include:

• Polyuria. Your body makes too much urine.
• Nocturnal polyuria. Your body makes too much urine at night.
• Bladder storage problems. Your bladder storage capacity has gone down over time, or your bladder function is disturbed—for example, in an overactive bladder.
• Sleep disorders. You aren’t able to sleep soundly.
• Mixed nocturia. A combination of two or more of these factors 

It’s important to note that these conditions could be due to lifestyle changes or signs of more serious conditions. For example, your body could make lots of urine if you drastically increase your water intake, but it could also do so if you have kidney disease or diabetes. 

Lifestyle Changes That Could Cause Nocturia: 

• Drinking too much liquid before bed (especially caffeine or alcohol). If you drink too much fluid too close to bedtime, you’ll make more urine at night, leading to more frequent bathroom visits. 
• Trained behavior. Some people have trained themselves to use the bathroom often at night. These types of habits could trigger wakefulness even if their bladder isn’t full. 
• Pregnancy. Pregnancy comes with a whole host of changes for expectant moms. For instance, it’s common to urinate more than once at night during pregnancy, and it becomes increasingly more common as the pregnancy progresses. The main reason is the growing uterus pressing against the bladder, leading to lower bladder capacity. Luckily, nocturia in pregnancy is considered normal and will resolve once the pregnancy is over. No medical treatments are needed, only behavior and lifestyle changes.  
• Old age. As people grow older, their bodies produce lower amounts of hormones regulating urine production. Additionally, men are more likely to have prostate enlargement, which may affect urination. Women, on the other hand, may experience urinary tract changes after menopause or childbirth, leading to an increased urge to pee at night. 
• Medication. Medication can also lead to frequent bathroom visits at night. This could be due to the main function of the medication — diuretics, for example — or due to the timing, dosage, or side effects of the prescription. 

Some drugs that may lead to symptoms of nocturia include: 

• Diuretics 
• Lithium 
• Phenytoin
• Vitamin D
• Demeclocycline 
• Propoxyphene 
• Methoxyflurane
• Cardiac glycosides 

Conditions Nocturia Could Be A Symptom Of

People experiencing nocturia should be sure to mention their symptoms to their doctor, as the condition may also be a sign of underlying health conditions.  Any condition that affects your ability to produce and store urine or your ability to sleep could cause nocturia. Examples of such conditions are: 

• Diabetes
• Pelvic prolapse 
• Uterine prolapse 
• Sleep disorders 
• Kidney disease 
• Hypercalcemia
• Prostate disease
• High blood pressure 
• Bladder obstruction 
• Restless leg syndrome 
• Urinary tract infections
• Congestive heart failure 
• Certain cancers, e.g., pancreas and prostate cancer. 

Other factors that have been associated with nocturia are: 

• Obesity 
• Depression 
• Use of antidepressants 
• Lack of physical activity 

How To Diagnose Nocturia

For those finding themselves running off to the bathroom a bit too frequently overnight, a healthcare provider can determine the cause of the nocturia and treat it. Here’s what to expect. 

Consulting a doctor. When you consult your doctor, they’ll ask questions about your experience. They may ask: 

• When did this start? 
• How many times do you pee during the day and each night? 
• Do you feel tired or sleepy when you wake up?
• Is your urinary volume large or small? 
• Do you drink alcohol or caffeine? 
• Are you taking any medication? 
• Has your diet changed? 
• Do you wake up wet? 

Your doctor may ask you to keep a diary of your sleep, urinating, and related activities. The diary will help you track anything that could affect your symptoms, such as:

• Number and type of drinks
• Current medicines and timing
• How long and well you slept
• How you feel when you wake up 
• Number of bathroom visits each night

With this information, your doctor will determine the likely cause of the nocturia and how to treat it. 

Physical Examination. During your visit, your doctor may also conduct a physical examination. This may include a close look at your legs, abdomen, rectum, blood pressure, nervous system, and heart and lung function. 

Laboratory investigations. Your healthcare provider may request laboratory investigations like: 

• Urinalysis. This test checks for any abnormalities in your urine. 
• Urine culture. This test checks for infections. 
• Blood tests. These tests detect diseases like diabetes, thyroid disease, kidney disease, or anemia. 
• Bladder scan. This test detects how well you empty your bladder each time you pee. 
• Cystoscopy. During this procedure, the bladder is inspected for signs of disease. 
• Urodynamic testing. This test checks your lower urinary tract function, especially its ability to transport, store and release urine. 

Nocturia Treatments

The underlying causes of nocturia have to be treated before symptoms can improve — and the good thing is nocturia is a highly treatable condition. Your doctor may recommend lifestyle changes, behavioral therapy, medication, surgery or a combination of these treatments. 

Lifestyle Changes 

Here are some lifestyle changes that may reduce nocturia — or help you learn to live with it in the meantime:  

• Drinking less fluid at night. Focus most of your liquid intake during the day and limit fluids 2-4 hours before bedtime.
• Limit alcohol and caffeinated drinks like tea, soda, and coffee. 
• Reduce dietary salt intake, especially in the evenings. 
• Manage your medications. If you take diuretics or any medication that could send you to the restroom, take them 6 hours before bedtime. 
• Elevate your legs and use compression stockings. Doing this may help reduce the need to pee at night if you have excess fluid in your legs.
• Take naps. If your circumstances permit, take brief morning or afternoon naps to catch up on any zzz’s lost to nocturia. The naps shouldn’t be too often or close to bedtime, so they don’t worsen your ability to sleep at night. 
• Practice regular physical activity. An afternoon walk, or any other exercise, helps control nocturia. Avoid long periods of standing still, which can cause fluid to collect in your legs.
• Reduce fall risk. To reduce the bother of frequent urination and the risk of falls, you can use a urinary can or commode. You can also consider low-level lighting and removing rugs or other fixtures that could trip you. 

Other therapies and habits you can consider to improve nocturia include: 

• Sleep hygiene 
• Kegel exercises 
• Delayed voiding 
• Behavior therapy 
• Fluid management 
• Pelvic floor muscle training 
• Urge-suppression techniques 
• Peripheral edema management 

Medications 

Some medications used to treat nocturia include: 

• Diuretics. These drugs can increase urine production during the day and reduce the need to pee at night. 
• Anti-diuretic hormone therapy. Desmopressin helps the kidneys produce less urine. 
• Anticholinergic medications. These drugs can treat an overactive bladder. 
• Alpha-blockers. These drugs are used in treating nocturia, particularly in men. 
• Topical vaginal estrogen. This drug is useful for treating nocturia in post-menopausal women.
• Botox bladder injections. This treatment helps people with an overactive bladder who don’t respond to alternatives. 
• Melatonin. Taking this supplement at bedtime can help reduce nocturia. 

Medications should only be taken when prescribed by a healthcare provider. In some cases,  you may also be offered minimally invasive procedures or surgery.

It’s normal to urinate once or not all at night. But as you grow older, say 65 years and above, you may need two overnight trips to the loo. However, urinating two times or more at night could be a sign of nocturia for healthy adults under 65. If you experience this, and it’s not due to lifestyle changes, you should seek expert medical attention. 

The Last Word from Sleepopolis 

Struggling to get a good night’s sleep can drastically affect your health and happiness—luckily for those with nocturia, there’s often a light at the end of the tunnel. Explore causes and treatment options with your doctor, and you should be back to getting steady slumber in no time.