About 1 in 3 adults over the age of 30 experience nocturia, the frequent need to urinate at night. This constant disruption during sleep can cause long-term problems like extreme fatigue, sleep deprivation, and an overall decrease in health and daytime functioning.
Nocturia can be caused by many factors, from simple things like an excess of fluid intake prior to bed, to more serious issues such as sleep disorders and underlying health conditions. If you’re one of the 50 million people in the United States suffering from nocturia, you’ll be happy to know there’s an array of natural solutions and lifestyle changes to help treat it.
In this post, we explain exactly what nocturia is, what causes it, common symptoms, and various ways to prevent it. Overcoming nocturia and learning how to prevent it is an important step for ensuring you enjoy quality sleep and get a good night’s rest.
What is Nocturia?
Nocturia is a condition causing you to wake up two or more times a night to urinate. As people age, nocturia becomes more common in both men and women.
It’s typical for most people to wake up during the night to urinate once, but more times than that may be the sign of an underlying condition, sleep disorder, or other cause. Even simple daily habits like drinking too much water may be the cause of nocturia.
Causes of Nocturia
According to a study by Creighton University Medical Center, nocturia is typically caused by one of four main problems: nocturnal polyuria, global polyuria, bladder functional storage issues, and sleep disorders. However, other factors like health conditions, pregnancy, and simple daily habits can also be the cause.
Found in up to 88 percent of patients, nocturnal polyuria is the most common cause of nocturia. Nocturnal polyuria occurs when a nighttime urinary production is greater than 20 percent of a total 24-hour urine volume in younger adults, and 33 percent in older adults.
Anyone with nocturnal polyuria will only experience a high urine volume at night; daytime volumes are reduced or normal. Oftentimes, this is caused by the body retaining fluid during the day which accumulates in the legs and feet. Upon lying down, gravity sends the fluid back into your veins, and off to your kidneys to be filtered, turning into urine.
According to the Cleveland Clinic, nocturnal polyuria can be caused by congestive heart failure, edema of the lower body, drinking too much fluid before bedtime, and having a diet high in sodium. It can also be caused by sleep disorders, which we will discuss shortly.
Where nocturnal polyuria happens during periods of sleep, global polyuria occurs throughout the day and night. It’s essentially a continuous overproduction of urine. Global polyuria is usually caused by too much water filtered by the kidneys and is often associated with high fluid intake. It can also occur if something in the urine, like glucose, is pulling the extra water out. Untreated diabetes can often cause polyuria.
Common causes of global polyuria include high fluid intake, untreated diabetes, diabetes insipidus, and gestational diabetes, which occurs during pregnancy.
Bladder Functional Storage Issues
Anyone with bladder storage issues struggle with urinating more frequently because their bladder is unable to fully empty when urinating. Without fully emptying, the bladder then fills up quicker, causing the need to urinate yet again. Bladder obstruction and benign prostatic hyperplasia can both lead to this issue.
Bladder functional storage issues can also be caused by a bladder unable to fill up completely before creating the urge to urinate. Multiple bladder issues like overactivity, infection, recurrent urinary tract infections, inflammation, interstitial cystitis, and malignancy can all be the cause.
Sleep disorders should be suspected as a possible cause of nocturia if you’re unable to fall asleep quickly after an episode. In fact, nocturia occurs in about half of patients with obstructive sleep apnea (OSA), which can cause nocturnal polyuria because of its effect on the diuretic hormone ANP. Moreover, those suffering from OSA experience frequent sleep disturbances and are more likely to notice their need to urinate.
Oftentimes, people aren’t aware an underlying sleep disorder might be the cause of their nocturia. Typically, they think their urge to urinate is the reason for their waking. However, studies have shown that in the majority of cases, sleep-related disorders (severe snoring, apnea, or Restless Legs Syndrome) are actually the cause of awakening during a nocturia episode.
Underlying Health Problems and Other Causes
The National Association for Continence notes nocturia is sometimes a symptom of a greater problem. Various health conditions can change the way your body functions and may alter the way urine is passed, causing nocturia. Some of these conditions include:
- High blood pressure
- Heart disease
- Congestive heart failure
- Vascular disease
Pregnant women typically experience nocturia as well, but usually clears up instantly after birth.
Symptoms of Nocturia
The symptoms of nocturia are frustrating and irritating. In fact, according to one study on nocturia, the condition is often described as the most bothersome of all urinary symptoms.
The most common symptoms of nocturia include:
- Waking up multiple times a night to urinate
- Urinating in high volumes
- Fatigue when waking up due to frequent nighttime urination
All of these symptoms can cause sleep disruptions and lead to further issues. Sleepless nights and extreme fatigue can impair thinking and judgement, lead to weight gain, cause irritability and mood changes, and even lead to more severe health conditions like depression and heart disease.
Simple Ways to Reduce and Manage Nocturia
Treatment for nocturia is not considered necessary until the patient is overly bothered by it. Typically, people seek treatment when they experience two or more voids per night and it begins to affect their sleep.
Since there are many different things that can cause nocturia, it’s important to pinpoint the underlying issue. This will help determine the most effective type of treatment. However, easy lifestyle changes, learning to manage the condition, and improving your sleep experience may all produce positive results when treating nocturia.
1. Adjust Daily Habits
In almost all cases, the following lifestyle changes are recommended as an initial first step to treating nocturia, regardless of the cause:
- Limit fluid intake two to four hours before bed
- If taking diuretics, take them six hours before bedtime
- Restrict your salt and caffeine—especially coffee—intake
- Elevate legs or use compressions socks, which helps prevent fluid accumulation
- Take afternoon naps
- Maintain a healthy weight to avoid putting extra pressure on your bladder
2. Manage the Effects of Nocturia
Along with treatment, there are various things you can do to manage the effects of nocturia. These include:
- Using a waterproof mattress protector to shield your bed from any accidents
- Wearing absorbent briefs, pads, or absorbent underwear to prevent wetness
- Removing any obstacles or furniture between the bed and bathroom to reduce the risk of falls
- Plugging in nightlights to illuminate the way to the bathroom
3. Reduce the Likelihood of Nocturia Episodes
Improving sleep hygiene habits may have positive effects on nocturia. A significant reduction of nocturia, up to 50 percent in some patients, can be achieved using the below techniques:
- Reduce your time spent in bed
- Make your bedroom comfortable by eliminating noise and light
- Go to bed at the same time each day
- Maintain a “not-too-warm but not-too-cold” room temperature—around 60 to 67 degrees Fahrenheit is best for sleeping
- Avoid blue light exposure from TVs, phones, tablets, or computers in the couple of hours leading up to bedtime
How many times per night is normal to urinate?
Many people can sleep six to eight hours without waking to urinate. But it’s very common for people to wake up at least once per night to urinate, and it’s even more common in older people—a study by the University of Pennsylvania found 35 percent of men aged 45 had one or more voids nightly, while 79 percent of men aged 80 did.
If you are waking up more than once per night to urinate and it’s causing disruptions in your sleep, consider consulting your doctor.
What causes nocturia?
Nocturia is mainly caused by producing excess urine, a bladder obstruction, or sleep disturbances. The most common significant cause, however, is nocturnal polyuria, which is the production of excess urine at night. This has been found to be a contributing cause in up to 88 percent of nocturia cases.
Bladder function storage issues can also cause nocturia. When a bladder can’t completely empty, it fills up quicker and the urge to urinate becomes more frequent. Alternatively, nocturia can happen if the bladder signals it’s time to urinate before it’s actually full. Both of these storage issues lead to frequent bouts of urination through the night.
Nocturia can also be caused or occur alongside underlying health conditions and sleep disorders. Most commonly, nocturia is seen in people suffering from obstructive sleep apnea due to its effect on the diuretic hormone ANP.
Is nocturia treatable?
Treatment is targeted towards the underlying cause of the nocturia. For example, if sleep apnea is causing your episodes of nocturia, working with a sleep specialist may improve your symptoms. If you’re simply drinking too much water right before bed, cutting back earlier in the evening will reduce your likelihood of nocturia. Pinpointing the cause of your nocturia is the first step in treating it correctly.
However, regardless of cause, there are many easy things someone can do to help prevent nocturia. Limiting fluid intake in the hours prior to bed is one great way to ward off nocturia. Ensuring any diuretics are taken at least six hours before bedtime, wearing compression socks, and elevating your legs with an adjustable bed frame (or stack of pillows) will also help to prevent nocturia.
Is nocturia the same as an overactive bladder?
Many people with an overactive bladder (OAB) experience nocturia as a symptom. With OAB, symptoms can also include urinary urgency, a frequency of urination, and even urge incontinence (leakage). While the effects may seem similar, OAB is related to not having full control over the bladder, whereas nocturia is simply having to urinate more than once per night.
The cause of OAB also differs from nocturia. Common causes include weak pelvic muscles, nerve damage, a UTI, or an estrogen deficiency in women.
Is nocturia normal in elderly people?
Nocturia is much more common in older people. Changes in the urinary system and in hormones as people age can be a contributing factor to nocturia. It can also occur alongside medical conditions, which become more prevalent in elderly adults.
It’s important though to not view nocturia as just another symptom of aging. Nocturia can greatly inhibit one’s quality of life, even among the elderly. The best way to treat nocturia is to first determine the underlying cause in order to find the most appropriate treatment.
While nocturia itself isn’t harmful, the effects it can have on our quality of sleep can be damaging. Frequent disturbances during sleep can lead to insomnia, extreme fatigue, or more severe health conditions. Nocturia can also be the sign of a more serious underlying health condition or sleep disorder, and should not be ignored.
If you find yourself waking up more than once per night to urinate, you may be experiencing nocturia. Consider changing daily habits like limiting nighttime fluids and enhancing your sleep experience to see if the nocturia goes away. If not, we suggest visiting your doctor to seek treatment as it could be a sign of something more serious. Remember, pinpointing the cause of the nocturia is the first step to treating it and getting back to enjoying restful nights of sleep with no disturbances.
This article is for informational purposes and should not replace advice from your doctor or other medical professional.