Are you waking up to go during the night? Find out what could be behind these unwanted nighttime trips to the bathroom.
If you dream of a solid night of sleep, but nighttime urination often interrupts those plans, you’re not alone.
“Nocturia, or the need to urinate at night, is a common complaint of many people,” said W. Stuart Reynolds, MD, MPH, assistant professor of urologic surgery at Vanderbilt University School of Medicine in Nashville, Tenn. According to the National Sleep Foundation, waking up to go is often experienced by older adults — 65 percent of people age 55 to 84 polled by the foundation reported waking at night to urinate at least a few nights per week.
All these nighttime trips to the toilet are causing serious sleep troubles. A study published in the Journal of Clinical Sleep Medicine found that older adults who woke frequently at night to urinate also had more trouble getting back to sleep, suffered from poor quality of sleep, and felt less rested after they did sleep.
So what’s behind those busy bladders? “It can be hard to determine if the waking is actually caused by the need to urinate or by some other disturbance in sleep and then the need to urinate is recognized or felt,” explained Dr. Reynolds.
“Most people consider that waking up at night to pee is benign, and it probably is benign when it’s once per night. Once or twice or more is considered a reflection of something abnormal,” said Xavier Preud’homme, MD, a biological psychiatrist and assistant professor of psychiatry and behavioral sciences and of medicine at Duke University School of Medicine in Durham, N.C. In these cases, it’s important to find out what is causing it and work with your doctor to determine the appropriate treatment.
Bladder Disorders and Related Issues
Bladder disorders, such as overactive bladder, can be a cause of nighttime urination. Overactive bladder affects about 16 percent of the population, Dr. Preud’homme said. A key sign is having a lower threshold of discomfort when it comes to bladder fullness. When it is even slightly full, you feel an urgent need to void, explained Preud’homme. The phenomenon can occur at night — an overactive bladder can wake you from very deep sleep and, once you’re awake, you’ll feel the urgent need to urinate, said Preud’homme.
A common bladder disorder that can trigger nighttime urination in men is benign prostatic hyperplasia, or BPH, an enlarged prostate. Both overactive bladder and BPH are usually treated with medications to calm the bladder or to shrink the prostate to allow urine to pass more easily, said Reynolds.
Often, frequent nighttime urination is simply the result of your bladder being overly full. “The more common causes of why people pee at night comes from a different family of problems that all ultimately lead to producing too much urine at night,” Preud’homme noted. “Producing too much urine at night is called nocturnal polyuria.” People with polyuria have voluminous voids, and they are not associated with such difficulty falling back asleep, he added.
Older people may experience nighttime urination because they produce less antidiuretic hormone, or ADH, which in turns helps the body to produce less urine at night. “Nocturia is the No. 1 cause in the elderly of daytime sleepiness,” Preud’homme said.
You might experience frequent nighttime urination if you have insomnia, but this may be because you’re awake and feel as though you might as well get up to void. Sleep apnea is another possible trigger for nighttime urination. “Sleep disturbances, such as sleep apnea, cause changes in sleep patterns which result in waking at night,” Reynolds explained. “If apnea is severe, it can cause the body to eliminate extra fluid as urine as well.”
Other Health Issues
A heart condition can increase nighttime urination and interfere with your sleep. “In certain heart conditions and poor circulation, pooling of fluid in the ankles and feet — edema, or swelling that builds up during the day — is released as urine when you lie down flat or with your feet in the air,” said Reynolds. “The swelling drains back into the torso and is eliminated as urine.”
When Daily Habits Are the Cause
If nighttime urination is a problem but your bladder isn’t to blame, certain habits may be the problem — you’re simply doing something that’s increasing your urine output at night. “Drinking too much fluid before bedtime also results in having to get up at night to urinate,” said Reynolds. “Certain medications, like diuretics, cause increased urine production, and if taken too close to bedtime, will result in having to get up to void.”
If there are no medical conditions causing nighttime urination, a few simple changes in your habits may help. “Limit fluids three to four hours before bedtime,” Reynolds advised. “If ankle or leg swelling is a problem, lie down with feet elevated for 30 to 45 minutes before bedtime to help drain the fluid.”
Next, focus on good sleep hygiene with these steps:
- Make sure that your bed is comfortable.
- Keep your room at a cool temperature, and be sure that it’s dark and quiet.
- Avoid using your bedroom for anything other than sex and sleep.
- Wind down for bed with a soothing bedtime routine, like meditation or a warm soak, and avoid stimulating activities before bedtime.
- Get regular exercise during the day (not in the hours before bed) and avoid caffeine too close to bedtime.
- Stick to a regular bedtime and wake time schedule and avoid naps.
By Diana K. Rodriguez – Medically reviewed by Niya Jones, MD, MPH