Is your sleep disturbed by trips to the bathroom? If you notice you wake up more than once per night to urinate, you may have nocturia (frequent night urination).
Besides disturbing a good night’s rest, nocturia can sometimes be a sign of an underlying medical condition.
This article will cover the types and causes of nocturia, how to diagnose and treat it, and methods for preventing it.
What is Nocturia (Frequent Night Urination)?
Nocturia is frequent urination at night.
If you get out of bed to go to the bathroom more than once per night, you’re not alone. Nocturia is estimated to affect more than 2 in 3 adults over the age of 40.
There are three types of nocturia:
- Nocturnal polyuria: You produce an excessive amount of urine during the night
- Bladder storage problems: Your bladder has trouble storing or releasing urine
- Mixed nocturia: A combination of both types of nocturia
A variety of things can lead to nocturia. Some people experience nocturia caused by simple habits that are easy to change.
While for others, nocturia may indicate a more serious underlying health issue.
Here are some common causes of nocturia.
Polyuria is when your body makes too much urine in a 24-hour period, and the excess can cause you to wake up for bathroom trips instead of sleeping.
It has many causes, such as drinking too much water, eating food that’s high in water content, being pregnant, or having a kidney infection.
Congestive Heart Failure (CHD)
If you have congestive heart failure, the heart is not pumping as effectively, so you can get fluid buildup in the legs and ankles.
The swelling usually starts to decrease when you lie down at night.
Your body then produces more urine to get rid of the extra fluid.
Edema means swelling or an accumulation of fluid in the body.
It can happen for various reasons, and it most often affects the legs and ankles.
At night, the excess fluid starts to drain out of the lower limbs and gets converted to urine, which can wake you up at night.
Obstructive sleep apnea is a common sleep disorder that causes people to stop breathing for short periods of time while sleeping.
People with obstructive sleep apnea are more likely to have nocturia.
If you have type 1 or type 2 diabetes, which presents with high blood sugar levels, the kidneys work harder to filter and cleanse the blood.
This can cause an increase in urine production and a need to urinate more often, even when you’re trying to sleep.
Gestational diabetes, or diabetes while pregnant, tends to cause fluid imbalances that lead to more frequent urination.
A less common type of diabetes, called diabetes insipidus, doesn’t involve blood sugar.
Diabetes insipidus causes you to have an imbalance of fluids in the body and, as a result, increases the chances of nocturia.
If you have a sudden and uncontrollable urge to urinate, you may have overactive bladder syndrome.
This condition can lead to embarrassing leaks, and it can significantly reduce your quality of life.
Nocturia is one of the most common symptoms of overactive bladder syndrome, often leading to interrupted sleep.
Sometimes people have the urge to urinate before their bladder fills up completely. Possible causes include bladder spasms or an infection of the bladder or urinary tract.
Another bladder issue is the inability to completely empty your bladder when you urinate, causing you to need to urinate more often.
Possible causes are prostate enlargement or bladder obstruction, where there’s a blockage preventing the flow of urine.
Caffeine is a diuretic, which means it stimulates the kidneys and causes them to produce more urine.
If you drink too much caffeine, especially close to bedtime, you’re more likely to wake up with the urge to pee.
Too Much Fluid Before Bed
Drinking too much fluid close to bedtime is a common culprit of nocturia.
It’s best to avoid alcohol and caffeine before attempting to sleep because they’re diuretics, which means they cause your body to produce more urine.
Excessive Sodium Intake
Too much salt in your diet might cause you to urinate more frequently.
This is because salt causes the body to retain fluid. When you lie down to sleep, you will likely get right back up to go to the bathroom.
Some medications have side effects that cause you to urinate more frequently.
- Diuretics, such as bumetanide (Bumex), furosemide (Lasix), hydrochlorothiazide (Microzide), and spironolactone (Aldactone)
- Demeclocycline (Declomycin), an antibiotic
- Lithium (Lithobid), for mood or bipolar disorder
- Excessive vitamin D doses
As we get older, more frequent urination at night is common.
Risk factors can increase the chances of having nocturia, including:
- Bladder infection
- Older age
- Heart disease
- High blood pressure
- Higher body mass index
- Prostate problems
- Uterus problems
To diagnose nocturia, your medical provider will perform a medical exam.
They’ll ask you questions about your symptoms and may test your urine for signs of infection or other problems.
If you have symptoms – like pain, fatigue, or swelling in your legs – there may be another underlying cause of your nocturia, and your medical provider may order more tests.
It helps to record a diary to share with your provider. Your diary should record the amount of fluids you drink, the time you drink them, and how often you get up to use the bathroom at night.
You’ll also want to give your medical provider a list of medications you take.
If you think you might have nocturia, your medical provider will evaluate the underlying cause to determine the treatment.
Depending on the cause, they may prescribe medications or treatments for your symptoms.
For example, if you’re diagnosed with a urinary tract or bladder infection, you may be prescribed antibiotics.
It’s possible your medical provider may recommend you see a specialist.
For instance, if you have signs of obstructive sleep apnea, you may be referred to a sleep specialist or a pulmonologist (lung doctor). Or, if the cause is diabetes, they may refer you to an endocrinologist.
Treatment is individualized, so it’s important to see your medical provider to determine the cause and treatment for your needs.
Regardless of the cause, there are some steps you can take to help reduce and prevent nocturia symptoms.
Consider the following to get a better night’s sleep:
- Minimize how much fluid you drink as you get close to bedtime – especially alcohol and caffeine.
- Keep your legs elevated and wear long compression socks to minimize swelling in the legs and ankles.
- Take afternoon naps to let excess fluid from your legs be absorbed into your bloodstream. This gives your body the chance to get rid of excess fluid through urination, well before it’s time for bed.
- If you take medications such as diuretics that cause you to urinate more often, ask your doctor if you can take your medications earlier in the day.
When to See a Medical Provider
Sometimes nocturia can be managed with a simple action like reducing fluid intake before bedtime.
See a medical provider if:
- Frequent urination is disturbing your sleep
- Nocturia seems to be getting worse
- You have any pain with urination
- You have other symptoms like fatigue, fever, swelling, or shortness of breath
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Frequently Asked Questions
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Classification of nocturia in the adult and elderly patient: a review of clinical criteria and selected literature. (2005).
Diabetes insipidus: The other diabetes. (2016).
Effect of caffeine on bladder function in patients with overactive bladder symptoms. (2011).
Nocturia: Focus on Etiology and Consequences. (2012).
Nocturia: risk factors and associated comorbidities; findings from the EpiLUTS study. (2015).
Overactive bladder syndrome: Evaluation and management. (2018).
Prevalence of nocturia in obstructive sleep apnea syndrome. (2015).
What is Nocturia? (n.d.).