During the night, there are centers in the brain that send signals to hormones in the body that tell the bladder to slow down the production of urine. This is partly so you can get enough sleep at night without having to get up during the night to urinate. Some people, however, suffer from nocturia.
What is Nocturia
Nocturia, also known as Nycturia, is a condition in which you frequently get up to use the restroom to urinate during the night. Unlike bedwetting, you are awake when you urinate because the bladder has sent signals to the waking centers of the brain so you are able to wake up to urinate.
While it is a good thing not to be wetting the bed at night, it causes a loss of sleep, which can interfere with your waking life. Most people can stay asleep for as many as 8 hours without having to get up to go to the bathroom. As a person ages, however, this capacity is not as strong; the problem of nocturia or frequent nighttime awakenings to urinate often begins in the middle age years or among adults who are considered elderly.
Getting up once during the night is considered within normal limits. Most people can quickly void and go right back to sleep without any real loss of sleep. Any more than that is probably not normal and can interfere with having a good night’s sleep. There are people who have such a severe problem with nocturia that they get up 5 to 6 times per night just to go to the restroom to urinate. This can have a big impact on the amount of sleep you get and can interfere with activities of daily living, especially if you have a hard time falling back to sleep after arising.
What causes nocturia?
Sometimes, nocturia is not the official diagnosis but is instead a symptom of having another illness altogether. Common causes of nocturia include the following:
- Bladder infections
- Bladder prolapse or sagging of the bladder
- Diabetes insipidus
- Bladder tumor
- Prostate tumor
- Uncontrolled diabetes mellitus
- Idiopathic nocturia, with no observable cause
- The taking of diuretic medication
- Pregnancy, with pressure put on the bladder by the growing fetus.
- Problems with the bladder sphincter
- Sleep apnea
What this means is that, if you have nocturia, it pays to see a healthcare professional to decide whether your nocturia has no known cause or is a symptom of another condition altogether.
Nocturia in elderly
As we get older, idiopathic nocturia is caused by a reduction of a hormone called ADH or antidiuretic hormone. We use this hormone to relax the bladder and produce less urine. The more urine we produce, the stronger is the signal to awaken and to empty the bladder. The bladder has a smaller capacity when we are older so the need to empty it is greater during the night (and the daytime, too). In addition, the medical problems described above are more common as we age so nocturia is more likely to be a symptom of something else.
How common is nocturia?
Nocturia is very common. In a National Sleep Foundation study from 2003, it was found that about 65 percent of all Americans between the ages of 55 and 84 have symptoms of nocturia at least some nights during the week. It can occur just a few nights a week or can be a nightly occurrence. When it becomes a regular part of your nighttime hours, it has the most impact on your waking hours and you suffer from all the symptoms of sleep deprivation, such as daytime sleepiness, difficulty concentrating, and poor memory. It can make it difficult to function in your everyday capacities due to fatigue.
Symptoms of Nocturia
Most people with nocturia report having to awaken several times during the night to urinate. Sometimes there is the urge to urinate but there isn’t really a full bladder. Your bladder is sending a signal to urinate even when the bladder is not technically full. Other times, you are actually producing too much urine at night and you have to void because of that. People who have swelling of their ankles during the day sometimes have a shift in fluid states when they are lying down and they find that nighttime is when the body chooses to get rid of the excess ankle fluid.
Nocturia can also involve the symptom of urinary urgency. Urinary urgency is a condition where you have to void and don’t have very much warning from the time you feel the urge to void and the time when you absolutely must empty your bladder. You can empty the bladder completely when you have nocturia or you may find that very little comes out even though you felt the urge to void. Nocturia can happen when your biological clock is off so that you keep the same routine of voiding during the night as you did during the day.
Treatment of Nocturia
Before going to the doctor about your symptoms, think about how much fluid you are taking in during the evening hours and whether or not the liquid you are taking in contains too much caffeine. Caffeine is a diuretic that can cause excessive urination. Think, too, about whether or not you are taking a diuretic pill at nighttime. Diuretics for the treatment of high blood pressure or heart failure should ideally be taken in the morning so it has a chance to wear off by nighttime.
See your doctor about your symptoms so he or she can rule out another illness as the cause of your nocturia. It might be helpful to write down some of your sleep habits so your doctor can identify any changes you may need to make and so the doctor can know how serious the problem is. The doctor may do a urine test for infection or perform cystometry, which measures the amount of pressure existing in the bladder. A visit to a sleep center might be in order to see if there is another sleep problem going on.
As for habits, it is a good idea to limit the amount of fluid you drink at night and avoid caffeine at night. Alcohol intake at night can also contribute to nocturia so this should be avoided for at least two hours before retiring. There are medications a person can take that makes the bladder less irritable during the night so you can sleep longer without having to get up to void.