Sleep Care

Frequent Trips to the Bathroom

For most of his life, George would occasionally wake up once a night to go to the bathroom to urinate.  However, since turning sixty he found himself going as many as five or six times a night—to the point where he started sleeping in a separate room from his wife because he didn’t want to disturb her with his frequent bathroom trips.  George often doesn’t feel rested in the mornings anymore, and wonders if his problems with nighttime urination could be a contributing factor.

A Frustrating Situation

Most people will get up to go to the bathroom to urinate—called “nocturia” (nocturnal urination)—once a night.  For some, however, the need to wake up and use the restroom occurs more often—and experts suggest two or more trips a night may be associated with daytime fatigue in some cases.

Nocturia occurs primarily in older people.  According to a 2003 poll conducted by the National Sleep Foundation, 65% of adults ages 55 to 84 years old reported disruptions in their sleep due to getting up to urinate at least several nights a week.  Nocturia is also prevalent for those suffering from obstructive sleep apnea, heart failure, liver failure or diabetes.  Pregnant women and those taking diuretic medications also may experience nocturia.  Studies have found significant links between nocturia and obesity, obstructive sleep apnea, and an increased risk for mortality (particularly among young men and women).

One of the challenges to effectively treating nocturia is identifying what its underlying cause might be for the individual.  For many, as the body ages and produces less anti-diuretic hormones, they are naturally able to retain less fluid as they were when they were younger.  Additionally, the bladder’s holding capacity decreases with age, making more trips to the bathroom a likely occurrence.

Nocturia and Sleep

Besides the physical act of getting up to use the bathroom during the night, nocturia can affect sleep in a number of different ways.  If too much urine is being produced, having a full bladder can make some sleeping positions uncomfortable and lead to increased tossing and turning during the night.  The “need-to-go” feeling and accompanying sense of urgency can be a powerful disrupter to a person’s natural sleep cycling during the night.  Nocturia can also be a sign that an individual’s internal “body clock” (or “circadian rhythms”) may be shifted, prompting normal daytime urinations to occur at night instead, and vice versa.

Studies investigating obstructive sleep apnea (OSA) and nocturia have found a significant link between the two.  Of particular note, more severe sleep apnea was associated with higher levels of urine production during the night—which could cause any of the problems previously mentioned.

Reducing the Nighttime Need-to-go

There are several behavioral changes that can often lead to a reduced number of trips to the bathroom during the night.  First, consider drinking fewer fluids—particularly caffeinated beverages—at least two hours prior to bedtime.  If possible, most fluids should be consumed earlier in the day, to allow time for urination to occur when awake or prior to laying down in bed for the night.

A physician may be helpful in identifying other causes for frequent trips to the bathroom, such as an overactive bladder or obstructive sleep apnea.  Treating other conditions such as these can often play a significant role in improving problems with nocturia.

In some cases, drugs can be beneficial.  For example, desmopressin is a synthetic copy of the body’s own antidiuretic hormone and works in a similar manner, making it effective for individuals whose problems with nocturia are due to too much urine being produced during the night.  Remember that any medications should only be used under a doctor’s supervision.

As someone who was used to being a night owl, George gave up his late-night drink before going to bed and also tried to reduce the amount of fluids he consumed during the day.  His physician recommended testing for sleep apnea, which revealed he did have some OSA.  After being placed on CPAP, George found he was sleeping much better and using the bathroom a lot less during the night.  “At my age,” he says, “when I lay down to sleep, I want to be able to sleep—not have to get up every hour to use the restroom.  While I miss my evening drink, I like getting a good night’s rest a lot more!”


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