Nocturia — the need to get up frequently to urinate during the night — is a common cause of sleep loss, especially among older adults. It affects nearly two-thirds of adults ages 55 to 84 at least a few nights per week.
A mild case causes a person to wake up at least twice during the night; in severe cases, a person may get up as many as five or six times. Not surprisingly, this can lead to significant sleep deprivation and daytime fatigue.
Nocturia becomes more common with age. As we get older, our bodies produce less of an antidiuretic hormone that enables us to retain fluid. With lower concentrations of this hormone, we produce more urine at night. Also, the bladder tends to lose holding capacity as we age, and older people are more likely to suffer from medical problems that affect the bladder.
Nocturia has numerous possible other causes, including disorders such as heart failure and diabetes, other medical conditions (urinary tract infection, enlarged prostate, liver failure, multiple sclerosis, sleep apnea) and medications (especially diuretics).
Therapies for nocturia fall into three categories: treatments to correct medical causes, behavioral interventions, and medication. The first step is to try to identify the cause and correct it. If this is unsuccessful, try behavioral approaches such as cutting down on how much you drink in the two hours before bedtime, especially caffeine and alcohol.
The most commonly used is desmopressin (DDAVP, Stimate), which mimics some of the action of the antidiuretic hormone. If the problem stems from increased contractions of the bladder, relaxant agents such as tolterodine (Detrol) and oxybutynin (Ditropan) can be effective.
The most common cause for nocturia is a urinary tract infection (UTI). This causes frequent burning and urgent urination throughout the day and night. The infection usually requires antibiotics to effectively treat it.
Another common cause of nocturia is excessive drinking—particularly drinks containing alcohol and caffeine. Consuming these substances in excess can lead to waking up and needing to urinate.
But some people have simply developed a habit of waking up during the night to urinate.
Nocturia is also common in people with organ failure—typically either heart or liver failure—and those who suffer from diabetes.
Nocturia can be an early symptom of pregnancy. This can develop at the beginning of pregnancy, but is more common later, when the womb presses on the bladder.
Some medications may cause nocturia as a side effect. This is particularly true of diuretics, which are prescribed to treat high blood pressure.
You should seek emergency medical care from a doctor if you lose the ability to urinate, or if you can no longer control urination.
Diagnosing the cause of nocturia can be difficult. Your doctor will need to ask a variety of questions. It can be useful to maintain a diary for a few days, recording what you drink and how much, along with how often you go to the toilet.
If it is caused by a medication, your treatment times may be changed to reduce their impact at night.
Nocturia can be a symptom of a more serious condition, such as diabetes or a UTI that could worsen or spread, if left untreated. Nocturia due to an underlying condition will usually stop when the condition is successfully treated.
It also disturbs the sleep cycle. If left untreated, it can lead to sleep deprivation, fatigue, dizziness, drowsiness, and depression.
It can be prevented by reducing the amount you drink before going to bed, avoiding drinks containing alcohol and caffeine and urinating before bed.