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Many people struggle with problems like "waking up to go to the bathroom even though I'm asleep" or "finding myself getting out of bed more often due to the urge to urinate."
Do you wake up to use the bathroom at night to urinate? Nocturia (nighttime urination) significantly impacts sleep because it requires you to wake up from sleep and leave your bed.
Waking up repeatedly to go to the bathroom can lead to your brain becoming fully awake each time, resulting in insufficient sleep and even sleep deprivation. Surprisingly, many people experience poor sleep at night due to nocturia, leading to daytime drowsiness that affects their activities.
This article will explain the causes and countermeasures for nocturia, which significantly impacts sleep. By reading this, you will gain a deeper understanding of nocturia and be able to resolve it!
1. How many times do you need to go to the bathroom at night for nocturia to be a concern?
The medical definition of nocturia is "waking up one or more times to urinate during sleep at night."
You might think, "Even just once?" However, if this happens almost every night, it can affect your sleep, and there may be an underlying cause.
A survey by the Japanese Continence Society reported that among people aged 40 and older, 71.7% of men and 66.9% of women wake up one or more times to urinate during sleep. This percentage increases with age, becoming even higher for those in their 50s and 60s.
Furthermore, if you wake up two or more times to urinate at night, it is considered to require treatment due to the decline in sleep quality and the significant inconvenience it causes in daily life.
If you wake up to use the bathroom "two or more times at night," you should consider consulting a specialized medical institution to investigate the cause.
2. Nocturia prevents you from sleeping soundly
It is well-known that lower urinary tract symptoms, including nocturia, reduce quality of life (QOL). Among these, the impact on sleep is considered to be significant.
However, many people attribute nighttime urination to aging and endure it as a natural phenomenon without seeking examination or treatment. If the cause of nocturia is identified and properly treated, the number of bathroom visits will decrease, and sleep interruptions will cease. As a result, you will be able to get better sleep.
Many patients who have experienced an improvement in nocturia by taking medication say, "Since I started taking the medication, I stopped needing to go to the bathroom and can sleep well. I wish I had sought treatment sooner!"
Thus, treating nocturia has the potential to significantly improve sleep and quality of life.
3. What causes nocturia? Can it be treated?
The causes of nocturia can be broadly divided into the following three categories:
- "Polyuria," where a large amount of urine is produced.
- "Urological diseases" caused by abnormalities in the prostate or bladder.
- "Sleep disorders" that cause the urge to urinate due to poor sleep.
Many people don't even know if they have nocturia, let alone its causes. Therefore, the causes of nocturia mentioned above are not widely recognized. However, if you know the cause, you can take countermeasures. Let's look at each in detail.
3-1. Polyuria: A large amount of urine is excreted in a day
The appropriate daily urine output is generally considered to be around 1,000–1,500 ml (body weight × 20-25 ml). When urine output exceeds 2,000 ml per day, it is generally considered polyuria. Polyuria is often primarily caused by excessive intake of fluids and salt.
Another reason is that with age, the amount of fluid leaking out of the blood vessels increases, leading to fluid retention in the lower body. When lying down to sleep at night, this retained fluid returns to the blood vessels, increasing the amount of blood returning to the heart. This then stimulates the secretion of a hormone called "natriuretic peptide," which increases urine output.
The secretion of this "natriuretic peptide" also increases with obstructive sleep apnea. Therefore, it is known that patients with sleep apnea syndrome produce more urine. Endocrine diseases such as diabetes, hypertension, congestive heart failure, and kidney diseases can also increase urine volume and cause "polyuria," so it may be necessary to check for any underlying conditions.
3-2. Urological diseases: Diseases related to the urinary system
Next are "urological diseases." Conditions such as benign prostatic hyperplasia, prostatitis, overactive bladder, and cystitis can increase the urge to urinate, leading to frequent urination. Rest assured that treatments for these urological conditions are well-established. Effective treatment has been proven to improve frequent urination and enhance quality of life.
Additionally, "reduced bladder capacity," which can occur due to aging, leading to a smaller amount of urine the bladder can hold, is also known to cause frequent urination. To check for urological diseases or abnormalities, it is recommended to consult a urologist first.
3-3. Sleep disorders: A state where there are some problems with sleep
Finally, "sleep disorders" can also cause nocturia.
When individuals struggle to fall asleep or experience middle-of-the-night awakenings due to sleep onset insomnia or disturbed sleep, anxiety can arise. This anxiety can trigger an urge to urinate and a compulsion to go to the bathroom, even when the bladder is not full.
In such cases, using sleep aids or establishing a regular sleep schedule to deepen sleep can reduce nighttime bathroom trips. Additionally, sleep disorders like restless legs syndrome and the previously mentioned sleep apnea can also cause nocturia.
With appropriate treatment, nocturia can improve, and you can achieve sufficient sleep, so consult a specialist.
It's not always clear whether "not getting enough sleep due to nocturia" or "nocturia due to a sleep disorder" comes first. "Sleep disorder" can be both a cause and a result of nocturia. Both frequent urination and sleep disorders undeniably reduce quality of life.
Proper examination and treatment can potentially improve both the troublesome frequent urination and sleep disorders simultaneously. If you feel even a slight sense of unease or discomfort, do not hesitate to go to the hospital.
4. Nocturia causes differ by gender
As mentioned earlier, there are three main causes of nocturia.
However, these do not apply to everyone under the same conditions. There are differences, just as some people experience nocturia and others do not. There are also gender differences, with the causes of nocturia varying by gender. Let's explain how they differ between women and men.
4-1. Female-specific cause: Overactive bladder
Overactive bladder, one of the causes of nocturia, is known to be more common in women. It is characterized by urgency (a sudden, uncontrollable urge to urinate, sometimes leading to incontinence).
A characteristic of women is that their urethra is short, making them prone to cystitis. Especially women who work jobs that prevent them from going to the bathroom for long periods may suffer from frequent urination due to chronic cystitis, which causes discomfort in the bladder and a strong urge to urinate.
Additionally, there is a condition called "pelvic organ prolapse," where the pelvic floor muscles and ligaments weaken due to childbirth or aging, causing organs such as the bladder, uterus, and rectum to descend. The descent of the bladder can cause discomfort and frequent urination, and sometimes even urinary incontinence.
4-2. Male-specific cause: Prostate enlargement
A male-specific cause is benign prostatic hyperplasia. Benign prostatic hyperplasia is common in middle-aged and older men, and it involves the prostate gland at the base of the urethra (bladder outlet) enlarging, making urination difficult and causing a feeling of residual urine.
Sensitivity to the urge to urinate increases, leading to frequent bathroom visits. Many people may have actually felt, "I'm going to the bathroom more often lately." Furthermore, difficulty urinating combined with a reduction in bladder capacity can lead to increased nocturia. Occasionally, it can also be prostate cancer, so it's crucial to be mindful and seek early diagnosis, such as by measuring PSA levels in a blood test.
5. Nocturia increases after the age of 50
According to a report by Dr. Honma (2006), the percentage of men who urinate one or more times at night is as follows:
As people age, the frequency of nocturia also increases, and approximately 90% of people in their 70s wake up at least once to use the bathroom.
Waking up at night to use the bathroom is thought to have some impact on sleep. Therefore, nocturia is a serious problem that cannot be separated from the consideration of sleep in the elderly.
Since over half of people in their 50s wake up at least once at night to use the bathroom, special attention is required from the age of 50.
If the cause is identified through appropriate examination, it can be properly treated. Many people who have undergone treatment often say, "I wish I had gone to the hospital sooner." If you feel like "I'm waking up to use the bathroom a lot lately," it is recommended to consult a specialist as soon as possible.
6. What are the countermeasures for nocturia?
First, we recommend keeping a bladder diary (voiding diary) to understand your urination patterns.
Specifically, try recording the number of times you urinate and the timing (time) during the day and night. If possible, also measure the amount of urine, as this will make it clearer. If you experience symptoms such as a strong urge to urinate or urinary incontinence, record that as well.
Additionally, keep a record of the types and amounts of beverages you consume.
A voiding diary provides crucial information for understanding the cause, such as whether "urine volume has increased" or "bladder capacity has decreased." If you consult a doctor, showing them the record chart will improve the accuracy of the diagnosis.
If you also record your bedtime, wake-up time, and subjective sleep depth, you can understand the relationship between sleep disorders and nocturia.
Keeping a voiding diary is surprisingly easy once you try it, and it allows you to objectively review your urination patterns. It is recommended to record for a week, but even a few days can help you understand your urination patterns, so start by recording.
6-1. Self-training to improve frequent urination
To improve frequent urination, self-training such as bladder training and pelvic floor muscle exercises can be effective.
Bladder training involves gradually increasing the amount of urine the bladder can hold by holding it for a little while even when you feel the urge to go to the bathroom. Start by holding it for 5 minutes, and gradually extend the time.
Pelvic floor muscle exercises strengthen the pelvic floor muscles by squeezing and relaxing the urethra, anus, and vagina. Slowly and tightly squeeze the urethra, anus, and vagina, hold for a moment, then slowly release. Repeat this 2 to 3 times.
First, lie down on your back with your knees bent. As you get used to it, you'll be able to do it standing up and in a short amount of time during daily life.
6-2. Don't overhydrate before sleep
Sometimes, nocturia is caused by drinking too much fluid before sleep. Many people consider hydrating before bed because they sweat during sleep and want to prevent dehydration. In such cases, limit your intake to about one glass of water and drink it in several small portions an hour or so before bed, rather than right before going to sleep.
Plain water (pure water without electrolytes) has a short time before it becomes urine, so sports drinks containing electrolytes are recommended. Electrolyte-containing sports drinks can help prevent leg cramps during sleep and have the effect of retaining water in the body, which also helps maintain skin moisture and elasticity.
Alcohol and caffeine before bed are not good for sleep, as they can not only lighten your sleep but also have a diuretic effect (they make you urinate more easily).
Summary: Understand how to manage nocturia!
Many people experience sleep disturbances due to nocturia (frequent urination), and it's a symptom that almost everyone experiences as they get older. The cause could be problems with the bladder or other urinary organs, or it could be related to a sleep disorder.
In any case, it affects sleep, hinders recovery from fatigue, accumulates sleep debt, and impacts the brain and body. If you experience any of the symptoms below, consult a specialist and get tested. You might find that treatment surprisingly resolves the issue, allowing you to sleep soundly at night.
- Do you wake up to use the bathroom two or more times at night?
- Do you suddenly feel a strong urge to urinate or experience urine leakage?
- After urinating, do you feel like there's still urine left or an immediate urge to go to the bathroom again?
- Do you find yourself unable to sleep at night and feel anxious, leading to frequent bathroom trips?
- If you frequently urinate at night, have you been told that you snore or stop breathing?
