How often do you wake up needing to pee in the middle of the night? Going to the loo in the early hours can be disruptive, especially if you struggle getting back to sleep.
However, if you find that this is happening often, you may have a condition called nocturia.
This condition affects around 40% of adults between the ages of 18 and 79, according to research – and it usually develops slowly over time.
“If nocturia starts suddenly, and nighttime voids become very frequent or there is bed wetting, this can signify a serious cause such as a urinary tract infection (UTI), or occasionally something more sinister,” Dr Deborah Lee of Dr Fox Online Pharmacy tells Yahoo UK. “Both bladder and prostate cancer can cause nocturia.”
Health implications of nocturia
Even when it does develop slowly, nocturia can lead to sleep loss which can increase the risk of high blood pressure, type 2 diabetes, heart disease, depression and cancer.
“Getting seven hours a night of good quality sleep is vital for health,” Dr Lee explains, adding that frequent waking during the night can lead to loss of REM sleep.
“During this phase of sleep, we are processing memories and learning procedural skills such as new tasks,” she says.
“REM sleep is important for problem-solving. It also supports wakefulness. Therefore loss of REM sleep affects our cognitive functioning and memories. A lack of REM sleep, means you wake unrefreshed in the mornings, feeling less alert, meaning accidents are more likely, and this can result in falls and fractures.”
Common causes of nocturia
Nocturia is often caused by something as simple as drinking too many fluids close to bedtime, but it can also be caused by other underlying conditions including:
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Diabetes – type 1, type 2 and gestational
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Cardiac failure
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Oedema (swelling) affecting the lower limbs
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Sleep disorders – including obstructive sleep apnoea (OSA)
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Drugs – such as diuretics, digoxin, lithium, phenytoin, and high-dose vitamin D
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Excess caffeine or alcohol, especially close to bedtime
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A high-salt diet
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Bladder obstruction, such as an enlarged prostate
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An overactive/ irritable bladder
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A bladder, or urinary tract infection
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Interstitial cystitis
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Bladder cancer
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Menopausal oestrogen deficiency
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Prolapse
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After gynaecological surgery
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Pressure on the spinal cord, due to spinal stenosis or neurological conditions affecting bladder control
How to reduce nocturia
First things first, if you are frequently waking up in the middle of the night to use the loo then you should book an appointment with your GP – especially if this is a new symptom.
“They will exclude common conditions such as diabetes, a urinary tract infection, or kidney disease, and advise you on how best to improve your symptoms,” Dr Lee explains.
Below are some other actions you can take to try and reduce nocturia symptoms.
1. Keep a fluid diary
“Keep a written record of how much you have had to drink, and when, over a seven-day period,” Dr Lee advises. “Also, record how often you had to get up to pee at night. You may notice a pattern which will give you a baseline for making improvements.”
2. Restrict fluids
Dr Lee recommends avoiding any drinks in the two hours before bedtime, especially if they contain caffeine or alcohol.
“Caffeine is not recommended after 6pm,” she adds. “Both are diuretics and will encourage you to pee overnight.”
3. Regular exercise
“Getting enough physical exercise is very important,” Dr Lee says. “Research shows men who do at least one hour of physical exercise per week are 13% less likely to experience nocturia, and 34% less likely to experience severe nocturia.”
4. Consider weight loss
Dr Lee says that being overweight or obese is closely linked to nocturia for several reasons.
“The increased amount of intrabdominal fat exerts increased physical pressure on the bladder,” she explains. “In addition, some of those who are obese are prone to night-time snacking. In men, obesity is associated with enlargement of the prostate which causes nocturia. However, losing weight improves nocturia.”
5. Reduce salt intake
“The vast majority of people consume more than twice the daily recommended amount of salt,” Dr Lee explains. “Eating too much salt is also a cause of nocturia because excess salt makes you thirsty, so you drink more. You can improve nocturia by lowering the salt content of your diet.”
6. Do pelvic floor exercises
For women, pelvic floor or kegel exercises have been shown to reduce symptoms of an overactive bladder.
7. Consider medication timings
“Take diuretics (water pills), first thing in the morning, not at night, so the need to pass a larger amount of urine will long since have disappeared when it’s time for bed later in the evening,” Dr Lee says.
8. Put your feet up
“When you get into bed and lie flat, any fluid which has collected in your lower legs and around your ankles during the day, when you were in the upright position, will be forced back into the bloodstream,” Dr Lee explains. “This excess fluid will then need to be passed out in the urine. To avoid having to get out of bed soon after you get in, make sure you get your legs up in the afternoon and early part of the evening.”
9. Quit smoking
Several studies have linked smoking to nocturia, so giving it up can reduce bladder inflammation and irritability.
