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Waking Up Frequently At Night to Pee (Nocturia) Can Endanger Your Health


Waking up more than once a night is called nocturia. Nocturia becomes more frequent with age. A survey of Singaporean men found that this is the most frequent and most bothersome of the lower urinary tract symptoms (LUTS)

Problems that can arise from nocturia

  • Disruption of sleep
  • Worsens quality of life
  • Daytime fatigue
  • Reduced vitality
  • Affects work performance
  • Risk factor for nighttime falls and fracture
  • Your spouse may also suffer sleep disruption

Nocturia may result from several different reasons:

  • You produce a great deal of urine (more than 2 liters) a day (polyuria)
  • Your body produces a large volume of urine while you sleep (nocturnal polyuria)
  • You produce more urine at night than your bladder is able to hold (low nocturnal bladder capacity). This causes you to wake up at night because you need to empty your bladder.
  • A combination of nocturnal polyuria and low nocturnal bladder capacity (mixed nocturia)
  • Poor sleep: Some people who have poor sleep and awaken frequently will go to the bathroom whenever they awaken. Typically in these cases, it is not the need to void that awakens them.

What are the causes of nocturia?

There are many possible causes of nocturia, depending on the type:

Causes of polyuria

  • High fluid intake
  • Untreated diabetes

Causes of nocturnal polyuria

  • Congestive heart failure
  • Edema of lower extremities (swelling of the legs)
  • Sleeping disorders such as obstructive sleep apnea (OSA - blockage of the upper airways during sleep associated with daytime sleepiness and snoring and interrupted breathing during sleep)
  • Certain medications
  • Drinking too much fluid before bedtime, especially coffee, caffeinated beverages, or alcohol

Causes of low nocturnal bladder capacity

  • Bladder obstruction
  • Overactive bladder
  • Bladder infection or recurrent urinary tract infection
  • Bladder cancer or stones
  • Enlarged benign prostate – (BPH) that obstructs the flow of urine

How is nocturia diagnosed?

To help your doctor diagnose nocturia, you will be asked to do fluid and voiding diary. This is a three-day record of how much you drink, how often you have to go the bathroom and the urine output. Your doctor will review the diary in order to determine the possible cause(s) of and treatment for the nocturia.

Treatment depends on the type and cause of nocturia. If obstructive sleep apnea (OSA) is considered, you may be referred to a ENT or sleep specialist. It is important to treat co-existing OSA, as this is a potentially serious condition that can lead to high blood pressure, diabetes and heart disease.

Interventions:

  • Restrict fluids in the evening (especially caffeinated beverages i.e coffee and tea, and alcohol).
  • Time intake of diuretics (take mid- to late afternoon, six hours before bedtime).
  • Elevate the legs (helps prevent fluid accumulation).
  • Wear compression stockings (helps prevent fluid accumulation).

Medications:

  • Anticholinergic medications to reduce symptoms of overactive bladder
  • Diuretics that assist in regulating urine production
  • Desmopressin helps the kidneys produce less urine at night