Waking up one or more times during the night to urinate—or nocturia—may have you asking if you should be worried if you pee a lot at night. Not necessarily—but it is a good idea to discuss the issue with a medical provider. Nocturia becomes more common with age and is a frequent complication for people who have given birth. In some cases, it may also signal a medical condition. Nocturia can significantly affect the quality of your sleep and your waking life. If it’s causing you problems, speak with a healthcare provider. Treatment options range from lifestyle modifications to treatment for underlying conditions.
WHAT CAUSES PEEING A LOT AT NIGHT?
The causes of nocturia vary, and people might have one or a combination of the issues. Tracking how much you drink, as well as how often and how much you urinate, can help you determine what’s causing you to pee so much at night. It can also be helpful to track your weight at the same time every day, using the same scale:
POLYURIA
Polyuria could be the reason you can’t sleep through the night without a bathroom break. There are two types of polyuria: nocturnal and global. Nocturnal polyuria is the most common cause of nocturia, affecting around 88% of people with the condition, but it affects older adults more often. Nocturnal polyuria happens when there is a decreased production of urine in the daytime compared to nighttime production. The nighttime production must be greater than 20% of the total amount of urine produced within 24 hours for younger adults and more than 33% for older adults. If polyuria occurs day and night, it’s considered global polyuria. This type of polyuria is the result of increased urine production during the day and at night. Global polyuria is defined as a person having a urine volume of more than 2,800 milliliters per kilogram within 24 hours or a produced volume of over 3,000 milliliters daily. Global polyuria is also related to excessive fluid intake in general.
BLADDER STORAGE AND CAPACITY ISSUES
Some people with nocturnal polyuria also have low bladder capacity, meaning that their bladder does not have enough “storage” for the amount of urine being produced. A number of things can cause low bladder capacity, including infections and inflammation. Alternatively, there can be emptying issues due to blockage.
Benign prostatic hyperplasia (BPH): Prostatic hyperplasia is when the prostate and surrounding tissue is enlarged. People who have this may feel like their bladder is full even after they urinate. Treatment options include prescription drugs like alpha-blockers or surgery.
Low bladder capacity at night: Many people who experience nocturia are affected by both nocturnal polyuria and low nocturnal bladder capacity. These are two separate issues, but people affected by both are diagnosed with mixed nocturia.
Overactive bladder: When your bladder is squeezing out urine at the wrong time, you may have an overactive bladder. This condition may cause you to urinate more than two times a night and more than eight times a day.
Urethral stricture disease: This condition can lead to nocturia. That’s when swelling, infection, or injury produces a scar that blocks or slows the flow of urine in the urethra, the tube that lets urine leave the body. The condition is more common in people with a penis because of the longer urethra.
SLEEP PROBLEMS
Nocturia may also be the result of sleep problems. These problems typically are rooted in having a lack of sleep or disrupted sleep throughout the night. It’s thought that the link between nocturia and sleep issues is bidirectional—one condition can affect the occurrence of the other.8 For example, a person might have disrupted sleep because of nocturia, but nocturia might occur because of the disrupted sleep.
Sleep disorders that can cause nocturia include: Insomnia, Sleep disordered breathing (e.g., sleep apnea), Restless legs syndrome (RLS), REM sleep behavioral disorder.
CIRCADIAN RHYTHM DISORDERS
Problems with hormones that work according to your circadian rhythm—your 24-hour rhythm—can lead to nocturia. Your circadian rhythm works like an internal clock. It puts you to sleep when it is dark and wakes you up when it is light. For people with circadian rhythm disorders, this sleep-wake pattern is dysfunctional or may even be entirely reversed. Circadian rhythm disorders affect more than when your body sleeps and wakes. They also affect your body’s metabolic processes, including when you need to use the restroom. So if your internal clock thinks you should be awake at night, it can also think you should urinate at night.
Types of Circadian Rhythm Disorders
There are different types of circadian rhythm disorders, including: Advanced sleep-wake phase disorder, Delayed sleep-wake phase disorder, Irregular sleep-wake rhythm disorder, Jet lag disorde, Non-24-hour sleep-wake rhythm disorder.
LIFESTYLE FACTORS
Researchers have indicated that moderate exercise is potentially beneficial for decreasing instances of nocturia.13 However, not engaging in exercise can do the opposite. The condition has been associated with being less physically active. Nocturia has also been connected to consuming a lot of salt. Research found that participants who did not reduce their salt intake experienced nocturia more compared to participants who did reduce their intake. Drinking a lot of fluids before bedtime—especially caffeine or alcohol—can also increase your nighttime bathroom trips. Caffeine and alcohol can make you have to pee more often in general and are considered bladder irritants.
MEDICAL OR MENTAL HEALTH CONDITIONS
Some medical and mental health conditions may be associated with nocturia as well. They include conditions such as: Anxiety, Congestive heart failure, Depression, Diabetes, Hypertension (high blood pressure), Liver failure, Obesity, Peripheral edema (swelling due to fluid buildup in lower limbs), Pregnancy, Urinary tract infections (UTIs).
Medications for some of these conditions, like hypertension and depression, may also contribute to nocturia.
WHEN TO CONTACT A HEALTHCARE PROVIDER
You may find yourself losing sleep because of nocturia. See a healthcare provider for an evaluation if any of the following statements are true for you:Waking up at night to pee has been going on for several days, You’re bothered by having to pee so much at night, You have a burning sensation when you pee.
HOW NOCTURIA IS DIAGNOSED
If the cause of nocturia is unknown, a healthcare provider may perform a cystoscopy. This is a procedure that allows the healthcare provider to examine the inside of your bladder by inserting a thin tube with a lens inside the urethra. Urgent issues like UTIs will need to be treated. You might be asked to keep a “fluid and voiding diary.” This entails keeping a record of everything you drink and every time you have to go to the bathroom. The diary can help a provider figure out what might be causing your nocturia.
TREATMENT OPTIONS FOR PEEING A LOT AT NIGHT
Generally, lifestyle changes and/or other medical treatments are recommended to treat nocturia. Treatment for nocturia might involve curing whatever ailment has led to the condition instead of curing the condition directly. Treatment may not be necessary either. Nocturia is considered a normal part of aging. If nocturia bothers you a lot, treatment can be helpful. It may not eliminate the condition entirely, but it can reduce your bathroom trips to one or two a night.
LIFESTYLE REMEDIES
If there’s no underlying condition to address, making lifestyle changes may help. Try these tips to help reduce the number of times you pee at night:
Avoid afternoon naps or take them before 3 p.m. Avoid going to bed too early.
Develop a relaxing bedtime routine about 20 to 30 minutes before bedtime. Try soothing music, yoga, breathing exercises, reading, or a warm bath. Create a relaxing bedroom environment (think lighting, temperature, sounds). Limit screen time before hitting the hay.
Elevate your legs at night and/or use support hose, or compression stockings, from after dinner until bedtime.
Get regular physical activity, but nothing too close to bedtime. You may want to take a morning or afternoon walk, for example.
Limit caffeinated beverages and alcohol before bedtime.
Limit how much fluid you’re drinking in the afternoon and stop drinking fluid two hours before bedtime.
Smoking can interfere with your sleep. Try not to use tobacco products after dinner.
Reduce the salt and protein in your diet, especially later in the day.
Train your pelvic floor muscle.
Try not to let your mind run. Avoiding thoughts of serious life problems, problem-solving, or “rehashing daytime events” may help you sleep.
Use compression stockings if you have swelling in your calves, ankles, or feet
Use your bed only for sleeping or sexual activity.
You may also want to consider using a bedside commode or urinal to reduce the number of times you have to get up at night. Using these devices can help reduce the risk of falls. If falls are a concern, try using nightlights and removing obstacles like loose rugs or furniture that could be in your way at night.
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