Many people are bothered by waking at night to pass urine. This problem increases with age. Treatment is guided by how bothered a patient is. One person who wakes twice at night might not be bothered by this and not need treatment and another person might be very bothered and seek treatment.
Multiple factors contribute to both the cause of the problem and the degree of bother. How long it takes someone to get to sleep, get back to sleep if they wake up, and how long they allow for sleep from bedtime to the time they need to get up, all impact on total sleep time. Sleep deprivation significantly impacts one's health and quality of life.
Nocturia is a complex and difficult problem to treat because often multiple factors contribute.
Bladder Problems:
Reduced bladder capacity and overactive bladder can require waking to void because the bladder can't hold the volume of urine produced overnight. Urge incontinence can then result in urinary leakage before making it to the toilet. Treatment for Overactive bladder can improve bladder capacity.
Incomplete emptying means that voiding before bed doesn’t empty the bladder reducing the time before the next void.
Fluid Problems:
The body should slow down urine production overnight. This normal ability to concentrate the urine at night declines with age. About two-thirds of the total daily urine should be passed during the day and only one third at night. A complete 24-hour output bladder diary is required to calculate if the night urine output is high. Multiple factors can increase the volume of urine produced overnight to beyond the capacity of the bladder requiring patients to void at night. These include:
- Various medications
- Heart failure
- Hypertension
- Diabetes
- Renal failure
- Lung Disease
- Liver failure
- Obstructive Sleep Apnea
- Neurological conditions
- Excessive fluid intake
Sleep disorders can impact on trouble getting to sleep, waking at night and difficulty getting back to sleep. Factors contributing to sleep disorders include alcohol, caffeine, smoking, drugs, chronic pain, nocturnal epilepsy, restless leg syndrome, withdrawal from drugs, alcohol or sleeping tablets, anxiety, depression, and other psychological or psychiatric conditions.
Menopausal symptoms can cause night sweats, waking and insomnia which may improve with hormone replacement.
Fluid retention during the day can be caused by numerous medical conditions. Lying down at night causes redistribution of this fluid back into the circulation and then excretion via the kidneys to cause a high urine production overnight. Leg elevation during the day above the level of the heart, compression stockings, and diuretics during the day to reduce fluid retention may help.
Deep sleep and failure to wake up with a full bladder sensation can result in bedwetting (enuresis).
Patient mobility and physical limitations can impact how long it takes to get to the toilet and whether patients require assistance with toileting.
