Frequent urination at night is also known as nocturia (reference 1). Nocturia is when you have to wake up and go to the bathroom at night. Naturally, this can be disruptive on your sleep. This is a problem which is on the rise: an increasing proportion of Singaporeans have nocturia (reference 2), in line with a worldwide trend.
Some doctors feel that one event of getting up to go to the bathroom per night is normal, while others believe that only a full 6 to 8 hours at night without emptying the bladder is normal.
In any case, regularly rising two or more times per night to go to the bathroom is not considered normal.
Frequent urination at night is not a disease in and of itself; however in many cases it is a symptom or an effect of an underlying disease or condition (references 2 and 3). In other cases it may have no obvious cause. However, it is always best to see a doctor if you are experiencing nocturia. This is because some of the underlying causes of frequent night time urination can be quite serious diseases, and seeing a doctor can present a window of opportunity to investigate and treat this condition.
There are many possible medical causes of frequent urination at night (references 1 and 3). Some of these are diabetes, hypercalcaemia, renal failure, cardiac disease and oedema. Multiple sclerosis and other neurological conditions such as cord compression and cauda equina can affect bladder control which can also cause nocturia.
Diseases of the lower urinary tract can also cause frequent urination at night; some examples of these are urethral disease, inflammation such as interstitial cystitis, urinary tract infection, tumour of the bladder, ureters or urethra, prostate cancer and benign prostate hypertrophy.
Sleep apnoea is also known to be a possible cause of nocturia. This happens when the disrupted breathing of a sleep apnoea patient causes wakefulness briefly during the night, which results in the person getting up to go to the bathroom.
There are also plenty of non-disease causes of nocturia. Some of these are pregnancy, drinking excessive fluid intake of any kind, drinking alcohol or caffeine soon before bed, and age-related decrease of an anti-diuretic hormone. In some older people, bladder capacity has decreased a little due to aging, and this therefore also results in frequent urination at night.
Certain medications can also cause nocturia as a side effect. Some of these medications are diuretics, antacids, and excessive calcium supplementation.
As you can see, some of the above medical causes are very serious. It is thought that this is why men and women who experience frequent urination at night have been shown to have a higher risk of early death than those who have no need to rise at night (reference 2). Furthermore, there is the compounding effect that getting up frequently at night results in fragmented sleep. This in turn leads to higher levels of cortisol, a stress hormone, which causes poor immunity and therefore poorer health (reference 2).
Treatment of nocturia depends on the cause, so there is no one-size-fits-all answer. In the vast majority of cases, if the underlying disease or disorder causing it is treated, then the symptoms of nocturia will disappear. The patient will be able to sleep through the night again. However, it's important to remember that there might be more than one cause of nocturia in the same person (reference 3).
In cases where a medical cause of nocturia has been ruled out by a doctor, then there are several lifestyle changes that can be made to help you keep bathroom trips at night time to a minimum (reference 2). These are:
- Decrease your fluid intake before bedtime.
- Eat dinner at least two hours before you go to bed. This allows you to pass out any fluid before going to sleep. In addition to the water you drink with your meal, there is also a surprising amount of water content in a solid meal itself.
- Avoid beverages containing alcohol or caffeine at any time in the evening.
- Do not keep a water bottle or water container beside your bed. If your mouth or throat feels dry when you wake up in the night, drink just a sip of water to relieve this - not a whole glass.
- If your bedroom is cool (e.g. due to air conditioning in the home), keep yourself warm by wearing socks and/or a blanket. Cold temperatures tend to stimulate urination.
Another lifestyle change you can make is to purchase a more comfortable mattress which will let you sleep more deeply. This is especially important if you need to urinate only because you happen to wake up then (as opposed to the reverse: waking up specifically because of an urge to urinate).
If you have an older or uncomfortable mattress, just rolling over for example may prove uncomfortable enough that you temporarily wake up. This causes you to decide you should go to the bathroom. If this repeats itself several times a night, you can see how this would be very disruptive to your sleep at night - and to your attention span the next day.
A latex mattress is widely considered to be the best type for comfort, and has been recommended by many osteopaths, physical therapists and chiropractors. In addition to comfort, latex is also highly durable, meaning you should reap the benefits of a deeper sleep for many, many years to come.
If you suffer from frequent urination at night (nocturia) your first step should be to see your doctor. This is because there are many causes of nocturia, some of which are quite serious medical conditions requiring prompt attention.
A qualified physician is needed to determine whether your frequent night time urination is caused by an underlying medical disorder. If so, then your doctor will treat the specific cause and this should relieve your symptoms. On the other hand, if the examining doctor rules out any medical cause of your nocturia, this is a good time to consider the lifestyle changes outlined above for a better night's sleep.
2. The Straits Times "Toilet Trips at Night a Cause for Worry" in Tan Tock Seng Hospital, June 2013.