There is nothing like a good night’s sleep. Young or old we all need our 40 winks. However, for some people the effects of a poor night’s sleep can disrupt daytime functioning and can have serious health implications.
This year, World Sleep Day will highlight the number one reason that people wake in the night – nocturia.[i] Nocturia is the need to get up and urinate at least once during the night. [ii] The condition is caused by a number of factors such as, drinking too much fluid before bed, particularly those that are caffeinated or alcoholic, being older, having a reduced bladder capacity, certain illnesses or taking certain medication such as diuretics.[ii],[iii] In rare cases it can be a symptom of a more serious underlying disease such as high blood pressure, diabetes or cardiovascular disease.2 However, the main cause of nocturia is the overproduction of urine, which is responsible for 88% of cases.[iv],[v]
Normally, the body produces less urine at night because of increases in a naturally occurring antidiuretic hormone called vasopressin. This hormone helps the body retain water and reduce urination to control the body’s water balance. Usually night time urine production is just a small proportion of the total amount produced over 24 hours, but as we get older this amount increases.[vi]
However, it is worth noting that although it is often dismissed as a symptom of old age, nocturia is the leading cause of interrupted sleep for adults of all ages. In fact, one in three people aged 30 and over and three out of four people aged 65 and over have nocturia.1,2
Getting up in the night to go to the bathroom might not seem something to be concerned about, especially if you have no problem dropping off as soon as your head hits the pillow, but disrupted sleep can lead to impaired memory and performance.[vii],[viii],[ix] Uninterrupted sleep is needed to sustain physical health, mental and emotional health.6 Studies show that sleep deprivation can increase your risk of serious health conditions such as diabetes and heart disease.[x]
Being tired during the day not only makes it harder to function, but can cause problems with perception and balance, associated with an increase in falls and injuries.[xi],[xii] More worryingly, fatigue due to poor sleep is thought to be a contributing factor in up to 60% of road accidents and is at least as dangerous as low-level alcohol intoxication.[xiii]
An Irish proverb said “A good laugh and a long sleep are the two best cures for anything.” I think that is true, but I would add “A good laugh and a long uninterrupted sleep are the two best cures for anything!”
If you are waking in the night to urinate more than once it is recommended that you make an appointment to see your doctor.
A doctor can diagnose nocturia and rule out urinary infections and other causes. Your doctor will most like recommend lifestyle and behaviour changes, such as reducing or avoiding drinking in the evening. In addition, if you have an underlying medical condition, for example one that requires you to take a diuretic, they might be able to help by adjusting the time of doses.
In some cases, if such lifestyle tweaks are not enough, your doctor may be able to discuss treatments that might be beneficial.
[i] Benefield LE. Facilitating Aging in Place: Safe, Sound, and Secure, An Issue of Nursing Clinics. 2014
[ii] National Association for Continence website, Nocturia page. Available from: http://www.nafc.org/nocturia/ [Last Accessed January 2018]
[iii] Cleveland Clinic. Nocturia. 2018. Available from: https://my.clevelandclinic.org/health/diseases/14510-nocturia [Last Accessed January 2018]
[iv] Weiss JP, van Kerrebroeck PEV, Klein BM, Nørgaard JP. Excessive nocturnal urine production is a major contributing factor to the etiology of nocturia. J Urol 2011; 186: 1358-63
[v] van Kerrebroeck P, Hashim H, Holm-Larsen T, Robinson D, Stanley N. Thinking beyond the bladder: antidiuretic treatment of nocturia. Int J Clin Pract 2010; 64: 807-16
[vi] Laureanno, P., Ellsworth, P., Demystifying Nocturia: Identifying the Cause and Tailoring the Treatment. Urol Nurs. 2010;30(5):276-287.
[vii] Bliwise DL et al. J Clin Sleep Med 2015;11:53–5.
[viii] Bliwise DL et al. Eur Urol Suppl 2014;13:e591–e591a.
[ix] Kobelt G, Borgstrom F, Mattiasson A. Productivity, vitality and utility in a group of healthy professionally active individuals with nocturia. BJU Int. 2003;91(3):190–5
[x] Orzel-Gryglewska, J. Consequences of Sleep Deprivation. International Journal of Occupational Medicine and Environmental Health 2010; 23(1): 95-114. doi:10.2478/v10001-010-0004-9.
[xi] Nakagawa H et al. J Urol 2010;184:1413–8.
[xii] Rafiq M et al. J Clin Epidemiol 2014;67:877–86
[xiii] Williamson, A.M. Feyer. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occup Environ Med. 2000 Oct;57(10):649-655