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Sleep Fundamentals || N is for Nocturia

From our Sleeping is Fundamental series

If you’re getting up to use the bathroom more than once a night, read on.

N is for nocturia

What is nocturia?

The term nocturia more commonly refers to the habit of rising in the middle of the night with a need to empty the bladder.

In a healthy individual, the need to use the bathroom after bedtime should be rare. You might have had an alcoholic beverage or drunk too much water at bedtime. Both might lead to a single rise in the night to use go to the bathroom.

However, more than one trip to the toilet over several nights a week suggest frequent nighttime urination is a bigger problem than drinking too much of anything before going to bed.

Who experiences nocturia?

According to data from the National Association for Continence, most people who experience nocturia are older, though people of all ages can suffer.

Gender differences also matter.

Beyond health-related conditions (see below), women have nocturia as the result of childbirth, menopause, and/or pelvic organ prolapse.

Men, on the other hand, experience nocturia as a consequence of enlarged prostate.

What causes nocturia?

Aside from poor sleep hygiene (as mentioned above), nocturia can be caused by a number of underlying health concerns:

Urinary tract, bladder, kidney, or prostate infections: In each case, the bladder may need to be emptied more frequently. The sensation to urinate may be more urgent in the middle of the night as well.

Overactive bladder: A medical condition of the bladder in which urine is overproduced both day and night.

Neurogenic bladder: The neurological mechanisms that facilitate signaling between the brain and the bladder can become dysfunctional. This is usually due to an underlying condition like multiple sclerosis.

Diabetes: Those with high blood sugar levels may experience nocturia as the body urinates to release excess glucose. Forms of diabetes not related to high glucose levels have been shown to be connected to nocturia as well.

Pregnancy: It’s not uncommon for women to experience nocturia while pregnant, especially in the last trimester, when the crowded cervix can press against the side of the bladder.

Pregnant women also generate and process about 40 percent more fluids during this time. This results in swelling (see Edema, swelling, below). The body seeks to reduce swelling by excreting fluids through the sweat glands and by way of urination.

Edema (swelling): The body also swells due to a number of medical problems or as the result of surgery. It will try to expel these fluids however it can. When high levels of fluids collect, frequent urination can occur, no matter what time of day.

Those who take diuretics for swelling might also experience more nocturia as a result; diuretic drugs are used to help the body flush toxins through fluids like urine.

Sleep apnea: Many people with untreated sleep apnea awaken in the middle of the night believing they need to use the restroom. In fact, the release of stress hormones following apneas is the real reason they are awake. Those stress hormones signal to the brain to empty the bladder, but generally, the volume of urine turns out to be small.

Why is nocturia a sleep problem?

The problem with nocturia is mathematical when it comes to sleep health.

You need a specific set of hours of sleep at night to maintain optimal health. For most adults, that’s between seven and nine hours a night, without interruption.

Our circadian rhythms need us to sleep over one long period of between seven and nine hours every night in order for the process to support optimal health and well being.

During that time, your sleep should follow a rhythmic architecture of five stages:

  1. brief wakefulness
  2. light and transitional sleep (stage 1)
  3. normal sleep (stage 2)
  4. deep sleep (stage 3), and
  5. rapid-eye movement (REM) sleep
  • Stage 3 sleep is a necessary stage as it provides the body with opportunities to heal and recover at the cellular level. This is the time that regenerative human growth hormone (HGH) is released.
  • Rapid-eye movement (REM) sleep is necessary to maintain memory, process learning, enhance moods, and support cognitive activities.

Without adequate amounts of these two stages of sleep, you risk suffering long-term physical and mental health problems.

When nocturia strikes, every interruption to our sleep architecture fragments sleep. That means one seven-to-nine-hour period becomes three or four shorter periods of sleep that cannot complete these full five stages.

Do you have nocturia?

If you experience frequent trips to the bathroom at night, consider the reasons you see listed above. If you can’t be sure why you have nocturia, talk to your doctor.

You may have one of these concerns: commonly, an undetected sleep disorder (such as sleep apnea) is to blame. It, or any of these other problems, will need attention if you are to enjoy consolidated sleep again.


Sleep Fundamentals || N is for Nocturia

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