Three new studies presented at the American Urological Association 2010 Annual Meeting are bringing attention to the condition called nocturia, defined as waking to urinate two or more times during the night, and that it may be a more serious condition than widely thought. In particular two studies suggest that nocturia in adults is associated with a significantly increased risk of death. Overall, waking to urinate more than twice a night increased mortality risk by 50 percent in men and by more than 30 percent in women.
Why nighttime urination has this result isn’t exactly understood, but there are possible explanations. “Chronic sleep loss adversely effects metabolic and endocrine function,” said Varant Kupelian, PhD, of the New England Research Institutes in Watertown, Mass. “Nocturia may be a marker of impending morbidity, such as cardiovascular disease or diabetes. Nocturia may also be a marker of overall health.” People in general should be able to sleep six to eight hours without having to get up to go to the bathroom. Nocturia is a common cause of sleep loss and sleep disturbance in men and women over the age of 50 and becomes more common as people age. In fact, nighttime urination is the most commonly cited reason for awakening by men and women alike.
Sleep-interrupting trips to the toilet increase the risk of falls and hip fractures and are associated with certain chronic diseases, including hypertension, diabetes, and cardiovascular disease (CVD), explained Dr. Kupelian. “Nocturia can negatively impact a person’s overall health, due to frequent nighttime visits to the bathroom that may result in fatigue as a result of interrupted sleep, as well as falls,” says Jeffrey P. Weiss, M.D., FACS, Professor and ACGME Program Director in the Department of Urology at SUNY Downstate Medical School. “This common condition is often under-diagnosed and misunderstood by the medical community and should be taken more seriously.”
People may not discuss the problem with their doctors because they see nocturia as part of the normal aging process, and doctors may not recognize nocturnal polyuria, the overproduction of urine at night, as a cause of nocturia. But it should be diagnosed and treated because of the increased risk of falling when you get up in the middle of the night to go and the sleepiness and fatigue that impact quality of life during the day.
"There are different types of nocturia:
- Polyuria: Your body produces a great deal of urine a day—over 2 liters. This can be due to a high fluid intake or untreated diabetes.
- Nocturnal polyuria: Your body produces a large volume of urine while you sleep. This can be due to a variety of reasons like congestive heart failure, edema, sleep disorders such as sleep apnea, certain drugs including diuretics or simply drinking too much fluid before bedtime, especially coffee or other caffeinated beverages or alcohol.
- Low nocturnal bladder capacity: Your body produces more urine at night than your bladder is able to hold, causing you to wake up to empty your bladder. This can be due to bladder obstruction, overactivity, infection or inflammation or a growth involving the prostate that obstructs the flow of urine.
- Mixed nocturia: This is a combination of nocturnal polyuria and low nocturnal bladder capacity from any of the causes listed above.
If you think you might have nocturia, see your primary doctor. To help your doctor diagnose nocturia, when you make an appointment, ask about keeping a two-day fluid and voiding diary before your visit. The diary should include how much you drink, how often you have to go the bathroom and the urine output, any medications you are taking, any urinary tract infections and any related symptoms. Your doctor will review the diary in order to determine the possible cause of and treatment. In some cases, you may be referred to a urologist. If sleep apnea is a possible problem, you may be referred to a sleep specialist. Treatment options may be as simple as limiting fluids in the evening or taking prescribed diuretics in mid- to late afternoon, rather than the evening. There are also medications that can reduce the symptoms of overactive bladder or help regulate or decrease urine production. You don’t have to put up with nighttime urination.