Nocturia

Nocturia is when you wake up to pee more than usual. It’s different than frequent urination, which is when you pee (urinate) too much while you’re awake. Nocturia (pronounced “nok-TOOR-ee-uh”) strictly means using the bathroom multiple times after bedtime, before you wake up to start your day.

It’s a very common condition, especially if you’re in your 50s or older. But it may also be a sign of an underlying problem. Nocturia can leave you feeling tired because it disrupts your regular sleep cycle. Treatment depends on the cause and may include lifestyle changes or medications.

Another name for nocturia is nocturnal urinary frequency. “Nocturnal” means it happens at night, when most people sleep.

Symptoms of nocturia

Symptoms include:

• Waking up two or more times to pee
• Peeing a greater total volume (polyuria)
• Feeling very tired or sleepy during the day
• Having less energy

How many times is normal to urinate at night?

Typically, you should be able to sleep six to eight hours without having to get up to pee. But it’s normal to get up once or twice to pee. If you have nocturia, you wake up to pee at least twice.

What is the main cause?

There are anatomical differences between males and females that can cause nocturia. For example, an enlarged prostate can affect males. Pregnancy, childbirth, menopause and pelvic organ prolapse can affect females.

Nocturia causes that can affect anyone include:

• Drinking too many fluids before bed, especially alcohol, carbonated drinks or caffeine
• Taking medications that contain a diuretic
• Accidentally creating a habit or routine in which you wake yourself up to pee, even if you don’t have to

Certain health conditions can cause nocturia. These include:

• Your body making too much pee for your bladder to hold
• Your body making less antidiuretic hormone (vasopressin), which helps control the amount of water in your body
• Diabetes
• High blood pressure (hypertension)
• Bladder obstructions
• Interstitial cystitis/bladder pain syndrome (IC/BPS)
• Urinary tract infections (UTIs)
• Heart disease or congestive heart failure
• Sleep disorders, including obstructive sleep apnea
• Restless legs syndrome

If you have obstructive sleep apnea, not using a CPAP machine can cause nocturia.

Risk factors

Anyone of any age can have nocturia. But you’re more likely to have it if you’re:

• Male
• Over the age of 50

Before age 50, it’s more common in females.

What happens if it’s left untreated?

Many underlying conditions that cause nocturia can get worse without treatment. This can cause additional sleep loss. A lack of quality sleep can affect your overall health and well-being. Getting up to pee a lot can also wake your partner and affect their quality of sleep.

How doctors diagnose nocturia

Your healthcare provider will review your health history and perform a physical exam. They’ll also ask questions about your symptoms, like:

• When did your nocturia symptoms first start?
• About how many times do you wake up to pee each night?
• Do you pee a lot or a little?
• Is there an increase or a decrease in the amount of pee each time you wake up to go?
• How much caffeine do you drink each day?
• How much alcohol do you drink each day?
• Do your symptoms keep you from getting enough sleep?
• Have you made any recent changes to what you eat and drink?
• What medications do you take, and when do you take them?

To help them make a diagnosis, your provider may also ask you to keep a bladder diary. They’ll ask you to record information like:

• How much you drink every day
• How often you go to the bathroom
• What time you go to the bathroom

They may also recommend that you get a special urine catcher with measuring lines. This allows you to measure and record the exact amount of pee every time you wake up to go.

To help determine the underlying cause, your provider may recommend some tests, including:

• Pee tests (urinalysis) to look for infections and protein in your pee
• Blood tests to see how well your kidneys are working
• Imaging tests to see if your bladder completely empties when you go
• Cystoscopy to see inside your urethra and bladder

What is the best treatment for nocturia?

It depends on the cause. For example, if you have an enlarged prostate, you may need medications or surgery. If you have sleep apnea, you may need medications, a CPAP machine or surgery.

Whatever the cause, your provider may first recommend small lifestyle changes. These changes are usually low-risk and can help cut down on the number of trips you make to the bathroom. They may include:

• Cutting back on fluids before bed, especially caffeinated drinks and alcohol
• Taking diuretic medications when you wake up or at least six hours before bedtime
• Elevating your legs while you’re sitting at home to help with fluid distribution
• Doing pelvic floor physical therapy to strengthen your pelvic floor muscles
• Wearing compression stockings to help with fluid distribution

Taking afternoon naps may also help. Sleeping allows your bloodstream to absorb liquids. Napping during the day may help your body get a jumpstart on absorbing liquids. You’ll need to pee after your nap. But it could help reduce your bathroom trips later.

Your provider may also recommend medications, like:

• Anticholinergics to help reduce symptoms of overactive bladder
• Diuretics to help control how much pee your kidneys make
• Desmopressin to help your kidneys make less pee

When should I see my healthcare provider?

Schedule an appointment with your healthcare provider if you’re waking up more than once or twice to pee and it’s bothering you. You should also see your provider if your nocturia symptoms don’t go away after treatment or get worse.

What can I expect if I have nocturia?

The outlook is relatively good. Nocturia is annoying and can affect your quality of life. But in most cases, it’s highly treatable.

The condition itself isn’t life-threatening, though some of the causes can be serious. If test results don’t indicate any medical problems, there’s no need to worry about nocturia causing serious harm.