Nocturia refers to the need to wake up one or more times at night to urinate.
It is very prevalent and the likelihood of having it increases with age. Around 50% of both men and women over age 70 report getting up at least twice per night to urinate. However, just because it is common does NOT mean you have to accept or live with it.
Causes and Risk Factors
Nocturia may be caused by high urine production at night, sleep disturbances not related to urination, the same causes of daytime urinary frequency, or a combination of these factors.
When to Speak with a Urologist about Nocturia
Whenever you are bothered by it! Studies have shown that patients with at least two nocturia episodes per night have decreased health from higher incidence of cardiovascular disease, falls, and weight gain. They can also have lower quality of life from daytime sleepiness, reduced productivity, and depression.
What to Expect when Seeking Treatment
An important step in the evaluation of nocturia is to assess for high nighttime urine production, which is a common cause. Completion of a voiding diary tracking urine volumes is consistent with high nighttime urine production if the volume of nighttime voids is at least 25-33% of the total voids over 24 hours.
Various conservative and lifestyle modifications can be helpful in reducing nocturia episodes. These modifications include reducing fluid intake in the evenings and sitting with legs elevated in the afternoon to encourage fluid reabsorption before bedtime. Patients diagnosed with sleep apnea should wear their CPAP machines in order to reduce urine production, and patients who take diuretics (“water pills”) should take those medications earlier in the day to avoid increasing the amount of urine you make overnight.
Similar management strategies to those used for daytime urinary symptoms can also be effective for patients who have nighttime symptoms (most commonly BPH in men and overactive bladder in women).
For those who do have increased urine production at night, a medication called Nocdurna can be useful. It is a dissolvable tab that goes underneath the tongue 1 hour before bedtime. The tab includes desmopressin, a hormone which works by causing the kidneys to reduce the amount of urine produced.