Reviewed by Dietitian Karen Ansel, MS, RDN
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Key points
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The need to pee frequently throughout the night can be a hidden sign of health conditions.
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These include diabetes, sleep apnea, overactive bladder or benign prostatic hyperplasia.
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If you routinely wake up to pee several times a night, talk to your doctor.
Picture this: you’re fast asleep and in the middle of a great dream, when an uncomfortable feeling wakes you up. It’s time to go to the bathroom. Of course, waking up to pee at night happens to everyone occasionally. But if it happens several times a night, it could be a sign of an underlying health problem.
“You should be able to sleep for about six to eight hours without getting up to go to the bathroom,” says urologist Justin Dubin, “If you’re waking up two or more times a night, that’s considered abnormal.”
The medical term for those excessive bathroom breaks is nocturia. Although nocturia itself is not a disease, it can be a symptom of one. And it’s more common than you might think, affecting 50 million US adults. Most are over 65, but even 1 in 3 over 30s say they wake up to pee two or more times a night.
Should you be worried? To find out, we talked to urologists and a dietitian about the conditions that can cause those nocturnal trips to the bathroom that are considered normal, plus practical tips to prevent them.
Conditions that cause excessive urination at night
There are many potential causes of excessive nighttime urination, including lifestyle habits, bladder capacity, some medications, and underlying health conditions. Here are four of the most common health problems that could be to blame.
Diabetes
If you find yourself using the bathroom more often than usual, it could be one of the first signs of blood sugar problems. Frequent urination is one of the first signs of diabetes, says urologist Scott D. Miller, MD, MBA, who diagnoses himself several times each year.
An estimated 15 percent of American adults are living with diabetes, and about 3 percent don’t know it. When diabetes is undiagnosed or poorly managed, elevated blood sugar levels can lead to more frequent bathroom visits.
How does it happen? “Elevated blood glucose levels can trigger osmotic diuresis, leading to excessive urination at night,” says Elizabeth Shaw, MS, RDN, CPT. This is when the kidneys try to lower blood sugar by flushing the excess glucose into the urine, and water follows. “This leads to increased urine production around the clock, including overnight,” adds Miller.
Sleep apnea
“Many patients are surprised to learn that their bladder symptoms are actually sleep-related,” says Miller. One to watch out for is sleep apnea. “Sleep apnea occurs when the neck muscles relax during sleep and block breathing, causing people to wake up repeatedly during the night,” says Shaw. Hints that you have it are snoring or gasping for air while you sleep.
Sleep apnea can also be a disguised reason for waking up to go to the bathroom. Beyond disrupting sleep, sleep apnea can lower blood oxygen levels, which triggers hormonal changes that encourage nighttime urination, Miller says. Specifically, it leads to increased secretion of atrial natriuretic peptide (ANP), a hormone that helps the kidneys remove water from the body.
Overactive bladder
If you find that you are going to the bathroom frequently throughout the day and more than twice a night, you may have an overactive bladder. “Overactive bladder is a condition where the bladder is oversensitive and sends frequent or sudden signals to urinate, even when it’s not full, leading to urgency and frequent trips to the bathroom day or night,” explains Miller. The good news is that there are medications that can help calm the bladder. So, if you’re always running to the bathroom, talk to your healthcare provider.
Benign prostatic hyperplasia
As men age, the prostate gland naturally enlarges. This condition is called benign prostatic hyperplasia (BPH). “When the prostate is enlarged, you can’t empty your bladder as well, so you [bladder] you may feel fuller more often, and the time you need to tolerate continence may decrease,” explains Dubin. Fortunately, for many men, lifestyle changes can help (more on that soon!).
What is normal?
For most adults, even a trip to the bathroom at night is considered normal. Consistently waking up two or more times a night (especially if it’s new, getting worse, or exhausting) deserves a medical visit, Miller says.
“You should be concerned any time nocturia disrupts daytime sleep or energy,” he says. “When nocturia comes on suddenly or is associated with painful urination, excessive thirst, leg swelling, or difficulty breathing, you should seek immediate medical attention.”
Tips to reduce nighttime urination
In addition to working with your healthcare provider to find out what’s causing these nighttime trips to the bathroom, experts recommend trying these tips.
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Stop drinking two hours before bed: Cut back on fluids two hours before bed, especially alcoholic and caffeinated beverages, Dubin says. Both alcohol and caffeine are diuretics that can make you urinate more often.
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Check your medicines: Some medications, such as diuretics for high blood pressure or heart conditions, can increase urination. For men with BPH, some antihistamines and over-the-counter medications can also be triggers. Ask your healthcare provider if it is possible to take these medications in the morning instead of in the evening, or if there is an alternative medication that might work for you.
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Treat underlying conditions: Untreated sleep apnea and diabetes can worsen sleep and increase urination. “It’s best to keep them under control to help with nighttime urination and better sleep,” says Dubin.
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Addresses leg swelling: Your feet can swell at night for various reasons. Some can be serious, which is why you should never ignore them. But there are also benign culprits, such as standing or sitting too much during the day, taking certain medications, or eating a lot of salty foods. Swollen feet can also make you need to pee frequently. “Elevating your legs or wearing compression socks in the evening can help shift fluid earlier, reducing nighttime urine production,” says Miller.
Our expert
It is normal to wake up at night to pee occasionally. But if it’s happening more than twice a night, it could be your body trying to tell you there’s a problem. “Getting up at night to urinate may not just be a bladder problem, it may be your body’s way of raising a red flag,” says Miller.
Conditions such as diabetes, sleep apnea, overactive bladder, and benign prostatic hyperplasia can make you need to pee frequently throughout the night. While a late-night trip to the bathroom is considered normal, anything else could indicate an underlying problem. Therefore, be sure to notify your healthcare provider. In addition to treating underlying health conditions, experts recommend reducing fluid intake two hours before bed, reviewing medications with your doctor, and addressing leg swelling. Instead, you might cut back on those nightly trips to the bathroom and finally get the rest you need.
Read the original article on EatingWell