Other sleep problems
Nocturia (Waking at Night to Urinate)
Waking up one or more times at night to urinate. Common with age, it fragments sleep and can point to treatable causes, including sleep apnea.
Overview
Nocturia means waking from sleep to pass urine. Waking once can be normal, especially with age, but waking two or more times a night is often bothersome, fragments sleep and increases the risk of falls in older adults.
Nocturia has several kinds of causes: producing too much urine at night (nocturnal polyuria), a bladder that holds less, or sleep problems that wake you and lead you to notice the need to urinate. Often more than one factor is involved.
Obstructive sleep apnea is an under-recognised cause. Changes in chest pressure during apneas trigger the heart to release a hormone that increases urine production, and treating sleep apnea often reduces nighttime urination.
Common symptoms
- Waking one or more times a night to urinate
- Passing large amounts of urine at night
- Difficulty getting back to sleep after waking
- Daytime tiredness
- Urgency or frequency during the day in some people
Causes and risk factors
- Drinking fluids, caffeine or alcohol in the evening
- Enlarged prostate (benign prostatic hyperplasia)
- Overactive bladder
- Obstructive sleep apnea
- Heart failure and fluid in the legs that is reabsorbed when lying down
- Diabetes or diabetes insipidus
- Diuretics taken later in the day
- Older age, pregnancy and menopause
How it is diagnosed
A clinician reviews your symptoms, medicines and health conditions and usually asks you to keep a frequency-volume chart (bladder diary) for a few days, recording fluids and every urination with volumes. This helps tell nighttime overproduction from bladder problems. Urine tests, blood tests for kidney function and glucose, a prostate exam and screening for sleep apnea may follow.
Treatment options
Fluid and timing changes
Reducing evening fluids, caffeine and alcohol and taking diuretics earlier in the day where appropriate.
Leg elevation
Raising the legs in the afternoon can move fluid before bedtime in people with swelling.
Treating sleep apnea
CPAP can reduce nighttime urination in people with OSA.
Bladder and prostate treatment
Medicines or procedures for overactive bladder or an enlarged prostate.
Desmopressin
A prescription option for nocturnal polyuria in selected adults, with monitoring of sodium levels.
Managing other conditions
Optimising diabetes and heart failure treatment.
What you can do yourself
- Limit fluids in the two hours before bed while staying well hydrated during the day
- Avoid caffeine and alcohol in the evening
- Empty your bladder just before bed
- Use a night light to reduce fall risk
- Keep a bladder diary to share with your clinician
When to see a doctor
- You wake two or more times a night to urinate
- You have pain, blood in the urine or a weak stream
- You are very thirsty or losing weight
- You snore loudly or someone notices breathing pauses
- You have leg swelling or shortness of breath
Frequently asked questions
How many times is normal to get up at night to urinate?
Waking once can be normal, especially in older adults. Waking two or more times is generally considered bothersome and worth discussing with a clinician.
Can sleep apnea make me urinate at night?
Yes. Sleep apnea can increase nighttime urine production, and studies show that treating it with CPAP often reduces nocturia.
Should I stop drinking water in the evening?
Reducing fluids in the couple of hours before bed can help, but do not restrict fluids overall, and avoid evening caffeine and alcohol.
Is nocturia always a prostate problem?
No. It affects both men and women, and causes include overproduction of urine at night, bladder issues, sleep problems, medicines and other conditions.
Sources
This page is general information, not a diagnosis or medical advice. Read our medical disclaimer.