Don’t Let Nocturia Keep You Awake at Night

As men and women grow older, they are both at an increased risk for nocturia, a condition marked by frequent nighttime urination. If your sleep is routinely interrupted two, three, or more times each night by hurried trips to the bathroom, you should consult a physician without delay, advises Christopher Saigal, MD, a urolo-gist at UCLA Health System. Often, he points out, this frustrating, sleep-depriving disorder may be eased, to an extent, through simple behavioral changes—avoiding the consumption of liquids before bedtime, for example. In other cases, however, nocturia may signal the presence of a serious systemic disorder requiring prompt medical attention.

Age-related changes

In many instances, nocturia can be attributed to certain physiologic changes that normally occur with aging in both men and women. According to Dr. Saigal, people can be bothered by the condi-tion in their 50s, but it typically occurs among those in their 60s and older. “Basically, it seems that two things happen,” says Dr. Saigal. “There is a natural decline in the body’s production of antidiuretic hormone, which concentrates the urine. Consequently, more urine is produced. At the same time, there is a gradual decline in functional bladder capacity, possibly due either to age-related degeneration of the nerves in the bladder or to organ tissue fibrosis. So more urine is being produced, and the bladder is less able to contain it.”

These age-related changes are almost always responsible for nocturia in women, Dr. Saigal notes. (There is no sound evidence that the disorder is in any way related to menopause, he adds.) In men, however, nearly half of all cases are associated with benign prostatic hyperplasia (BPH), a noncancerous and often manageable enlargement of the prostate gland that commonly occurs in older males.

Disease-related causes

Dr. Saigal cites heart failure and diabetes as examples of other serious conditions that can cause nocturia. “People with heart failure will often have excess fluid in their tissues,” he says. “At night, when they put their legs up, the fluid drains into the vascular space, circulates, and is eventually filtrated into urine. And diabetic patients, who may have too much sugar in their system, will often experience significantly increased urine output during the night.”

Whether nocturia is a natural byproduct of the aging process or is spawned by the presence of a comorbid condition, the most persistently debilitating consequence has to do with the sleep interruptions caused by the need to urinate. “It’s a quality-of-life problem,” Dr. Saigal says. “I’ve had patients complain of having to get out of bed six or seven times every night, and this can be very destructive. This kind of constant sleep interruption can make you tired and irritable during the day, and this can have a terrible impact on your family life and job performance.”

Diagnostic measures for frequent nighttime urination will initially be aimed at excluding the presence of conditions such as heart disease and diabetes. The patient also will be asked about his or her patterns of day-time voiding, which, if excessive, could be caused by an overactive bladder or bladder spasms.

“If we suspect isolated nocturia,” says Dr. Saigal, “we’ll ask the patient to keep a voiding diary to record how often they’re going to the bathroom during the night and how much urine they’re passing each time. If the patient is simply producing too much urine, we have a medication to correct that.” He cautions, however, that the medication—an antidiuretic hormone (Vasopres-sin)—also can cause insufficient urine production, which can upset the patient’s serum electrolyte balance. In addition to this medication, “We can offer the patient instructions on behavior modification that may help,” says Dr. Saigal. “We tell them, for example, to stop drinking fluids three hours before going to bed and to void right before going to sleep. We also ask them to cut down on drinking caffeine and alcohol during the afternoon and evening hours, because these are diuretics.”

Although nocturia is “pretty persistent once it starts occurring,” such behavioral modification, says Dr. Saigal, probably reduces nighttime urination to a “reasonable level” for 30 percent to 40 percent of patients.

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