Nocturia–a medical term meaning having to urinate frequently during the night–is a common curse of late life. In fact, 65 percent of adults age 55 and over responding to a Sleep in America poll indicated that they often had to get up one or more times a night. When interruptions are more frequent–up to five or six a night–getting a good night’s sleep becomes virtually impossible. To make matters worse, nocturia tends to occur at a time when aging brings about changes in sleep architecture, with lighter and more easily interrupted sleep.

Normally, less urine is produced during the sleeping hours, and the bladder easily stores a six- to eight-hour accumulation. Nocturia occurs either because more urine is produced or the storage capacity of the bladder becomes compromised. In many cases, both are involved. Whereas a young adult secretes about 14 percent of daily urine production during sleeping hours, a person over age 65 is likely to secrete 34 percent or more. This difference is due at least in part to age-related changes in the production and release of antidiuretic hormone.

Seniors also frequently suffer from high blood pressure and congestive heart failure–disorders that cause fluids to accumulate in the body–often in the lower body. With the body supine during sleep, excess fluids are likely to be excreted as urine.

Treatment for both conditions often involves diuretic medications, which get rid of the excess fluid by increasing urine production. Most doctors advise their patients to take their pills early in the day to avoid sleep disruption. Desmopressin, an oral antidiuretic, has been found effective in treating nocturia in young adults, but the drug has side effects and is usually not recommended for patients taking diuretics.

Obstructive sleep apnea, characterized by loud snoring and repeated episodes when breathing is blocked for 10 seconds or longer, is also associated with nocturia. Studies show that a person with severe sleep apnea makes an average of 2.6 trips to the bathroom during the night.

At any age, of course, nocturia can be caused simply by drinking too many fluids, particularly coffee or alcohol, in the evening. The first step in treatment always involves cutting back on unnecessary fluid intake in the evening.

Regardless of how much urine is produced, nocturia can occur when bladder capacity is limited. For males, a major cause of bladder dysfunction is benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate gland. As urine leaves the bladder on its way out of the body, it passes through a narrow tube that is surrounded by prostate tissue. When excessive growth occurs in this area of the prostate, urinary problems can occur that eventually make it difficult to completely empty the bladder. Men with BPH often see a doctor primarily because nocturia is making it impossible for them to get a good night’s sleep.

Medications are now available to inhibit the growth of prostate cells. More severe cases require surgery to remove part of the prostate. Both of these treatments, however, can have negative effects so it’s important to be sure the problem is BPH rather than over-active bladder.

Affecting about 19 percent of senior males and females, over-active bladder involves involuntary contractions of the bladder, causing frequent signals to urinate even though the bladder is not full. Over-active bladder sometimes results in incontinence or leaking, and it is a major cause of nocturia.

Anticholinergic medications may be prescribed to treat over-active bladder, but initially many doctors recommend behavioral therapy, sometimes assisted by biofeedback. The goal is to train the patient to wait longer and longer periods to allow the bladder to fill properly.

Since there are so many possible causes of nocturia, doctors often ask patients to keep a 24-hour voiding diary and to measure the amount of urine expelled during the night. With a proper diagnosis, conservative treatment can be started. Good sleep is essential to continuing health. If you’re among those who are frustrated and sleepy because of night-time urination, help is available.

Michelle Herbert Thomas, PharmD, CDE

Clinical Director, Richmond Apothecaries, Inc.