Updated: Oct 19
You finally get to sleep, and then 2 hours later, your bladder comes a calling. Not cool! And completely exhausting. It's hard enough to get a good night's sleep lately, without your bladder unnecessarily interrupting those ZZZ's. Luckily there are some simple steps you can try today, for a better sleep tonight.
Why do I wake up to pee at night, anyway?
The fancy word for your bladder waking you up to void is nocturia, and it can be caused by several things. According to this excellent study by Matthias Oelke et. al. in 2017, causes for nocturia can be broken down into three main categories:
Decreased bladder capacity—while many people with bladder problems assume they "have a small bladder", this may or may not be the true reason for their woes. Problems with holding it all night can also stem from many other causes, including: overactive bladder syndrome, problems with fully emptying the bladder, interstitial cystitis/painful bladder syndrome, or even a urinary tract infection.
Increased fluid intake—drinking overly large amounts during the day in a quest "to be healthy" or drinking right before bed can lead to bladder overload at night. And if the drinks contain caffeine, carbonation or alcohol, your bladder gets hit with a double whammy. This understandably can then wake us up at night, so our bladder can deal with all the extra fluid. There are also certain medical conditions which can cause excessive thirst and drinking, leading to the same overload.
Increased nighttime urine production—this can occur from taking certain medications right before bedtime, such as diuretics, as well as from our own drinking habits (such as drinking that late-night latte). Certain medical conditions such as diabetes mellitus and chronic venous insufficiency of the legs (where the valves in the veins of your legs don't function properly, leading to leg swelling), can also cause excessive urine production at night.
With all these causes, what is a person to do?! Addressing nighttime voiding may be as simple as watching what you drink and when, or complex enough to need your physician's assistance. Read on to learn about some common-sense strategies to try, and what to do if you need more help.
How common is nocturia, and why does it matter?
Nocturia is actually really common, and pretty equally affects men and women of all ages. Studies show that between 20-44% of women aged 20-40 get up one time or more per night to go to the bathroom, while 11-35% of men in the same age group wake to pee. And the prevalence increases from there as we age. One study reported a prevalence of 34% in women aged >40 years—that is 1 in 3 women over the age of 40. Clearly this is a common problem, and one that can affect our health greatly.
Aside from the obvious irritation of having your sleep interrupted, there are other important reasons to break this habit and work to get more shut-eye. The more often you wake up at night from your bladder, the more distress this can cause your body. This may include:
Reduced total sleep time and more fragmented, lower-quality sleep. This can lead to you being excessively sleepy during the daytime, interfere with your focus, and even alter your mood.
For older adults, nocturia can create a higher risk of falls and fall-related injuries, especially if they are rushing to get to the bathroom due to urgency
Nocturia has also been associated with reduced scores on quality of life measurements as well as other negative health conditions including depression. In this study of women aged 30-79, nocturia was associated with a threefold increase in odds of depression.
Here's the good news: there is something you can do about it! Don't let your bladder ruin a good night's sleep.
Steps to keep your bladder (and you) asleep at night
Let's explore some strategies to try before giving in to your bladder.
Avoid drinking anything after dinner. If you need to have a sip or need to take medication, make sure you have only plain old water, and only as much as you absolutely need.
Stick to drinking plain water during the entire day. Your goal is to avoid drinking anything that may irritate your bladder, such as coffee, tea, sodas or other beverages with carbonation. Note: If you regularly drink a caffeinated beverage in the morning, you may not want to stop cold-turkey, as this can cause headaches, but try to minimize the amount you drink.
If able, adjust your medication time. Some medications, such as diuretics, can cause nighttime urination. If you are taking a medication with a side effect of increased urination, consider discussing the timing of when you take it with your physician or pharmacist; adjusting the time of day when you take it just might help you avoid waking at night.
Two hours before bed, elevate your legs and exercise your ankles. (Tip: Set an alarm for 2 hours before your normal bedtime to remember to do this.) Lie down on your bed, floor, or couch and put pillows under your legs, so that your feet are elevated above the level of your heart. In this position, do 20 ankle pumps, 20 ankle circles in each direction, and 10 leg lifts on each leg. After the exercises, continue to rest in this position, with your legs elevated, for another 5 minutes or so. Then you may get up and continue your evening as usual.
Empty your bladder right before bed. I know, Captain Obvious, but it has to be said.
Keep your bedroom cool, but you keep warm. Being cold can stimulate your bladder, so be sure to have your bed comfy and warm. Sleep experts recommend a cool, yet comfortable room temperature to help you get your zzz's. See this excellent site for more tips to improve your general sleep.
The ideas behind the above strategies are to keep your bladder calm and empty, as well as to get the fluid that may accumulate in your legs during the day to be processed by your kidneys BEFORE you go to bed, so you can sleep through the night.
How do I know these exercises are helping?
For starters, you should be sleeping better, or at least longer, before you have to answer the call of nature. If you normally, for example, get up 2 times per night, and now you only get up once, then you're on to something. Keep the program up! If you normally wake at 2 am to void, but now are waking at 4 am instead, that's a win! Keep going. It's best to try these strategies every night for at least a week, as it can take time to know if they are making a difference.
If after a week, you are still getting up just as often and at the same time(s), then you may need some professional guidance to uncover your unique cause of voiding at night. Many specialists are equipped to assist you, including your primary care physician, OB-GYN, urogynecologist, urologist, or you can make an appointment with me for guidance.
Take action today to help your bladder (and you)
sleep better tonight
Remember: as always, it is important to check with your healthcare practitioner BEFORE starting any new exercise program, especially if you have a serious health condition. You can also schedule a virtual appointment with me to see if these suggestions are right for you.
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About the Author:
Angela is the owner of My Pelvic Therapy, PLLC and a licensed physical therapist. Prior to starting her telehealth private practice, she worked as a senior physical therapist for 17 years at Advocate Lutheran General Hospital in Park Ridge, IL, specializing in helping both women and men overcome their pelvic floor challenges. She received her physical therapy degree from Duke University, biology degree from University of Illinois, and is a lifelong learner of all things PT.