Nocturia

[David_H]

Hi all. Anyone with experience of frequent night time urination? I find myself having to get up about four times at night even though I stopped drinking maybe 3 or 4 hours before going to bed and I don't pee that often during the day. I do have a single beer early evening so I'll be cutting that out to see if it makes a difference. Anyine else found cutting alcohol makes a difference? In my 70s and been told no prostate or UTI issues. Perhaps its just another of those aging issues and I'll have to put up with it? Thanks Dave

[ml66uk]

Me too, though I smoke and drink too much late at night (typically 2-2.5 pints). I used to be able to drink more without a problem though. Other men my age (59) seem to think it's normal to get up to pee 2-3 times/night, but it was 3-4 for me, sometimes more, and I've been TATT (tired all the time) for years now.

My GP originally put me on Tolterodine, and when I mentioned it to a urologist I've been seeing about kidney stones, he later prescribed Tamsulosin in addition, though I'm now just taking the Tamsulosin by itself. I still wake up around 2x/night, but that's a lot better than it was. Tolterodine made me wake up with a very dry mouth btw, though you can get that from Tamsulosin too.

[David_H in reply to ml66uk]

Thanks for your reply, very interesting. Hope this isn't a one off but last two days I had nothing to eat or drink (no alcohol) after 6.30pm. Went to bed at 11 and only got up 2, possibly 3 times so just relieving quantity and any irritation from beer and caffeine seems to have improved matters. I'll stick to this for a few days and see it improvement stays

[kaliska0 in reply to David_H]

If you are not drinking anything for 12+ hours and still peeing twice you are treating urinary issues by dehydrating yourself to the point your body has no choice but to try to save as much water as possible. This can lead to a variety of health issues. Excess urination is one of those symptoms that it's far better to solve than merely avoid because you NEED fluids. Many people are mildly dehydrated every morning even when they don't avoid any liquid in the evening. Dehydration negatively impacts sleep and reduced sleep can increase dehydration. Not sleeping as deeply is less likely to trigger the body to produce less urine so you need to pee more often. You have a never ending circle with lack of water and lack of sleep making each other worse. Reducing fluids and anything that could trigger more urine production is not the same as no fluids. Drinking some small amounts periodically later in the day is necessary to avoid dehydration and improve sleep.

somnologymd.com/2024/06/hyd...

The body also adjusts to water intake and will create more urine when you drink more water than usual even if it doesn't need to get rid of all the increased water. Conversely you dehydrate easier if you suddenly drink less than usual even if it's within the recommended amounts. It takes awhile to alter signals in response to changes in activity, sleeping times, and fluid intake.

We aren't even meant to sleep 8 hours straight without waking up for a short time and in past history often a little food and drink, which is probably why waking up once a night to pee is frequently not considered abnormal. The sleep 8 hours straight and stay awake the entire rest of the time concept is a relatively recent schedule so we could fit all work hours into 1 longer block of time during daylight hours. Few cultures have been following this schedule long enough for human evolution to catch up and most countries where society has stricter view of acceptable sleeping times have higher rates of sleep deprivation.

First make certain no medication including those that don't require a prescription or any nutritional supplements that you take do not have a diuretic effect. Sometimes it's an overlooked secondary effect of common medications and other things we don't really think about. Also assess salt, sugar, and protein intake. These require more urine production to get rid of the excess. Even sources typically thought of as healthy options like protein and meal replacement shakes can contribute to needing to get rid of more sugar or protein byproducts.

Vasopressin levels react to our daily sleep schedule and current activity to increase and decrease urine output. It can't be too strong though or it might prevent the body from eliminating harmful compounds so it's quite easy for it to fail. Occasionally diuretics are used at a specific time of day to reduce urine output later at night but this is not an ideal approach. It's much the same as simply not drinking enough since you have to deplete your body of enough water it risks dehydration before it will reduce urine output. It is also hard to predict how long a diuretic will impact you and continue to encourage the body to produce more urine.

Since the body responds to your daily schedule sometimes you can do things that help produce more urine during the day and less at night or the wrong things that accidentally trigger the body to produce more urine at night. Anticipation of needing to get up to pee can end up increasing that problem. Due to a bladder disorder I had a risk of being unable to retain urine while sleeping so I would try to reduce my bladder getting full enough the muscles failed by peeing as late as possible before I fell asleep. Even with it not being a problem for many years if I lay down in bed without emptying my bladder first I soon feel a strong need to do so. If I don't fall asleep quickly and realize a fair amount of time has passed I will start to feel like I need to pee again only an hour or 2 later. My body responds to the habit I created but sometimes excessively or needlessly. Then I start to get thirsty during nights I don't sleep well because the more I'm awake the faster my bladder gets full. Add thirst to reasons I can't sleep but I don't want to drink too much. It's very hard to stop thinking about it and just sleep without getting up and then taking longer to fall asleep making the whole situation worse. Established routines can have a surprising impact on what your body does.

Unfortunately with age urinary problems gain more possible causes and sometimes multiple causes. It becomes harder to find the reasons or even a good solution that doesn't risk other negative health effects. You have to look at a lot of factors. Often people don't want to go through the effort and doctors don't want to go looking for a cause when it may be impossible to determine and require a lot of time ruling things out. Especially when money or doctor availability is a problem. Since excessive night time urination happens to 50-80% of people as they age many just accept it as another one of those things they have to deal with.

racgp.org.au/afp/2012/june/...

sciencedirect.com/science/a...

Anticholinergics like the previous person mentioned are catch all solutions because they reduce production of body fluids regardless of the cause. Reduction of fluid production does sometimes apply to saliva, sweating, eye lubrication, etc... potentially causing a variety of annoying side effects. Since those things are not a significant health risk for most people it is a common option to try for a variety of things including as a non-prescription sleep aid. Older antihistamines that can cause drowsiness are also anticholinergic with the same risk of other side effects. Anticholinergics used for urinary issues do work a little differently and target more specific fluid production along with muscle contractions. The odds of side effects like dry mouth and drowsiness are not the same for all medications with anticholinergic effects. They also won't all work as well for different people or problems with different causes.

[David_H in reply to kaliska0]

Well thank you very much for such a comprehensive reply. I will have to read it a few times to take it all in.

[PhilFreeToAsk in reply to kaliska0]

Thank you kaliska0. I was really impressed with your reply to David_H. I was wondering if you would be able to comment on my condition.

I pass about 75-80% of my urine at night. I go on average about 4 times per night with nearly a full bladder, 300-400ml each time. I am woken more than 4 times otherwise I would be getting out of bed nearly double that. By 2pm, I may have passed over a litre. My urologist suggested Demopressin in one breath and said he would not offer it to me because of its side effects. I don't want to take it either. Typically, I would take 1.5 litres of fluids per day and pass over 2 litres in 24 hours.

My behaviour maybe contributing to this pattern of nocturia.

It has become increasingly difficult to get back to sleep after getting up. So any advice or comment on this would be useful.