It’s normal to wake up once a night (or less) if you’re under 65, and 1-2 times per night if you’re over 65. Being woken up more often than this by your bladder is called Nocturia.
Nocturia is different than waking up in the night for another reason, and then going to the toilet - it is waking up because you feel the urge to urinate.
Causes of Nocturia:
· Medical conditions such as:
o Untreated Sleep Apnoea
o Diabetes – all types
o High Blood Pressure
o Restless Leg Syndrome
o Bladder Obstruction
o Benign Prostate Enlargement
o Pelvic Organ Prolapse
o Nocturnal Polyuria (where your body produces too much urine at night)
o Lower Leg Oedema / Lymphoedema
· Lifestyle factors:
o Stress
o Insomnia / Poor Sleep
o High Fluid intake
o High caffeine intake
o Alcohol intake close to bedtime
· Some medications can increase urine production – speak with your GP about this.
· Pelvic Floor / Pelvic Health conditions
o Overactive Bladder - frequent daytime urge can continue into the night
o Bladder Pain
o Post-prostatectomy - in the first 6-8 weeks following surgery it's common to wake multiple times a night to urinate, but if this continues seek help
Interrupted sleep can have a huge impact on your mental and physical health, so this is an issue worth treating.
Bladder Habits to Reduce Night Waking:
Go to the toilet immediately before sleep – that way you start sleeping on an empty bladder.
Stop drinking all liquids 2-3 hours before sleep.
If you need to take medication, only drink enough for that.
If you suffer from dry mouth -try dry mouthwashes (such as Biotene), or dry mouth gels.
Stop caffeinated drinks (such as coffee, coca cola, and black tea) 6-8 hours before bed.
Caffeine is a bladder irritant (can make you need to wee when the bladder isn’t full), a diuretic (increases your urine production), and a stimulant (keeps you awake) for up to 6-8 hours after taking it.
Reduce alcohol consumption
While alcohol can make you feel sleepy, it reduces the quality of your sleep AND makes you need to urinate more.
If you suffer swollen or puffy feet/ankles/legs late in the day:
Elevate your legs for 30min in the early evening so your body can clear the excess fluid.
Consider wearing compression socks in the daytime.
What else can help?
Treating any daytime overactive bladder,
treating any back/hip/pelvic pain,
strengthening and/or relaxing the pelvic floor,
practicing good sleep hygiene,
reducing stress,
getting 30 minutes of exercise a day
Your Physiotherapist may also consider posterior tibial nerve TENS and other modalities.
If Physiotherapy is not improving your symptoms, speak with your doctor as it is time to investigate for underlying medical issues. Treating any underlying health conditions is essential for improving nocturia.