This common nocturnal habit could be a sign of illness — it’s time to worry

Reviewed by dietitian Karen Ansel, MS, RDN

Main points

• Frequent urination throughout the night can be a hidden sign of some health conditions.

• These include diabetes, sleep apnea, overactive bladder or benign prostate hyperplasia.

• If you regularly wake up to urinate more than once a night, talk to your healthcare provider.

Picture this: You’re fast asleep and in the middle of a big dream, when an uneasy feeling wakes you up. This is your bladder calling, telling you it’s time to use the bathroom. Of course, having to urinate at night happens to everyone sometimes. But if it’s happening more than once a night, it could be a sign of an underlying health problem.

“You should be able to sleep for six to eight hours without waking up in the bathroom,” says urologist Justin Dubin, MD, adding that if you wake up two or more times per night, that’s considered abnormal.

The medical term for those excessive bathroom breaks is nocturia. While nocturia itself is not a disease, it can be a symptom of one. And it’s more common than you might think, affecting 50 million adults in the U.S. Most are over 65, but 1 in 3 over 30 say they urinate two or more times a night.

Should you be worried? To find out, we talked to urologists and a dietitian about what those nighttime bathroom trips might be, what’s considered normal, as well as practical tips to prevent them.

Excessive nocturnal urination

There are many possible causes of excessive nighttime urination, including lifestyle habits, bladder capacity, certain medications and underlying health conditions. Here are four common health problems that could be to blame.

Diabetes

If you find yourself getting up to use the bathroom more often than usual, this could be one of the first signs of blood sugar problems. Frequent urination is one of the early symptoms of diabetes, says urologist Scott D. Miller, MD, MBA, a diagnosis he makes several times each year.

An estimated 15% of American adults are living with diabetes, and about 3% are unaware of it. When diabetes goes undiagnosed or poorly managed, high blood sugar levels can lead to frequent trips to the bathroom.

How does this happen? “High blood glucose levels can trigger osmotic diuresis, resulting in excessive nighttime urination,” says Elizabeth Shaw, MS, RDN, CPT. This happens when the kidneys try to lower blood sugar by pulling excess glucose into the urine, and water follows. “It increases urine production around the clock, including overnight,” adds Miller.

Sleep apnea

“Many patients are surprised to learn that their bladder symptoms are actually related to sleep,” says Miller. One to watch out for is sleep apnea. “Sleep apnea occurs when the neck muscles relax during sleep and stop breathing, causing people to wake up frequently during the night,” says Shaw. Tip-offs are to eat grass or get air while you sleep.

Sleep apnea can also be an alarming reason you’re getting up to use the bathroom. In addition to disrupting sleep, sleep apnea can lower blood oxygen levels, which trigger hormone changes that encourage nighttime urine production, Miller says. Specifically, it increases the secretion of atrial natriuretic peptide (ANP), a hormone that helps your kidneys remove water from the body.

Overactive bladder

If you are going to the bathroom frequently throughout the day and have more than two trips per night, you may have an overactive bladder. “Overactive bladder is a condition in which the bladder is hypersensitive and sends frequent or sudden signals to urinate, even when it’s not full, causing urgency and frequent bathroom trips day or night,” explains Miller. The good news is that there are medications that can help calm your bladder. So, if you’re always running to the bathroom, talk to your healthcare provider.

Benign prostatic hyperplasia

As men age, the prostate gland naturally enlarges. This condition is called benign prostatic hyperplasia (BPH). “When the prostate is enlarged, you can’t empty your bladder as well, so your [bladder] You may feel full more often, and the time you need to hold your urine may decrease,” explains Dubin. Fortunately, for many men, lifestyle changes can help (more on this soon!).

What is normal?

For most adults, a nightly bathroom trip is considered normal. Waking up two or more times in a row in one night (especially if it’s new, worsening, or tiring) deserves a medical visit, says Miller.

“You should be concerned when nocturia disrupts sleep or daytime energy,” he says. “When nocturia is sudden or accompanied by painful urination, excessive thirst, leg swelling or difficulty breathing, you should seek immediate medical attention.”

Tips to reduce urination at night

In addition to working with your health care provider to find the cause of those nighttime bathroom trips, experts recommend trying these tips.

• Stop drinking alcohol two hours before bed: Cut back on all liquids, especially alcohol and caffeinated drinks, two hours before bedtime, Dubin says. Both alcohol and caffeine are diuretics that can make you urinate more often.

• Check your medication: Some medications, such as diuretics for high blood pressure or heart conditions, can increase urination. For men with BPH, some antihistamines and over-the-counter cold medications can also be triggers. Ask your healthcare provider if it is possible to take these medications in the morning instead of in the evening or if there is an alternative medication that may work for you.

• Treat underlying conditions: Untreated sleep apnea and diabetes can lead to sleep disturbances and increased urination. “It’s best to keep them under control to help you urinate at night and sleep better,” says Dubin.

• Address leg swelling: Your feet can be numb at night for a variety of reasons. Something can be serious, so you should not ignore it. But there are also benign culprits, such as standing or sitting too much during the day, taking certain medications, or eating too many salty foods. Swollen legs can also cause you to urinate more frequently. “Elevating the leg or wearing compression stockings in the evening can help move fluid earlier, reducing nighttime urine production,” says Miller.

Our experts

Waking up at night to urinate occasionally is normal. But if it happens more than twice a night, it could be your body trying to tell you there’s a problem. “Getting up at night to urinate isn’t just a bladder problem, it can be your body’s way of raising red flags,” says Miller.

Conditions like diabetes, sleep apnea, overactive bladder and benign prostate hyperplasia can make you need to urinate frequently throughout the night. A nightly trip to the bathroom is considered normal, but anything more could indicate an underlying issue. So, be sure to let your healthcare provider know. In addition to treating underlying health conditions, experts recommend reducing fluids two hours before bedtime, reviewing your medications with your healthcare provider, and addressing leg swelling. In turn, you can cut down on those nightly bathroom trips and finally get the rest you need.

Read the original article on EatingWell