6 Reasons You Keep Waking Up at Night to Pee

By Christa Sgobba |

Nighttime treks to the bathroom are costing you a good night’s sleep—and may signal more serious health problems.

nocturia

Dream of sleeping through the night? You’re not alone. Almost 60 percent of adults 65 and older report waking up for a bathroom trip at least twice during the night—and a third wake up at least three times to urinate, according to a study in the Journal of the American Geriatrics Society.

Nocturia, the scientific term for excessive nighttime urination, becomes more common as you get older, explains Christopher Smith, M.D., an associate professor of urology at Baylor College of Medicine.

“When you are younger, you may make 20 percent of your total urine volume while you’re sleeping, but when you are older, it may go up to 33 percent,” he says. “On top of that, your bladder capacity may be decreasing, so it’s kind of like a double whammy, and you are having more frequency at night.”

Nighttime urges to go impact everyone differently. Some people may wake up three times a night to pee, but because they are able to fall right back asleep, they don’t think of it as an issue. Others who get up only once but end up tossing and turning for the rest of the night may consider it a huge problem.

If it’s messing with your sleep, it’s a health problem—and not just because it will affect your energy level the next day, says Ronan Factora, M.D., a geriatrician at the Cleveland Clinic.

“A good night’s sleep is important for brain health,” he says. “It’s a time when the brain recalibrates, gets rid of abnormal proteins, and rests.”

What’s more, studies show a restless bladder is associated with other health woes, including daytime drowsiness, depression, and weight gain. Even your heart health can take a hit because of lack of sleep, according to the Centers for Disease Control and Prevention.

If nightly bathroom trips are making you feel lousy, there are ways you can help scale them back—but first you and your doctor must determine what’s triggering them. Here are six common causes of strong middle-of-the-night urges to go.

Reason #1: Sleep Apnea

Obstructive sleep apnea, a disorder marked by repeated stops and starts in breathing during sleep, is a condition that becomes more common as you get older.

“Your oxygen levels will drop, and as a result, the body wakes itself up so you can take a deep breath of air and provide the oxygen the body needs at the time,” Dr. Factora explains.

Sleep apnea—which causes a wide range of symptoms, including loud snoring, gasping during sleep, waking up with a headache, and feeling inexplicably exhausted during the day—can also make you wake up repeatedly at night to urinate.

And it’s not just because you notice you have the urge to go when your body awakens. Sleep apnea messes with the production of antidiuretic hormone, which actually causes you to produce more urine at night.

If you notice or suspect any sleep apnea symptoms, you should get checked out by your doctor, who may recommend a sleep study. If you do have sleep apnea, a continuous positive airway pressure (CPAP) machine can treat it by helping keep your airways open.

“It not only helps them sleep better, but actually reduces urine output at night and nocturia,” Dr. Smith says.

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Reason #2: Swollen Extremities

Swollen legs and feet can occur as a result of conditions like congestive heart failure or kidney disease, or even as a side effect from high blood pressure meds called calcium channel blockers, Dr. Factora says.

This retained fluid can also cause you to get up more during the night to go to the bathroom.

That’s because when people go to bed, they finally elevate their feet. All of that fluid then gets reabsorbed and filtered through the kidneys, which can cause more urine production at night, Dr. Smith says.

The best thing to do is help mobilize the fluid before you go to bed, he says. This can be done by elevating your legs hours before bed or wearing compression stockings. If you take meds like diuretics to help with swelling, check with your doctor to see if you can take it earlier in the day, since they can increase nocturia.

Reason #3: Poorly Timed Evening Meals

Okay, so maybe you’re not chugging a big glass of water before bed. But you could still be consuming fluids that can affect nighttime urination.

“A lot of the fluid you take in is from food that you eat,” Dr. Smith says. And some foods—juicy watermelon, protein smoothies, your favorite soup—contain more liquids than others.

“Patients are eating dinner late or snacking before bed,” he says. “That fluid is going to mobilize in their system. When they go to bed, it’s going to cause more frequency at night.”

That’s why he recommends shifting your dinner to at least three to four hours before going to bed. What else can help: Spread out your fluids over the morning, afternoon, and early evening. Not only will you cut down on nighttime bathroom breaks, but you’ll help yourself stay hydrated all day—which is vital for good health.

Reason #4: Food Sensitivities

Sorry, chili lovers, spicy foods and tomato-based dishes can irritate the bladder, Dr. Smith says. Ditto citrus and chocolate.

Alcohol and carbonated drinks can do the same, adds Dr. Factora, which can cause your bladder to squeeze more frequently.

Caffeine is another common culprit that can lead to more nighttime bathroom trips. In some people, the effects can last several hours. In that case, you may want to cut yourself off from coffee and teas in the afternoon.

Food sensitivities won’t be a trigger for everyone, of course. That’s why the experts suggest that anyone bothered by strong nighttime urges start a bladder journal. In addition to tracking your bathroom treks, take note of what you eat and drink, and any effects they have on your bladder.

You can download a Nocturia Symptom Tracker from the National Association for Continence here. Don’t forget to share your notes with your doctor.

Reason #5: Enlarged Prostate

As men get older, their risk of benign prostatic hyperplasia (BPH)—an enlargement of the prostate gland—goes up. Roughly half of men who are in their 50s show evidence of it, according to a 2017 review in the Asian Journal of Urology.

When the prostate grows larger, it can press on the urethra, the tube which carries urine out of the body. If your prostate is compressing your urethra, your bladder will have to work harder to try to empty.

“It may not be able to fully empty, so you’re retaining urine,” Dr. Smith says. “If you are emptying your bladder only halfway, then it’s going to take half as much time for it to get full again, so you are going to have more frequency.”

Plus, by making your bladder squeeze harder to try to empty, it also makes it more irritable—meaning it will feel fuller at lesser volumes.

The result: An enlarged prostate can increase your need to go both during the day and night. It can also cause other symptoms, including difficulty starting to urinate or a weak stream.

But Dr. Smith says it’s the frequent nighttime urges that really bring men in for help. Again, it all comes back to wanting that full night’s rest, he says.

Your doctor can determine whether your nocturia is caused by an enlarged prostate, and if so, prescribe meds to help.

Reason #6: Uncontrolled Diabetes

One sign of diabetes is an increase in urinary frequency if your blood sugar levels are too high, Dr. Smith says.

“What that blood sugar does is it draws, like a sponge, more fluid out of the body and into the urine,” he says. That can produce larger amounts of urine, leading to more frequency at night.

Some people with diabetes may also have weakened bladder muscles, he says, making it difficult to empty completely, which can also cause more frequency.

Working with your doctor to help keep your blood sugar under control can cut down on the bathroom trips—and help you feel better overall.

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