[Repost] Do you need to get up several times to urinate during your sleep?
By Professor Wu Wen-cheng, Department of Urology, Kaohsiung Siaogang Hospital
During a clinic visit, I saw an elderly couple in their seventies, looking somewhat embarrassed and distressed, expressing their distress over the frequent waking up to urinate during the night. They asked me if bladder weakness is a common ailment in older people. The couple often had to get up to urinate, sometimes three or four times a night, sometimes seven or eight. The husband, in particular, was slow and had once fallen due to mental confusion, requiring several stitches. The wife, who also frequently needed to urinate and worried about her husband falling again, had difficulty sleeping and often needed sleeping pills to fall asleep. This uncomfortable feeling of having to get up repeatedly to urinate during the night is something most young people find hard to understand.
Most of our urine is excreted during the day. During sleep, the secretion of antidiuretic hormone (ADH) automatically increases, resulting in only a small amount of concentrated urine being excreted. Therefore, the amount of urine at night is small, and most people only get up to urinate once a night at most. The International Society for Nocturia (ICS) defines nocturia as: waking up to urinate during sleep and then falling back asleep, with more than one urination per night. However, many researchers define it as waking up to urinate two or more times during sleep. Some also define it as a total urine volume during sleep exceeding 351 TP3T per day. If defined as waking up twice or more at night, adults aged 20-40 have approximately 2-181 TP3T; however, it is most common in people over 70 years old, with men having as high as 29-591 TP3T and women 28-621 TP3T.
Nocturia is a multifactorial disease, and its causes are related to the increase in diseases associated with aging. Obesity, sleep apnea syndrome, heart failure, lower extremity edema, diuretic use, diabetes, lower urinary tract dysfunction, etc. are all risk factors. Generally speaking, its causes can be roughly divided into three categories: (i) reduced bladder capacity, (ii) increased nighttime urination, and (iii) sleep-disordered breathing.
(a) Diseases that reduce bladder capacity: stroke, Parkinson's disease, multiple sclerosis, herniated disc, spinal stenosis, and bladder problems caused by diabetes. These diseases can all reduce the amount of urine each time due to overactive bladder, causing frequent urination and nocturia. In addition, lower urinary tract infections, bladder or prostate tumors, pelvic injuries or gynecological or colorectal tumors pressing on the bladder, and even drug abuse (such as amphetamines and ketamine) can also cause similar symptoms.
(II) Diseases that increase nighttime urination: Excessive drinking of water or caffeinated beverages at night, insufficient secretion of diuretic hormones, nephrotic syndrome, chronic liver disease, congestive heart disease, poor venous circulation, lymphedema, and malnutrition leading to insufficient albumin in the blood, causing edema in the peripheral limbs (especially the lower limbs). These patients urinate significantly less during the day, but during sleep, due to the change in posture, venous and lymphatic return is easier, and the fluid from the peripheral edema slowly enters the bloodstream and is excreted by the kidneys as excess water accumulated during the day, resulting in nocturia.
(III) Sleep-disordered breathing mainly refers to sleep apnea syndrome. The cessation of breathing during sleep causes temporary hypoxia, leading to increased pulmonary vascular resistance and the secretion of atrial diuretic peptides, resulting in a diuretic effect and causing nocturia. If this problem is cured, the frequency of nocturia will also greatly improve.
Targeting the underlying cause and providing the most appropriate treatment is the best way to improve nocturia and restore sleep quality. Patients experiencing this problem must first adjust their lifestyle according to the cause and then observe the effects. If symptoms persist, appropriate medication is recommended. Regularly check on your elderly parents to see if they experience nocturia. If their symptoms are significant and affecting their quality of life, taking them for examination and treatment is also a way of showing filial piety.