I have too many nighttime awakenings, what should I do?

Author: Chen Zhou, attending physician at Shanghai Changhai Hospital, doctor of medicine

Reviewer: Mei Xiaobin, Chief Physician, Shanghai Changhai Hospital

"I slept through the spring without knowing the dawn, and heard birds singing everywhere. There was a sound of wind and rain at night, and I didn't sleep well last night!" For many people, the reason for "not sleeping well last night" is not "the sound of wind and rain", but nocturia... So, what are the reasons for increased nocturia? What tests should be done to clarify the cause of increased nocturia? Is there any way to cure it?

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1. What is nocturia?

Nocturia, as the name suggests, is the behavior of getting up to urinate after falling asleep at night. It should be noted that increased nocturia generally includes two aspects: the first is increased urine volume, and the second is increased urination frequency.

What we often call increased nocturia generally refers to an increase in the number of nocturnal urinations, more than three times, or an increase in the amount of urine at night, more than a quarter of the total daily urine volume. This type of "increased nocturia" is clinically significant. The number of nocturnal urinations generally increases with age, and more than half of the elderly over 70 years old will have the problem of increased nocturnal urination [1]. Occasional waking up at night, or only waking up once a night, is not a big problem and is generally considered normal.

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2. What causes increased nocturia?

If you consult a nephrologist about increased nocturia, he may first ask you if you have high blood pressure. This is because long-term high blood pressure is most likely to cause kidney damage, and the most common result is increased nocturia. But in fact, there are too many reasons for increased nocturia.

At present, the more clear causes of increased nocturia can be divided into physiological and pathological causes. The former include obesity, insomnia, nervousness, drinking a lot of fluids before going to bed, renal dysfunction in the elderly, physiological reduction of the bladder in pregnant women, and the use of diuretics, while the latter can be divided into the following types.

1. Urinary system diseases: Patients with diseases such as prostate hyperplasia, prostate cancer, kidney stones, urinary tract infection, nephrotic syndrome, etc. may experience increased nocturia.

2. Cardiovascular diseases: patients with hypertension, congestive heart failure, coronary heart disease, etc.

3. Endocrine diseases: Patients with diabetes and diabetes insipidus may also experience increased nocturia.

3. How to determine the cause of increased nocturia?

If you have the problem of increased nocturia, it is recommended that you first check whether the above reasons exist and determine whether your increased nocturia is physiological or pathological. If you think it is pathological, then according to your specific situation, you can choose to go to the nephrology, urology or endocrinology department for medical treatment and do corresponding examinations, such as urine routine, renal function test, hormone level measurement, urinary system ultrasound examination, sleep monitoring, etc., to further clarify the cause.

4. How to treat or improve increased nocturia?

For one or two occasional nocturia, you may be able to find the cause yourself, such as drinking too much water or alcohol before bedtime, which is not a big problem. However, for regular nocturia, you need to pay attention to it and go to the hospital to find the cause. Only when the cause is clear can you carry out targeted treatment under the guidance of a doctor.

References:

[1]TIKKINEN KA, TAMMELA TL, HUHTALA H, et al. Is nocturia equally common among men and women? A population based study in Finland[J]. J Urol, 2006,175(2):596-600.

[2]THEODORE MJ Jr. Nocturia: Clinical presentation, evaluation, and management in adults[EB/OL]. (2023-02-15)[2024-08-06]. https://www.uptodate.com/contents/nocturia-clinical-presentation-evaluation-and-management-in-adults/print.