Reasons Why You're Getting Up To Pee So Much at Night

Nocturia is defined as waking up one or more times during the night to urinate. When the loss of sleep from nocturia leads to falls, reduced work productivity, symptoms of depression, or other problems, it is called clinically relevant nocturia. In other words, it affects your quality of life and treatment is needed.

Nocturia can often mean that another underlying health condition is present, such as high blood pressure or a sleep disorder. Any underlying condition causing your nocturia will need to be treated to stop you from waking up at night to urinate.

If you ask yourself, "Why do I pee so much at night?," read on to learn more about why that may be the case and how nocturia may be treated.

What Causes Nocturia?

The causes of nocturia vary, and people might have one or a combination of the issues.

Polyuria

Polyuria could be the reason you can't sleep through the night without a bathroom break. There are two types of polyuria: nocturnal and global.

Nocturnal polyuria is the most common cause of nocturia, affecting around 88% of people with the condition, but it affects older adults more often.

Nocturnal polyuria happens when there is a decreased production of urine in the daytime compared to nighttime production. The nighttime production must be greater than 20% of the total amount of urine produced within 24 hours for younger adults and more than 33% for older adults.

If polyuria occurs day and night, it's considered to be global polyuria.

Global polyuria is the result of increased urine production during the day and at night. This type of polyuria is defined by a person having a urine volume of more than 2,800 milliliters per kilogram within 24 hours or a produced volume of over 3,000 milliliters daily. Global polyuria is also related to excessive fluid intake in general.

Bladder Storage and Capacity Issues

Some people with nocturnal polyuria also have low bladder capacity, meaning that their bladder does not have enough "storage" for the amount of urine being produced. A number of things can cause low bladder capacity, including infections and inflammation.

Many people who experience nocturia are affected by both nocturnal polyuria and low nocturnal bladder capacity. These are two separate issues, but people affected by both are diagnosed with mixed nocturia.

Additionally, an overactive bladder can cause low nocturnal bladder capacity. So can a bladder obstruction, such as benign prostatic hyperplasia.

Prostatic hyperplasia is when the prostate and surrounding tissue expands. People who have this may feel like their bladder is full even after they urinate. Treatment options include prescription drugs like alpha blockers or surgery.

Another condition called urethral stricture disease can lead to nocturia. That's when swelling, infection, or injury produces a scar that blocks or slows the flow of urine in the urethra, which is the tube that lets urine leave the body. The condition is more common in people with a penis because of the longer urethra.

Sleep Problems

Nocturia may also be the result of sleep problems. These problems typically are rooted in having a lack of sleep or disrupted sleep throughout the night.

It's thought that the link between nocturia and sleep issues is bidirectional—one condition can affect the occurrence of the other. For example, a person might have disrupted sleep because of nocturia, but nocturia might occur because of the disrupted sleep.

Sleep disorders that can cause nocturia include:

• Insomnia
• Sleep disordered breathing (e.g., sleep apnea)
• Restless legs syndrome (RLS)
• REM sleep behavioral disorder

Also, problems with hormones that work according to your circadian rhythm—your 24-hour rhythm—can lead to nocturia.

Your circadian rhythm works like an internal clock. It puts you to sleep when it is dark and wakes you up when it is light. For people with circadian rhythm disorders, this sleep-wake pattern is dysfunctional or may even be entirely reversed.

Circadian rhythm disorders affect more than when your body sleeps and wakes. They also affect your body's metabolic processes, including when you need to use the restroom. So if your internal clock thinks you should be awake at night, it can also think you should urinate at night.

Lifestyle Factors

Researchers have indicated that moderate exercise is potentially beneficial for decreasing instances of nocturia. However, not engaging in exercise can do the opposite. The condition has been associated with being less physically active.

Nocturia has also been connected to consuming a lot of salt. Research found that participants who did not reduce their salt intake experienced nocturia more compared to participants who did reduce the intake.

Drinking a lot of fluids before bedtime—especially caffeine or alcohol—can also increase your nighttime bathroom trips. Caffeine and alcohol can make you have to pee more often in general and are considered bladder irritants.

Medical or Mental Health Conditions

Some medical and mental health conditions may be associated with nocturia as well. They include conditions such as:

• Anxiety
• Congestive heart failure
• Depression
• Diabetes
• Hypertension (high blood pressure)
  
• Liver failure
• Obesity
• Peripheral edema (swelling due to fluid buildup in lower limbs)
• Pregnancy
• Urinary tract infections (UTIs)
  

Medications for some of those conditions, like hypertension and depression, may also contribute to nocturia.

What To Do if You’re Waking up to Pee Too Often

If you find yourself losing sleep because of nocturia, the first thing you should do is see a healthcare provider for an evaluation.

If the cause of nocturia is unknown, a healthcare provider may perform cystoscopy. This is a procedure that allows the healthcare provider to examine the inside of your bladder by inserting a thin tube with a lens inside the urethra.

Urgent issues like infections will need to be treated. You might be asked to keep a "fluid and voiding diary." This entails keeping a record of everything you drink and every time you have to go to the bathroom. The diary can help a provider figure out what might be causing your nocturia.

Treatment for nocturia might involve curing whatever ailment has led to the condition instead of curing the condition directly.

For example, if a urinary tract infection is causing your nocturia, you may need to take antibiotic medications. Or, if high blood pressure is causing your nocturia, your provider might recommend watching your salt intake or being more physically active.

If there's no underlying condition to address, making lifestyle changes like cutting back on fluids before bedtime may help.