The Question: I often wake up once (or twice) in the middle of the night to use the bathroom -- even when I said no to that glass of wine before bedtime. Is there a way for me to put an end to these midnight bathroom breaks?
The Answer: There is nothing more frustrating than setting yourself up for a solid night's rest only to be disrupted by your bladder in the middle of it. The Huffington Post spoke with Dr. Ilene Rosen, a member of the board of directors for the American Academy of Sleep Medicine who is board certified in sleep, internal, and pulmonary medicine, to better understand why this occurs, the potential underlying conditions that could be causing it, and what you can do to control it.
While getting up to go to the bathroom once a night is probably not that big of a deal, going two times or more can be very disruptive, as well as a sign that an underlying condition may be to blame.
As with most sleep problems, the roots of nocturia -- the medical term for frequent night peeing -- lie with none other than the circadian rhythm.
"In general, our circadian clock controls most of the functions in our body," Rosen told The Huffington Post. "And then in addition to the central circadian clock, there are also clocks at the cellular level, likely in all the cells in our body. Because of that, there's a circadian variation in all of our organ functions."
With a functional circadian rhythm, a person produces less urine and thus has less of an urge to go. But a dysfunctional rhythm might mean that your bladder didn't get the memo. On the other hand, it isn't always a matter of a messed up body clock: One common and expected cause of nocturia is aging, which includes changes in bladder function -- mainly, that the bladder is no longer able to tolerate higher volumes of urine, according to Rosen. A younger person can sleep through the night, whereas an older person who produces the same amount of urine has to get up.
A problem with many origins
That said, there are medical conditions that may be the culprit, and the most common one Rosen sees in patients is obstructive sleep apnea.
"People with obstructive sleep apnea actually have physiologic reasons why they have to go to the bathroom during the night," she said. "In an apnea episode, the brain gives a signal to breathe, and all the chest muscles work properly to do that except the upper airway is closed off."
Here's how it works: As the diaphragm contracts, pressure builds up between the lungs because that airway is blocked, and that pressure causes the heart to stretch. When it stretches, it releases the hormone atrial natriuretic peptide, which signals the kidneys to produce more urine. That's why when Rosen is speaking to a patient with nocturia, she often looks for other sleep apnea symptoms, like snoring.
Rosen also suggested that restless leg syndrome could be to blame, because people wake in the middle of the night due to their movement and mistake that disturbance for a need to go to the bathroom. Diseases like Parkinson's disease, heart failure and diabetes can also make people go to the bathroom more during the night.
So can pregnancy and obesity. According to Rosen, any abdominal girth that increases the pressure on the abdominal cavity can cause people to have the sense that their bladder is full. A 2013 study even found a strong association between depression, anxiety and nocturia.
What to do next
Once you determine the cause of your midnight bathroom breaks, the next step is figuring out how you can control them. Unfortunately, Rosen said there isn't really a way to change your daily routine (other than monitor fluid intake and take diuretic medications earlier in the day) that will prevent multiple awakenings each night. However, if you're an older adult struggling with an overactive bladder caused by the spasming of the sphincter muscles, you can do pelvic exercises to help improve your control.
Paired with checking with a physician to see if it's caused by an underlying condition, one of the best ways to deal with nocturia is to focus on creating healthy sleep hygiene. Set a consistent sleep and wake time, minimize exposure to stimulation before bed, and even make your route to the bathroom less jarring so it's not as disruptive when the time comes. Clear the path to the door, and consider using a subtle nightlight in the bathroom so you don't have to flip the bigger switches, waking you up even more and thus making it harder to fall back asleep as you return to your side of the bed.
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