To Pee or Not To Pee: When Urination Keeps You Up At Night

Who has not dealt with this annoying symptom, having to wake up in the middle of the night to urinate? Ever wondered why? Or maybe you are up all night pondering what you can do about it! Let’s take a look…

The commonest causes can be broadly divided into three groups:

1. Fluid load: anything that increases the amount of fluid your kidney has to filter out ( Elementary, my dear Watson! That wasn’t hard to come by)
   • pregnancy: boy was it any fun when I realized I was waking up every 4 hours with my first pregnancy and then every 2 to 3 hours with the second to urinate, but all for a good cause
   • drinking too much fluids or drinking fluids too close to bedtime
   • diuretic/ water pill use as for heart failure or high blood pressure
   • diuretic in disguise: tea, coffee, beer
   • obstructive sleep apnea: believe it or not
   • varicose veins

2. Bladder causes: anything that restricts the ability of the bladder to fill up, or causes the bladder to be irritable and/or want to squeeze out anything it holds

• urinary tract infection
• overactive bladder which means literally that: the bladder wall is over-active and trying to squeeze frequently as if to empty itself
• anything pushing on the bladder from outside that reduces the space available to fill, and thereby causing to urinate often to empty the normal amount of urine, as from an enlarged uterus (pregnancy, fibroid etc.), enlarged prostate, constipation, etc.
• interstitial cystitis: where the bladder wall has inflammation making it irritable and sometimes painful, the IBS-equivalent of the urinary tract , often stress-induced
• stress

3. Causes beyond the bladder and fluids: systemic illness which require excessive urination to balance electrolytes, sugar etc.

• diabetes mellitus: characterized by elevated blood sugar with excessive thirst, excessive urination and increased hunger
• diabetes insipidus: characterized by elevated blood sugar with often low blood sodium levels and excessive urination
• hormonal: menopause with low estrogen level
• causes that alter the normal diurnal fluid excretion pattern, causing greater urination at night (mainly by increasing production of AVP, a hormone that regulates the body’s fluid balance):
  • Alzheimer’s disease
  • Parkinson’s disease
  • pneumonia
  • stroke
  • medicines like SSRI’s

Now that we know some of the causes, what can we do about it?

Well, the first thing to do would be to identify and treat the underlying cause. Some additional measures may also be helpful:

1. Limit water/ fluid intake after 7 pm to just a few sips only when needed
2. Avoid coffee, tea, alcohol esp beer from afternoon onwards
3. Void the bladder before going to bed
4. Here is a less known hack (shhh…….): I am going to let you in on a little secret – for those with sleep apnea, sleeping with the head end elevated as with a wedge pillow/ putting a couple of thick books under the headboard may help redistribute the fluid and reduce urination at night. This tip is not publicly available easily, but someone close to me tried and tested it and it works, so I would like to share this with you; knowledge is power, my friend!
5. Discuss with your doctor about medications that may be affecting your bladder.

Here’s to a full night’s sleep zzzzzzzzz 🙂