If you have urinary incontinence or nocturia (a frequent need to use the bathroom at night), you probably already know too well how bladder control problems can ruin a good night’s sleep. But could your sleep issues actually be causing those problems?
“It’s been shown that many people who have incontinence or urinary urgency during the day or night have a high incidence of obstructive sleep apnea,” says Steven Y. Park, MD, an assistant professor of otolaryngology at the Albert Einstein College of Medicine in Bronx, N.Y., and author of Sleep, Interrupted: A Physician Reveals the #1 Reason Why So Many of Us Are Sick and Tired. “Undergoing an apnea [event] prevents blood from reaching the heart. When you start breathing again, the blood rushes back into the heart and the heart chambers dilate, which causes the heart to think that you’re overloaded with fluid. This leads to the creation of atrial natriuretic hormone, which causes the kidneys to produce more urine.” And more urine means more trips to the bathroom.
Incontinence, Sleep, and Your Overall Health
People often wake up at intervals from 90 minutes to two hours, or the length of one sleep cycle. When you reach the deep sleep phase, muscles relax, breathing stops, and then you wake up and feel like you need to go to the bathroom. In addition, a large number of awakenings and lack of deep sleep can irritate the bladder and lead to earlier sensations of needing to void, according to Dr. Park.
However, that’s not to say that everyone who has bladder control issues at night has sleep apnea, or that sleeplessness is necessarily causing incontinence. “Many patients have primary urinary tract pathology, such as an overactive bladder in women and an enlarged prostate in men, that may actually cause the sleep disturbance,” says Kevin Bigelow, MD, a board certified urologist at Ironwood Physicians' Center for Urological Services in Phoenix.
Having a heart condition can also be a complicating factor. When you lie down at night, additional fluid may return to the heart and kidneys, resulting in more urine production. Medications such as diuretics often used to help heart issues can cause an increased urge to go to the bathroom more frequently, too, as can conditions such as diabetes, high blood pressure, and vascular disease.
Putting Sleeplessness to Rest
Fortunately, there are ways to help decrease interrupted sleep and nighttime urinary output and get a better night’s rest:
- Rule out other medical causes. Have your doctor check for any possible underlying conditions that could be contributing to increased urination at night. Also rule out infection. “There can be worsening of incontinence or frequency when someone has a bladder infection,” says John Kowalczyk, DO, a board-certified urologist at St. Vincent Medical Center in Los Angeles. This can be determined by a simple urine test.
- Avoid drinking too much before bed. If possible, stop all liquids one to two hours before bedtime and avoid all caffeine in the evening. Watch out for large salads eaten in the evening, too — they contain a good deal of liquid.
- Try to reduce fluid build-up. “Afternoon naps, elevation of the legs, and compression stockings may reduce fluid build-up and help alleviate waking during the night to void,” says Elaine McInnis, a health educator at the National Association for Continence in Charleston, S.C.
- Beware of alcohol. Alcohol acts as a diuretic and can cause more frequent urination.
- Evaluate your medications. Some prescriptions, such as antidepressants, can cause the bladder to not fully empty. Others, like diuretics, increase frequency. In the case of diuretics, check with your doctor to see if it’s possible to take them in the morning to lessen their impact.
- Go frequently before bed. “Some patients may need to urinate twice before they go to bed — they may not empty their bladder well the first time,” says Michael Safir, MD, a board-certified dual fellowship trained urologist from Mission Community Hospital in Panorama City, Calif.