Why do you pee more at night?

The most common cause is poor sleep hygiene triggered by consuming caffeine, alcohol, and excessive fluids too close to bedtime. Other possible factors include circadian dysfunction and medical conditions like bladder storage problems and sleep disorders.

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Somewhere in the middle of the night, your bladder is gripped by a powerful urge to visit the restroom, propelling you from sleep to wakefulness. Otherwise known as nocturia, waking up during the night to pee happens to most people, especially older adults.

But how many times is it normal to urinate at night? Should you get it medically checked out if it’s twice or more? Also, why do you pee so much at night? Is it because you drank too much water before bed, or is something more serious at play?

If you’ve been losing sleep because of the middle-of-the-night awakenings, or over the above questions, this post is for you. Below, we explain what nocturia is, when you should be concerned about it, and the common reasons why you pee so much at night.

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What Is Nocturia?

According to the National Library of Medicine, nocturia is “the need for patients to get up at night on a regular basis to urinate.” To qualify for this phenomenon, sleep must happen before the bathroom trip and recommence afterward. Take note that nocturia isn’t bedwetting (nocturnal enuresis), which the International Continence Society (ICS) defines as “any unintended voiding during night-time sleep.” Another important distinction is that waking up during the night because of factors like loud noises or thirstiness and deciding you might as well relieve yourself isn’t nocturia. Instead, you’re indulging in a “convenience void” as opposed to a true “nocturnal void.” Despite what many people think, nocturia isn’t a medical condition but a symptom of poor sleep hygiene, circadian dysfunction, and other health problems. There are numerous possible causes of nocturia, making it hard to diagnose the root factor, as you’ll see later.

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How Common Is Nocturia?

Because almost everyone wakes up to pee at least once during the night, “nocturia is common across populations,” as mentioned in the Journal of Urology. “It is most prevalent in older people but it also affects a significant proportion of younger individuals.” And science has the statistics to back it up. 11-35.2 percent of young men aged 20-40 years old wake up once or more during the night to use the facilities. Among women of the same age group, the prevalence rate is almost double that (20.4-43.9%). In the older populace, about 68.9-93% of men 70 years old and above get up at least once during sleep to pee. Meanwhile, the prevalence rate of nighttime urination in women is 74.1-77.1%. On the whole, about 16-20% of younger people regularly wake up to pee at least twice every night. In older people, that prevalence rate hikes up to 60%. Women are also more prone to nocturia.

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When Should I Worry About Frequent Urination?

Given that nocturia is an exceedingly common issue, should you worry about it? Well, it depends.

Nocturia Isn’t a Problem for You If…

The RISE app shows your unique sleep need when you go to your Profile. The urge to pee only rouses you about once or twice on most nights and you don’t have any difficulty falling back to sleep after a bathroom visit. In this instance (assuming you’re giving yourself enough time in bed to sleep – and your sleep hygiene is otherwise on point), you probably have no trouble meeting your sleep need (the genetically determined amount of sleep your body needs), which means you likely don’t have much sleep debt. This is the amount of sleep you’ve missed in the past 14 days relative to your sleep need. To feel and function at your best, keep your sleep debt below five hours, which you can track on the Sleep screen in the RISE app. If middle-of-the-night awakenings due to a full bladder aren’t impacting your daytime functioning, there’s no need to get too hung up over the fact that you wake up to pee. As we’ve mentioned, it’s completely normal and happens to many of us. Don’t let it become too much of a concern that hikes up your anxiety levels, ironically causing you to lose sleep when you aren’t actually struggling with sleeplessness induced by nocturia in the first place.

Nocturia Is a Problem for You If…

You frequently wake up with an urgent need to relieve your bladder during sleep. Frequent nighttime urination can be defined as more than twice per night, resulting in excessive sleep fragmentation (waking up during the night). This, in turn, quickly leads to sleep debt. Because nocturia can come from poor sleep hygiene, you probably have trouble falling back asleep (a common symptom of poor sleep hygiene), which further intensifies sleep deprivation. As your nighttime sleep patterns are interrupted, you likely experience excessive daytime sleepiness that prevents you from feeling and functioning at your best. Nocturia also adds another layer of danger in the form of an increased risk of falls and related injuries, particularly if you make a mad dash to the toilet because you can’t hold it in any longer. The disorientation and sleep inertia (wake-up grogginess) from waking up in the middle of the night, dark surroundings, and slippery bathroom tiles in some instances only elevate the hazard of a fall. This is especially so among older adults who likely struggle with mobility problems. It’s estimated that about a quarter of all falls in the older populace happened overnight, and roughly 25% of these injuries can be blamed on nocturia.

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Why Do I Pee So Much at Night?

Understanding when nighttime urination is a cause for concern and its unwanted consequences is only part of the solution. To effectively tackle it, you and your healthcare provider will have to work together to determine the underlying cause(s) for the right treatment options. The possible causes of why you pee so much at night range from behavioral (i.e., poor sleep hygiene) to physiological (read: circadian dysfunction) to medical (translation: various health conditions).

Poor Sleep Hygiene

Sleep hygiene is the upkeep of behaviors that influence the way you sleep. Many of them take place during the day and in the few hours leading up to your bedtime that don’t involve literal snoozing. In the context of frequent nighttime urination, poor sleep hygiene usually takes the form of:

Too much fluid intake in the few hours before your target bedtime.

Consuming certain foods and drinks that act as diuretics increases urine production. For example, caffeinated beverages, alcohol, and salty foods. Take note that caffeine and alcohol not only incite nocturia but also delay your bedtime and fragment your nighttime sleep. Activities that trigger anxiety, depression, and stress have been associated with an overactive bladder. Certain unhealthy sleep behaviors may also contribute to convenience voids that make you think you’re peeing more than usual when in fact you’re waking for other (sleep hygiene-driven) reasons. For instance, ill-timed light exposure at night (particularly blue light) and a sleep environment that’s too hot, noisy, or bright could be why you woke up during the night. And once you’re up, you may feel that you might as well relieve yourself before going back to sleep. It’s also worth noting that poor sleep hygiene can worsen sleep disorders linked to nocturia, namely, insomnia and obstructive sleep apnea (OSA), as you’ll see in later sections.

Age-Related Circadian Dysfunction

Did you know there’s an internal clock that determines how much urine your body produces over a roughly 24-hour period? That's the suprachiasmatic nucleus (SCN) located in the brain’s hypothalamus, also called the master circadian clock. About 20% of this biological clock consists of arginine vasopressin (AVP) producing neurons. AVP, or vasopressin, is an antidiuretic hormone that regulates your body’s fluid balance over a roughly 24-hour period. It retains water and reduces urine output. Research shows that the circadian rhythm of urine production is formed from the age of five. Vasopressin follows a biological rhythm that peaks during the night, correlating with the fact that less pee is passed during sleep than daylight. When comparing young adults to older people, studies show that the latter don’t exhibit this nocturnal rise in vasopressin hormone, signaling age-related circadian dysfunction. As a result, older adults have a higher urine output during nighttime hours than young adults, even though the amount of urine for both groups over 24 hours is relatively the same. What’s more, older men have “two-fold higher plasma AVP levels than older women,” which explains why females are more likely to experience nocturia. Besides that, researchers highlighted that the age-related drop in sleep pressure (aka the sleep homeostatic process) means “older people spend less of their sleep time in the deeper stages of sleep.” In other words, “they are also more likely to be awakened by signals from the stretch receptors in the wall of the bladder that a young adult might sleep through.” Lighter sleep also increases the possibility of middle-of-the-night awakenings due to factors other than the urge to pee. Think a too-hot bedroom, a partner’s snores, and even medical conditions like restless leg syndrome that are more prevalent with old age. Once awakened from sleep, you may decide to visit the bathroom “just in case” before going back to bed.

Nocturnal Polyuria

Per the National Library of Medicine, nocturnal polyuria is the most common cause of nocturia (a prevalence rate of 88%). It’s defined as “nighttime urinary production that is greater than 20% of the total 24-hour urine volume in younger adults or more than 33% in older individuals.” But what causes nocturnal polyuria? Caffeine consumption, alcoholic drinks, and excessive fluid intake before bed are mostly to blame, signaling poor sleep hygiene. Health conditions like congestive heart failure, sleep apnea, and chronic venous insufficiency in the lower body are also linked to nocturnal polyuria. Certain medications like diuretics, antidepressants, and blood pressure-lowering drugs may also instigate nocturnal polyuria by increasing urine production and disrupting sleep. Nocturnal polyuria is also linked to the circadian dysfunction mentioned earlier. As you’ll remember, vasopressin steps up its production during sleep to reduce urine output, increase urinary concentration, and elevate systolic blood pressure. When AVP doesn’t surge at night, you experience nocturnal polyuria that makes you take frequent bathroom trips during what should be your sleeping hours.

Global Polyuria

Global polyuria refers to a continual urine output that takes place throughout the day and night. As another trigger of nocturia, global polyuria is generally linked to excess fluid intake that may be due to underlying conditions like diabetes and estrogen insufficiency.

Bladder Storage Problems

Frequent trips to the toilet that only let out a small amount of urine each time signals a bladder storage problem (urinary retention) and may be why you pee so much at night.

Bladder storage issues could be due to medical conditions such as:

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An enlarged prostate gland in men (benign prostatic hyperplasia)

Urinary tract infections (UTIs)

Bladder infections

Interstitial cystitis (bladder pain syndrome)

Specific forms of cancer like bladder cancer and prostate cancer (in men)

Consuming caffeine, alcohol, and too much fluids close to your bedtime can also impact the frequency and urgency of urination.

Sleep Disorders

Sleep problems themselves may be why you pee so much at night.

Statistics show that nocturia coexists with sleep apnea in about 50% of the affected individuals due to higher-than-normal levels of the diuretic hormone, atrial natriuretic peptide (ANP). This hormone helps sodium and water pass out of the body to reduce blood pressure and volume. In sleep apnea, elevated ANP levels cause more sodium and water to be excreted, which leads to more frequent urination. Insomnia is another common sleep disorder of which excessive peeing is a side effect. Not being able to fall asleep and stay asleep means you’re inclined to do other non-sleeping activities, like visiting the bathroom, which can lead to the illusion of needing to pee so much at night. Other sleep issues like restless leg syndrome and snoring can also fragment your sleep and incite the same scenario.

Peripheral Edema

People with peripheral edema (swelling in the legs) may feel the need to urinate more often when they lie down in bed. The supine position causes excess fluids to flow toward the kidneys and be passed out as pee. There are many underlying causes of swelling in the ankles and feet. It could be a diet high in salt, long hours of standing or sitting still, pregnancy, and poor circulation. Other health conditions like heart failure, liver failure, renal failure, and hypertension are also associated with peripheral edema.

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Should I Cut Down on My Water Intake?

The RISE app shows your Melatonin Window on your Energy Schedule to help you determine when you should stop drinking too much fluids before bed. In an attempt to stop peeing so much at night (if it’s indeed an actual problem), you may resort to limiting your water intake. Unfortunately, doing so will only cause dehydration, which can lead to sleeplessness — the very thing you’re trying to avoid in the first place. Research also indicates that mild dehydration dampens your mood and cognitive performance. Instead of reducing your water intake, practice good sleep hygiene by frontloading the earlier part of your day with enough fluids. Drink as much water (and other healthy liquids) as you can from the moment you wake up until the late afternoon. From there, slow down your fluid intake and cut it off at least two hours before your target bedtime — research shows that stopping fluid consumption one hour before sleep wasn’t enough for people with nocturia. We recommend going to bed within your Melatonin Window, which you can view on your Energy Schedule in the RISE app. This is the period in which your body’s rate of melatonin production (the sleep-promoting hormone) peaks to help you fall asleep and stay asleep more easily. Knowing when your Melatonin Window starts helps you time your daily fluid intake to avoid drinking too much water before bed. Besides avoiding excessive fluid intake, steer clear of diuretic-like substances like caffeine and alcohol at the right times. Because caffeine can stay in your system for up to 10-12 hours, add the “Limit Caffeine” habit to your Energy Schedule in RISE. You’ll get an in-app reminder when to stop drinking caffeine based on your unique chronobiology. The same goes for the “Avoid Late Alcohol” habit, which applies to alcoholic beverages. P.S. If you'd like to find out how to effectively time caffeine consumption or even cut caffeine out of your life, check out our post on “Energy without Caffeine.”

Don’t Let Nighttime Urination Interrupt Your Sleep

For many people, waking up to pee once or twice during the night is normal. As long as you don’t rack up too much sleep debt and feel excessively tired during the day, nocturia likely isn’t something you should lose sleep over. On the other hand, if you are indeed waking up regularly to urinate and find yourself sleep-deprived over it, it’s time to pinpoint the underlying causes. Poor sleep hygiene like drinking too much water before bed is usually the reason why you pee so much at night. Coupled with age-related circadian dysfunction and other underlying causes like nocturnal polyuria and bladder storage problems, nocturia can threaten your sleep and daytime energy levels. Whether or not you need to see a licensed healthcare professional like a urologist, you can stop peeing so much and start getting enough sleep with the RISE app. Thanks to its 20+ science-backed habits, RISE helps you bolster your sleep hygiene to make sure you’re sleeping when you need to and have energy during the day.

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Get more of your sleep questions answered:

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risescience.com - Why Do I Pee So Much at Night? Should I Be Worried? - Rise Science

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