For World Sleep Day, our Children’s Specialist Nurse, Davina Richardson, has written a blog on nocturia and why it is important to get a good night’s sleep.

All humans need to sleep. Good sleep is as important for overall health and wellbeing as a balanced diet and getting sufficient exercise. It helps us to function better during the day by improving our thinking and learning ability as well as concentration; it improves our ability to socialise; it increases our ability to be more effective when exercising; it helps improve mood and reduces anxiety; it helps supporting the immune system, so reducing the likelihood of catching colds; it also reduces the likelihood of accidents.

For older people good sleep makes falling less likely. For children good sleep may improve behaviour, reduce overactivity and improve school performance.

Many people have difficulties with sleep and there are lots of different causes for sleep problems. These can include work or family commitments, such as shift working, working long hours or being a care giver. Other factors such as lifestyle choices, or not leaving enough time for sleep may cause problems. However, for many adults and children, medical conditions can interfere with sleep, including conditions that affect the kidneys and bladder.

What is Nocturia?

Nocturia is the medical term for having to wake at night to empty your bladder. It is considered normal to have to wake once a night to use the toilet in both adults and children. However, waking more often than this, due to bladder difficulties can disrupt sleep, not just for the person affected, but also for other members of the household.  Nocturia is a common medical condition.

Nocturia can be caused by many different issues. Some, such as drinking too much later in the evening, or having too many caffeinated drinks throughout the day, may be easy to solve. Others are more difficult to address and may need the support of a healthcare professional for both assessment and treatment.

One cause of nocturia is the kidneys producing more urine than they should at night.  Other than drinking more than the body needs, and having alcohol or caffeine before bedtime, reasons for making too much urine at night include:

• Untreated diabetes. Excessive sugar in the blood stream will result in sugar passing through the kidneys into the urine. The sugar going into the urine will take extra water with it, so increasing urine output
• Fluid retention during the day. This often accumulates in the legs and feet.  When the affected person lies down to sleep at night, the extra fluid is more able to re-enter the person’s veins and be removed by the kidneys, increasing urine production while they are in bed. Putting the feet up on a stool in the evening may help
• Sleep apnoea. This is the term given to people whose breathing stops and starts when they are asleep. It may also be associated with snoring and needs further assessment
• Taking certain medications. Some medicines, including diuretics (water tablets) increase urine production
• Having a large protein or salt intake in food later in the evening results in the kidneys making more urine
• Reduced hormone secretion. The body produces a hormone at night (vasopressin) that helps the kidneys reduce urine production.  Reduced levels of vasopressin is associated with bedwetting in children. However, natural production of vasopressin reduces with age and may be a cause of nocturia, particularly in older people

Another cause of nocturia is having a bladder that is not able to hold as much urine as it should. Therefore, the bladder fills more quickly. If this happens then the person may have nocturia, even if the kidneys are not making too much urine overnight.

Other issues include:

• A problem with how well the bladder holds onto the urine as it is produced, with the bladder wanting to empty before it is full. These problems include overactive bladder, urinary tract infections, pain or inflammation in the bladder. Rarely bladder cancer may also make the bladder signal that it wants to empty earlier than it should.
• A bladder problem that makes it difficult to empty completely when the person goes to the toilet, so there is often or always some urine left behind. These problems for men include benign prostatic hyperplasia – a condition where the prostate becomes enlarged and obstructs the urine flow, but may also be linked to prostate cancer.

Nocturia is also associated with obesity, stroke, Parkinson’s Disease and hypertension (raised blood pressure).

Nocturia is recognised by healthcare professionals as causing significant disruption to sleep, often for the affected person’s family as well as for the individual, with a knock-on negative effect on daytime functioning, quality of life and long-term health and wellbeing. It can affect anyone of any age, including the elderly, children and young people. It can be an early symptom for some medical conditions. It may be that simple lifestyle changes are sufficient to reduce or solve the problem.

Nocturia is different from nocturnal enuresis. This is because with nocturia the person wakes to use the toilet. With nocturnal enuresis urine is passed during sleep. Nocturnal enuresis can affect anyone of any age but is more common in childhood.  Treatment is available for all ages.

If waking more than once a night to use the toilet, or if wetting during sleep is causing you concern, consult your healthcare professional (GP, practice nurse, or for children school nurse) and ask for advice and support. Make World Sleep Day 2021 the day you start to address the problem if you or someone you love is having sleep disrupted by having to go to the toilet more than once during sleep.

Bladder & Bowel UK provide information on bladder and bowel conditions for people of all ages on their website at www.bbuk.org.uk. To receive the Bladder & Bowel UK free quarterly electronic newsletter for the public, which is full of interesting articles, suggestions and information for people affected by bladder and bowel conditions, fill in the form on the ‘contact our helpline’ link on the Bladder & Bowel UK website at https://www.bbuk.org.uk/ and ask to be added to the mailing list.

To contact our confidential helpline, fill in the form at https://www.bbuk.org.uk/

For more information about bladder conditions in children visit the Bladder & Bowel UK website at https://www.bbuk.org.uk/bladder-resources/