Stop obsessing over how much water you’re drinking and cut the caffeine — Claire Cohen on how to avoid those disruptive loo trips.

One minute you’re sleeping soundly, the next you’re awake and … oh,
surely not? You need the loo.

It’s a nuisance but for 8.6 million Britons, nocturia — the medical term for needing to pass urine during the night — is a real issue, with getting up twice or more considered to be abnormal. The condition typically occurs in older men, with 69 to 93 per cent of those aged over 70 getting up to pee — though a study involving 30,000 adults from the UK, US and Sweden found that 76 per cent of women over 40 were also living with it. Some medics have reported a rise in younger patients, with nocturia now affecting 20 to 44 per cent of men aged between 20 and 40.

“It can start at any time,” says Marcus Drake, professor of neurological urology at Imperial College London, who attributes the number of younger sufferers to more reporting of the condition, especially if it leads to poor sleep, a modern obsession.

The urological surgeon Daniela Andrich, honorary lecturer at University College London, thinks health-consciousness among the social media generation might itself be contributing to nocturia.

“They are sensitive towards their bodily functions and that can create more anxiety than in previous generations,” she says. “If you’re anxious, the pelvic floor can tense up and that can directly impact on how well the bladder works.”

The good news is night-time toilet breaks aren’t necessarily a sign of something sinister. One simple cause is how much water we’re drinking — too much, say the experts, thanks to the wellness industry’s H₂O obsession. Drake regularly sees patients worried because they’re “only” drinking four litres a day and then wondering why they’re getting up at night. “The body needs about one litre a day to function satisfactorily, so if you’re drinking four litres that means your body makes more urine.”

We’re also hydrating at the wrong times. “If you have a busy day you can forget to drink, end up dehydrated and then catch up in the evening. So your bladder will get full right before sleep,” Andrich says.

Coffee is a bladder stimulant and alcohol has an impact too. “Drinking a lot of beer in the evening can disrupt how your body processes sugar, with the result that your kidneys don’t function as well and make more urine overnight instead of slowing down,” Drake says.

Screens could also partly be to blame. A recent study found that people who watch more than five hours of television or videos each day are 48 per cent more likely to urinate at night. The link is unclear, but researchers suggested the sedentary habit “escalates the risk of obesity and diabetes, both of which are established risk factors for nocturia”.

Sitting for too long can also alter the body’s circadian rhythm and cause it to produce normal amounts of urine in the day — the average person goes 4-6 times — but large volumes at night, a condition called “nocturnal polyuria”.

“A healthy lifestyle is a good protector against nocturia,” Drake says. “Cardio fitness is particularly important because if your blood pressure is slightly off, your kidneys try to reduce the amount of fluid in your blood vessels by making more urine.”

For women over 40, the cause may be hormonal. The loss of oestrogen associated with perimenopause and menopause can make the bladder more sensitive as it starts to fill and send a stronger message to the brain that you need to go.

When should you worry? Nocturia, especially if accompanied by snoring, may be a sign of obstructive sleep apnoea, a condition where your breathing stops and starts while you sleep. “It causes people to generate more urine at night because pressure changes in the chest influence the hormones that regulate how your kidneys function,” says the neurologist and sleep expert Dr Guy Leschziner. This fools them into thinking there’s excess fluid in the body that needs expelling.

Nocturia can also be associated with hypertension, type 2 diabetes, kidney disease and even heart disease.

If you’re worried, Dr Andrich suggests monitoring the flow of urine. Does your bladder feel empty? Is it very slow? Is there blood?

Drake advises recognising what’s normal for you. “A sudden change that gets substantially worse over a couple of weeks should trigger you to see the doctor, unless there’s an obvious explanation. But if you’re sporadically waking once a night and it’s been like that for a while? It’s probably not anything too serious.”

Five tips to stop nocturia ruining your sleep

1. Stop fluid-loading

Avoid fluids for at least three hours before bed, and don’t keep a glass of water on your bedside table.

2. Cut the caffeine

Try not to drink coffee after breakfast. Instead choose antioxidant-rich hibiscus tea.

3. Fancy a nightcap?

Don’t overdo it. Alcohol, a diuretic, causes the body to remove fluids from the blood more quickly. That’s why you’re up peeing at night and dehydrated come morning.

4. Reduce your screen time

The link between watching TV and nocturia might not be clear, but there’s no doubt that being sedentary is bad for you. Exercise regularly and avoid eating ultra-processed food.

5. Practise sleep hygiene

If you do get up to go, don’t turn the light on for long, don’t look at your phone and keep your bedroom cool. The optimum temperature for sleep is 16-18C.

Written by: Claire Cohen

© The Times of London