Why Am I Waking Up So Much to Pee?

You’re in the middle of an amazing dream, walking through a peaceful field. Birds are singing and the sun is shining. You approach a waterfall and dare to touch it — when you jolt awake from the dream with the strongest urge to pee for the second (or third) time that night. 

Waking up in the middle of the night to pee is common and completely normal if it’s only once a night. But when your body wakes you from dream after dream to groggily walk to the bathroom, it may be a condition called nocturia.  

What is nocturia? 

Nocturia is the term for waking during bedtime hours to pee. And while waking up to pee during the night is not something to be worried about, doing so two or more times each night is worth investigating.  

For those with nocturia, the condition is more than just bothersome — it negatively impacts quality of life.  

“Each episode of nocturia is preceded and followed by sleep,” says Dr. Sandra Hadjinian, a urologist at the Urology Clinic at UW Medical Center – Northwest. “It’s a misconception that nothing can be done about it, and that it’s normal to get up more than once a night.” 

Causes of nocturia

To understand how to treat nocturia, it’s important to understand the different causes.  

Habits and behaviors 

First, unfortunately, your behavior and lifestyle might be contributing to your episodes of nocturia. This isn’t to say you’re doing anything wrong, just that you might need to do things a little differently to help your body stay asleep at night instead of bothering you for a bathroom break. 

Typically, these changes surround diet and fluid intake.  

“Consuming too much fluid, in general, as well as drinking close to bedtime, can cause nocturia episodes,” says Hadjinian. “The type of fluid can cause nocturia, too, such as caffeine and alcohol.” 

Other dietary factors like a high sodium diet can also cause nocturia, Hadjinian says. Basically, when you have a lot of salt, your kidneys have to do some extra work to flush it out, resulting in increased urine production. Being mindful of your sodium intake could help with that. 

Sleep disorders 

Having a sleep disorder isn’t something that you can always control. Especially if left untreated, the inconsistency in sleep patterns that can come with some sleep disorders can also nudge you awake with the urge to pee. 

“Sleep apnea, insomnia and other conditions that cause sleep disturbances can lead to nocturia,” says Hadjinian. “Some people wake up feeling the need to empty their bladder but are actually awakened by a sleep disturbance.” 

Medications 

Certain medications, especially diuretics (medications that increase the production of urine) are sometimes the culprit of nocturia. 

For example, medications like beta-blockers, lithium, some allergy medications, irritable bowel syndrome treatments and asthma medications can help you feel better during the day but might wake you up a few times at night. As always, don’t stop taking your meds, but if the constant waking up has you at your limit, talk to your doctor about it at your next follow-up. 

Health conditions 

Hadjinian says that health conditions such as diabetes, anxiety, cardiovascular disease, urinary retention, pelvic organ prolapse, restless leg syndrome and edema can cause nocturia. If you have these conditions, it’s not guaranteed you’ll have a midnight bathroom rendezvous, but it is something to keep in mind. 

And while age isn’t a health condition, Hadjinian says that age can increase the likelihood of nocturia. In fact, about half of adults between 50-79 have nocturia.  

Changes in hormone levels that happen with aging can also impact the body’s nighttime urine volume, causing the need to pee after bedtime. For example, decreased estrogen levels that can be experienced in menopause or post-menopause can lead to increased urination. Genetic conditions or autoimmune conditions can also be a contributing factor. 

How to prevent nocturia 

Hadjinian gives us a few suggestions on how to limit getting up to pee and improve your chances of sleeping through the night:  

• Stay hydrated during the day and restrict fluid intake leading up to the evening and nighttime hours.  
• Reduce your sodium intake. 
• Try to avoid medications that make you pee more at night, if they’re not medically necessary. 
• Make sure to pee before bedtime. 
• Try to keep bedtimes and wake-up times as consistent as possible. 
• If you’re experiencing a hormone imbalance, work with your doctor to see if diet changes, lifestyle changes or hormone therapy could help.  

Most importantly, make sure to listen to your body. If anything feels off, it might be a sign to see your doctor. 

Tackling the symptoms  

“Any sudden or acute changes in urinary habits, feeling like you can’t completely empty your bladder after urinating and any other obstructive urinary symptoms could indicate that it’s time to see your doctor,” says Hadjinian. “These could be symptoms like having to wait before the stream starts despite the urge to urinate, a stream that starts and stops, urinary incontinence, painful urination or blood in the urine.” 

And if your symptoms of nocturia are impacting your quality of life, know that your doctors are ready and waiting to help. Hadjinian says to reach out to a urologist — or have your primary care doctor refer you to one — so they can conduct a full evaluation and help determine the most effective treatment options for you. 

A sleep study is another option that your doctor might suggest to rule out any underlying sleep apnea, which can contribute to nocturia. Finally, you and your doctor can also talk about treatment methods or medical management, if needed, after your evaluation. 

It’s time to get a good night’s rest and return to your dreams — you might even be able to chase some waterfalls without the current waking you up.