Up to 80 per cent of people who complain of a disturbed night's sleep report that incontinence is the main reason they wake up in the middle of the night. Consultant urologist Stephen Mattocks tells Jennifer Grech about the importance of raising awareness about nocturia.

From wrinkles to mobility issues, ageing manifests itself in many visible signs. However, there are other issues such as isolation which, although too real, are hidden away. Others, such as insomnia and incontinence, are invisible because they are suffered in silence, in shame, and in the middle of the night.

Nocturia, or frequent urination at night-time, is a common but poorly reported and largely misunderstood urological disorder in adults. Although many people wake up during the night to urinate, the condition has received little attention in medical literature, and definitions vary widely.

Friday was World Sleep Day, an annual event to raise awareness of sleep disorders and the burden that they place on society. Initiated by the World Association of Sleep Medicine (WASM), the day acknowledges the importance of a good night’s sleep and the impact of sleep on health and quality of life.

Nocturia is one of the most distressing symptoms in older men with benign prostatic hyperplasia. Photo: Shutterstock

Sleep problems constitute a global epidemic that threatens health and quality of life for up to 45 per cent of the world’s population. Despite this widespread issue, much of the public may be ignoring key triggers for disturbed sleep – with nocturia being the most common cause for interrupted sleep.

This continued disturbance has a significant negative impact on our health in both the long and short term and can also be a symptom of serious health problems such as diabetes, high blood pressure or cardiovascular disease.

“The causes of nocturia are varied and it is paramount to try to identify the cause before attempting treatment,” says consultant urologist Stephen Mattocks.

He says nocturia is not just isolated to a particular demographic: up to 50 per cent of elderly men and women display symptoms of nocturia, but it can affect all ages as 15 per cent of people over the age of 30 make at least two trips to empty their bladder every night.

The impact on the quality of life and the association with morbidity makes this a priority to diagnose and treat. Mr Mattocks believes nocturia is a serious issue that should not go ignored.

Nocturia can be caused by an overproduction of urine at night or an overproduction of urine during the daytime and night-time, which leads to having to get up in the night to empty the bladder.

In the very old, nocturia is associated with higher rates of accidental falls and fractures

“Patients report nocturia as a leading cause of sleep disturbance, affecting both sleep onset and maintenance. Nocturia is associated with increased rates of depression, work absenteeism, lower self-rated physical and mental health, congestive heart failure, and increased all-cause mortality,” explains Mr Mattocks.

“Before talking about causes, we must talk about what normally happens when we go to sleep. Urine is produced by the body all the time at a rate of about one to 1.5mls per minute. This obviously varies with the quantity and quality of fluids that are consumed.”

“During the day and night the body releases a hormone called antidiuretic hormone (ADH) which acts on the kidneys to slow down urine production. With ageing, the level of ADH production is reduced and the kidneys response to circulating levels of the hormone decreases, resulting in an increase in urine production and consequently a larger volume of fluid is sent down into the urinary bladder, so in effect there is also an element of polyuria, an increase in urine volume production.

“Apart from this, the ageing bladder is more sensitive to filling and sends the brain increasing signals that it needs to empty,” adds Mr Mattocks.

“There are also lifestyle factors that may cause or aggravate nocturia, like alcohol consumption, drinking before bedtime, and excess tea and coffee drinking.

“Diuretic medication taken at the wrong time can also cause nocturia.

“Nocturia is a source of significant bother for some patients. Nocturia is one of the most distressing symptoms in older men with benign prostatic hyperplasia and is the lower urinary tract symptom most strongly associated with poor quality of life ratings.”

Often nocturia first occurs about two or three hours after sleep begins, during a period of slow wave sleep.

“Frequent night-time awakenings likely indicate that those being affected are not getting sufficient deep sleep, resulting in impairments in memory, attention, coordination, and balance – all of which are related to increased incidence of falling,” says Mr Mattocks.

In the very old, nocturia is associated with higher rates of accidental falls and fractures.

While it can affect anyone regardless of age or gender, the good news is that nocturia is treatable. Anyone who is losing sleep over these symptoms is encouraged to speak to his doctor. There is no need to suffer in silence.