For people with overactive bladder, many aspects of day-to-day life can be interrupted. And unfortunately, overactive bladder doesn't usually take a break when a patient lies down in bed.
Some patients may have difficulties getting a full and restful night’s sleep due to their symptoms. And not getting a full night’s sleep can be associated with a variety of negative physical and mental results.
Thankfully, there are ways patients can work with doctors to attempt to ease their nightly bladder problems.
The Nocturia Problem
When people need to urinate at least twice during the night, it is called nocturia.
Nocturia can be related to overactive bladder, and it can also be a separate condition in its own right. Regardless of what other conditions coexist, waking several times a night to visit the bathroom can be be a serious issue for patients.
Nocturia is more common among older people, a fact which carries risks of its own.
In an interview with dailyRx News, Sophie Fletcher, MD, Director of Research at the Methodist Center for Restorative Pelvic Medicine in Houston, Texas, highlighted the additional concerns present for these patients.
"Many elderly patients suffer falls from getting up throughout the night," said Dr. Fletcher. "Elderly patients who wake twice a night are at significantly higher risks for a fall, and the risk rises as nocturia episodes rise. This places already at-risk patients at further risk for fractures."
Overactive bladder in general is more common among older people, partially because as the body ages, contributing disorders that can interrupt bladder function become more common.
Regardless of age, when a person wakes several times a night, their sleep cycles may be disrupted and they may have problems feeling alert or awake during the day.
According to Mayo Clinic, any overactive bladder or bladder control issues can affect a patient's quality of life and harm their overall well-being. The organization reports that alongside sleep disturbances, depression and emotional distress can also occur.
Changes Patients Can Make
According to the National Association For Continence (NAFC), there are several lifestyle or “behavioral therapy” methods that patients can pick up to try and reduce the number of times they need to rise during the night.
For one, taking note of how much they are drinking as the day wears on is a simple way to make a difference.
“Limiting the intake of fluids in the evening results in a decreased amount of urine produced in the late evening into the night,” reports NAFC.
Taking special care with caffeinated beverages or alcohol can also help, as these beverages are notorious for interrupting sleep.
However, the Cleveland Clinic, a non-profit academic medical center based in Ohio, stresses that patients should not go too far in the other direction. It is still crucial that everyone drink plenty of “non-irritating” fluids.
“People with bladder symptoms often drink fewer liquids so they don't have to urinate as often,” reports the organization. “You should regularly drink about three to four glasses of liquids per day. Try to spread them out as evenly as possible throughout the day.”
The Cleveland Clinic says that drinking too few fluids causes production of highly concentrated urine, which can actually be irritating to the bladder and may itself cause frequent urination.
Some patients find it helpful to schedule time for afternoon naps when having trouble sleeping through the night. Keeping time for a little extra rest during the day can help make up for the sleep lost at night.
According to NAFC, some patients may benefit from a combination of multiple behavioral treatments, while for others, making just one change can make a big difference in their nocturia.
However, Dr. Fletcher stresses the importance in obtaining a proper diagnosis before effectively easing nocturia symptoms.
According to Dr. Fletcher, nocturia can sometimes be related to bladder obstruction from an enlarged prostate in men, bladder prolapse or "fallen bladder" in women, sleep apnea, a change in daily urine production in elderly patients or other factors.
"The treatments for each of these examples is different," said Dr. Fletcher. "Therefore, nocturia is one condition where a definitive diagnosis is needed before treatment."
Several of these examples in particular and overactive bladder in general become more common as the body ages. And according to the Mayo Clinic, as the risk for problems like diabetes and cognitive decline (potentially after strokes or alongside Alzheimer's disease) increase, so does the risk for incontinence. These disorders have the potential to disrupt bladder function.
For this reason, older patients should be particularly active in noticing changes in bladder function and discussing them with their doctor.
The Mayo Clinic does take care to note that "Although common among older adults, an overactive bladder isn't considered a normal part of aging." Doctors can help identify and diagnose potential problems.
Keeping a Diary
Before visiting the doctor, it is a good idea for patients to keep a diary in the several days leading up to the appointment.
By recording details about their overactive bladder and/or their nocturia, patients can better provide doctors with specific facts about their symptoms.
It is probably best to record too much detail as opposed to too little in these situations. Mayo Clinic recommends recording “when, how much and what kind of fluids you consume, when you urinate, whether you feel an urge to urinate and whether you experience incontinence.”
NAFC also suggests thinking about the number of times patients wake to urinate during the night and when, how much urine is expelled, drinking patterns, what type of drinks are consumed, medications taken, any recent or recurrent urinary tract infections or any other symptoms or factors that come to mind.
“Your diary may reveal patterns that help your doctor understand your symptoms and identify contributing factors,” reports the Mayo Clinic.
According to Dr. Fletcher, "A 'voiding diary' or 'bladder diary' is extremely helpful for a physician evaluating nocturia. Usually, it is the first tool a urologist will use to evaluate the situation."
"Sometimes nocturia can be related to something as simple as a high consumption of caffeinated beverages around dinner time. Other times, the patient may be experiencing a shift in their daily pattern of urine production," said Dr. Fletcher. "The diary will demonstrate what’s going on, and help the urologist target further testing to confirm the diagnosis."
By being proactive in keeping a diary, visiting a doctor for an accurate diagnosis and trying changes at home, patients and doctors can work together to help stop the bladder from interrupting a good night’s sleep.