Common Causes of Waking to Urinate at Night

Man awake sitting up on edge of bed at night
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If you wake during the night to pee, you may be interested in learning about the common causes of this occurrence. What is nocturia? What are some of the potential causes? Why is it more common as we get older? Discover the potential roles of diabetes, obstructive sleep apnea, and prostate or bladder problems in waking to urinate at night.


Nocturia is defined as the excessive need to get up and urinate during the night. You may find yourself using the bathroom several times per night and this can be disruptive to your sleep. It is generally considered to be abnormal to wake to urinate when it occurs more than once at night. It is different from enuresis (or bedwetting), which more commonly occurs in children.


There are a handful of frequent causes of nocturia. The most common may be drinking too much water or other fluids (especially caffeine or alcohol) too close to bedtime. Reducing fluid intake after dinner may help to reduce this contribution.

Normally our bodies are able to concentrate our urine and allow us to sleep through the night without getting up, but as we get older this may not work as well. In addition, older men may have nocturia as the result of retaining urine due to benign prostatic hyperplasia (BPH). Women may experience bladder weakness and other urological problems.

Inflammation or infection of the bladder or urinary tract may lead to increased urination overnight. Other major medical problems also may contribute, including:

  • Diabetes
  • Chronic renal (kidney) failure
  • Congestive heart failure
  • Hypercalcemia (high blood calcium level)

There are a number of medications that may cause nocturia. The most common are the diuretic medications that are used to treat high blood pressure or peripheral edema (swelling in the feet and ankles). One example would be Lasix (furosemide). Others medications that might cause nocturia include the following:

  • Demeclocycline
  • Lithium
  • Methoxyflurane
  • Phenytoin
  • Propoxyphene

Finally, there are some sleep disorders that might also cause nocturia. Obstructive sleep apnea is well known to contribute to frequent nighttime urination. This may be because sleep apnea results in light sleep, leading to an awareness of bladder fullness. In addition, the strain of sleep apnea leads to the heart signaling the kidneys to dump fluids, as it experiences stretch from negative intra-thoracic pressure, similar to what occurs in a volume overload state. The hormone signal from the heart leads to small amounts of urine being produced by the kidneys, prompting frequent peeing at night.

Treatment of sleep apnea often greatly reduces the frequency of nocturia.

The Role of Benign Prostatic Hypertrophy (BPH) in Men

Benign prostatic hypertrophy (BPH) is a very common cause of nocturia in older men and refers to a non-cancerous, or benign, condition where the prostate gland, which surrounds the urethra or pee tube, becomes enlarged and thus obstructs the flow of urine. Concomitantly, the bladder wall also thickens, which makes it harder for you to void urine correctly.

Among men older than 50, BPH is the most common disease of the prostate. According to the NIH in 2010, an estimated 14 million Americans had symptoms suggestive of BPH. This condition affects about half of all men aged between 51 and 60. Furthermore, this condition affects about 90 percent of men aged 80 or more.

If symptoms solely occur at night, consider the role of sleep apnea before blaming prostate enlargement. There are different ways that BPH can be treated, including surgery and medication. Some people who can tolerate symptoms of BPH may decide to postpone treatment after speaking with their physician.

If you think that you have BPH based on symptoms that you're experiencing, you should make an appointment with your physician to discuss diagnosis and management.

Getting Help

If you have trouble waking too often during the night to pee, you may want to speak with your physician to investigate what the underlying cause might be for you. Strongly consider the role of undiagnosed sleep apnea and, if present, pursue treatment as it may help to avoid unnecessary surgery or medications.

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Article Sources

  • Dugdale, DC. "Urination – excessive at night." MedlinePlus, National Institutes of Health.
  • Kryger MH, et al. “Principles and Practice of Sleep Medicine.” Elsevier, 6th edition, 2016.