Addressing Nocturia: Why Patients Wake All Night

The complaint “I am up all night” is commonly voiced by patients, often indicating nocturia—waking more than twice per night to urinate. While it may feel like a full night without sleep, this typically means frequent awakenings due to urinary urgency. The critical first questions for clinicians are: “How many times do you wake at night to urinate?” and “How much does this bother you?” A thorough patient history is essential, as nocturia can stem from a variety of underlying causes.

Medications like diuretics taken in the evening may increase nighttime urine production. Other contributing factors include comorbidities such as congestive heart failure, menopause (often paired with insomnia), obstructive sleep apnea, restless leg syndrome, hypertension, obesity, and uncontrolled hyperglycemia from diabetes. Evaluating daytime bladder capacity and diuresis patterns is also important.

Bower and colleagues recommend asking targeted follow-up questions and utilizing the “TANGO” screening questionnaire to identify comorbid conditions linked to nocturia. These include heart, sleep, metabolic, and hormonal disorders.

The development of approved medications for nocturia, such as Noctiva, provides physicians with greater confidence in offering effective treatment. Addressing nocturia not only improves sleep but also enhances overall quality of life, particularly in older adults who are disproportionately affected. This multi-factorial symptom requires individualized assessment and treatment, underscoring the importance of a detailed clinical evaluation to determine the most appropriate intervention.

Newman, D. (2018, December 11). Chief Complaint: “I Am Up All Night” – How should you respond. UroToday: Center of Excellence, Bladder Health. Retrieved from https://www.urotoday.com/center-of-excellence/bladder-health/109029-chief-complaint-i-am-up-all-night-how-should-you-respond.html