Toilet Trips Unfriendly to Sleep

Nocturia with insomnia linked to increased wakefulness and being less rested

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) When the toilet calls in the middle of the night, it can be difficult to go back to sleep. It can be especially difficult for older adults with insomnia.

Frequent bathroom trips caused more than half of the unnecessary wake up calls at night among older insomniacs, according to a new study.

Nocturia, or the urge to urinate in the middle of the night, is common among older adults with insomnia, according to the researchers. The condition is linked with decreased restfulness and increased wakefulness.

"Go to the bathroom before bed."

Jamie Zeitzer, PhD, from the Department of Psychiatry at Stanford University, and colleagues investigated whether frequent trips to the bathroom at night impacted sleep patterns in older adults with insomnia.

Nocturia is characterized by frequent nightly bathroom trips because of greater urine production during the day and night. The condition is linked with chronic urinary tract infections, prostate conditions in men, diabetes, heart failure, obstructive sleep apnea and other sleep disorders as well as a number of other conditions. 

The study included more than 140 participants who were about 63 years old on average. All had insomnia and more than half were women.

Participants logged their sleeping patterns for two weeks, including the time they went to bed and woke up, how rested they felt and how often they woke up in the middle of the night.

The logs also tracked how long it took participants to fall asleep and the number of times they woke up specifically to go to the bathroom. 

During a third week, researchers observed participants' rest and activity cycles in a process called actigraphy.

Researchers found that about 54 percent of all nocturnal awakenings logged by participants were linked to nocturia. 

As participants made more nightly trips to the bathroom, they also slept less efficiently and reported feeling only moderately rested. On average, they scored about 3.8 out of 7 in restfulness.

In addition, the researchers found that numerous trips to the bathroom also affected whether participants woke up after falling asleep, the number of times participants woke up and how long they were awake as measured through the actigraph.

The time participants stayed awake after a nighttime bathroom trip was about 12 percent longer on average as measured by the actigraph compared to waking up for other reasons. Some stayed awake up to 24.5 percent longer because of nocturia.

On average, waking time after sleep onset was almost 21 percent longer during the nights that participants woke up to go to the bathroom. Waking up during the night for the bathroom did not effect total sleep time.

"Nocturia appears to worsen the already poor sleep of individuals with insomnia, perhaps by providing a stimulus for waking which is then often accompanied with turning on the lights (further decreasing sleepiness) and an opportunity for a lengthy awakening," researchers wrote in their report.

"The ultimate question remains whether the urge or need for urination causes the awakening, or after awakening due to another cause, an individual then feels the urge or need to urinate," they wrote.

Researchers noted they weren't able to show which of the awakenings were linked with bathroom trips.

They also noted that actigraphy is not as accurate as polysomnography, another kind of sleep study, in measuring how long participants were awake at night.

The study was published March 15 in the Journal of Clinical Sleep Medicine.

The Medical Research Service of the Veterans Affairs Palo Alto Health Care System and the Department of Veterans Affairs Sierra-Pacific Mental Illness Research, Education, and Clinical Center funded the study.

One of the authors is a private investigator for Vanda Pharmaceuticals. Another was a consultant for Ferring Pharmaceuticals. No other conflicts of interest were reported.

Reviewed by: 
Review Date: 
March 25, 2013
Last Updated:
December 31, 2013