Men who wake up multiple times every night to urinate may be suffering from a curable breathing condition rather than an enlarged prostate, according to general practitioner, author, and broadcaster Dr Philippa Kaye.
Writing on male health, Dr Kaye highlighted the case of a patient named Ken, who was urged to visit her clinic by his exhausted wife after his nightly trips to the bathroom increased from once a night to four, five, or six times. Ken had remained unconcerned about the frequent waking, assuming it was an inevitable part of getting older caused by his prostate gland.
Blaming the prostate is an explanation Dr Kaye encounters on a daily basis from men over the age of 50. The prostate is a small gland that produces fluid that makes up part of semen, and it naturally enlarges as men age, often causing bladder issues. However, Dr Kaye warned that this assumption is so deeply ingrained that patients and their doctors frequently fail to consider other potential causes.
Medical professionals refer to the need to wake at night to urinate as nocturia. While waking once during the night is generally considered acceptable, waking more frequently is a symptom rather than a diagnosis and should be investigated. In some cases, nocturia can be a sign of a life-threatening disease, though even harmless underlying causes can be effectively managed with proper care.
Tracking symptoms with a bladder diary
To determine the exact cause of nocturia, Dr Kaye recommends keeping a bladder diary for three consecutive days. Patients must record the exact time and estimated volume of every drink consumed, as well as every instance of urination throughout both day and night.
To measure liquid volume accurately, patients are advised to keep a plastic measuring jug beside the toilet to pee into before recording the volume and emptying it into the bowl, ensuring the jug is rinsed out after each use. Within a few days of tracking, a revealing diagnostic pattern typically emerges.
The first common pattern involves producing a normal amount of urine overnight while being unable to hold much liquid in the bladder. Patients experiencing this issue must urinate frequently throughout both the day and night. This represents a storage problem, which is most often caused by an enlarged prostate obstructing the outflow of the bladder.
Storage issues caused by an enlarged prostate can be managed using medications that relax muscles in the prostate and bladder or reduce the size of the prostate itself. In severe cases, surgeons can perform an operation to cut away sections of the enlarged prostate tissue.
Overnight urine overproduction and kidney disease
The second diagnostic pattern occurs when a patient produces an unusually large volume of urine overnight, far beyond what is typical during sleep. Unless a person drinks two litres of water immediately before going to bed, overnight overproduction usually signals an underlying health condition.
One primary cause of overnight urine overproduction is damage to the kidneys, the organs responsible for filtering water and waste products from the blood. Damaged kidneys can produce excessive amounts of urine. This damage is typically caused by chronic kidney disease, a silent condition where the organs slowly cease working, often triggered by lifestyle factors such as a poor diet, obesity, and excessive alcohol consumption.
An increased need to pee is frequently one of the first signs of chronic kidney disease. General practitioners can diagnose the condition using a blood test called an eGFR, which measures kidney function. Treatment involves lifestyle modifications such as regular exercise and an improved diet, while advanced cases may require medication.
Diabetes is another commonly overlooked cause of nocturia. The high blood sugar condition frequently causes frequent urination and is closely linked to kidney disease, with many patients suffering from both conditions simultaneously. Diabetes can also be diagnosed using a simple blood test and is managed through similar lifestyle changes and prescription drugs. Additionally, certain blood pressure medications, as well as consuming alcohol or caffeine in the afternoon or in the hours before bed, can contribute to nocturia.
The link between sleep apnoea and nocturia
Despite the prevalence of prostate and kidney issues, Dr Kaye noted that a very common cause of nocturia remains largely unrecognized by many men. In Ken's case, his wife revealed that he also snored extremely loudly, leading Dr Kaye to connect his sleep disruption to a breathing condition called obstructive sleep apnoea.
Obstructive sleep apnoea occurs when throat muscles relax during sleep and block the airway. Sufferers snore loudly, experience pauses in breathing, or gasp for air before waking up briefly to resume breathing, often with no memory of the event. The condition is more common in men, particularly those who carry extra weight or are older.
Crucially, obstructive sleep apnoea directly drives nocturia due to a specific biological reaction. Straining to breathe against a blocked airway creates pressure inside the chest, which stretches the heart's upper chambers. In response, the heart releases a hormone called atrial natriuretic peptide, which signals the kidneys to dump excess water at the exact time the body should be conserving fluid overnight.
Health risks and treatment options
The combination of sleep apnoea and nocturia severely disrupts sleep for patients and their partners. However, sleep apnoea is more than a nuisance; over time, the condition raises the risk of heart disease and takes a heavy toll on physical and mental health.
Treating sleep apnoea effectively reduces nocturia. Some patients choose to use a continuous positive airway pressure (CPAP) machine, which consists of a face mask worn during sleep that uses air pressure to keep the airways open. However, CPAP machines are not a cure, meaning patients must wear them every night, and many find them cumbersome and loud.
For many patients, losing weight is one of the most effective ways to treat obstructive sleep apnoea. Weight loss reduces pressure on the airway, easing breathing symptoms and decreasing night-time urine production. Dr Kaye urges men struggling with broken sleep not to dismiss their symptoms as an inevitable prostate issue, but to start a bladder diary and consult their doctor.
