Sleep, Interrupted

February 28, 2007 10:17 PM

Why am I waking up exactly one hour after I fall asleep... with a giant urge to urinate... almost every night?

I am a male in his mid-30s, and apart from some depression, I'm in otherwise good health. This has been going on for well over a year, and it really does seem to happen almost exactly an hour after I've fallen asleep; or as near as I can tell.

Most (but not all) nights I'll wake with the desperate urge to urinate... and I do mean desperate... to the point where I feel like I'm going to lose control of my bladder. There is no burning, nor any other symptoms, that go along with the urge. What's strange is that, roughly 25% of the time, I won't be able to "go" at all once I'm up. On those occasions, I'll just go back to sleep and be fine until morning. And about half the time when I am able to go, it's nothing significant. I don't generally drink copious amounts of liquids before bed.

I do not have any related or similar problems during the waking hours, so it does not seem like prostatitis based on what I've read. (Although, now that I think about it, I can't stand to sit in the middle of a row in a crowded theater. If I do, I'll usually be convinced that I have to get up and go before the show starts, and then usually not be able to produce anything. I guess I've got "issues".)

I recently asked my doctor about this, and he responded with a more-or-less blank stare. Any ideas?

posted by anonymous to health & fitness (14 comments total)

Drinking too much?
Blood sugar issues?
posted by caddis at 11:30 PM on February 28, 2007

As far as I know, this is a common symptom of diabetes. I'm surprised your doctor wouldn't have at least mentioned that.
posted by wackybrit at 11:44 PM on February 28, 2007

Not sure what sort of time frame you consider "before bed", but a fellow I know says he's stopped drinking water after about 7:30 PM to avoid nightpees. You might at least try.
posted by xueexueg at 11:52 PM on February 28, 2007

Urgency is the desire to pee, regardless of how full the bladder is. It's not certain what causes urgency but some research suggests that it's pooling of a little urine in the bladder neck. A little urine might trickle in the connecting part of the urethra, sending off a signal to your brain that you need to go.
Often, people have this problem after prostate surgery or other incontinence-corrective surgery. But I assume you would have mentioned that if you had it. I would guess (IANAD (IA 6 weeks into medical school) but I have done research on internal sphincters and incontinence) that something is amiss with the distal end of your bladder and/or your internal urethral sphincter. If the former is at a weird angle, then lying down for an hour might let a small (but present) amount of urine pool, causing the feeling of urge. If the problem is with the sphincter, then it might be letting a little trickle of urine in and causing the urge to pee. You mention that "25% of the time... [you] are unable to go". By "go" do you mean a voluminous torrent that would be indicative of the urge you felt or does literally nothing come out? Also, does lying down during the day cause this too or is only while sleeping? Either way, I would suggest seeing a urologist... maybe stick a scope up your urethra and make sure it's all good.
posted by shokod at 1:56 AM on March 1, 2007

Prostatitis?
posted by ewkpates at 3:02 AM on March 1, 2007

You just wake up that one time--no other times during the night? The fact that you don't actually pee pretty much rules out diabetes or drinking too much. I'm pretty sure phantom needing-to-urinate feelings can be a sign of prostate problems, but I don't think they'd manifest just at one point during the day. You'd feel it all day and night long as the tumor (or whatever) pressed against your bladder.

I like shokod's idea, especially since it only happens after you've been in an unnatural (wrt daytime) position for a while. Or, similarly, maybe you've got an internal organ rattling around in there (?!) and it settles onto your bladder when you lie down. In fact, my wife has noticed that having the cat sit on her hip while she's lying down makes her feel like she needs to pee. You don't have a cat sitting on your groin, do you?

The theater comment makes it sound psychological, but that might be a red herring since a lot of people have this issue.

ObIANAD
posted by DU at 4:43 AM on March 1, 2007

I would get the prostate checked out just in case--it may not be inflammed but hypertrophied that's causing the urgency, plus accounting for not letting you be able to start the stream when you want
posted by uncballzer at 5:16 AM on March 1, 2007

This can be any of a variety of things. Your best bet would probably be to ask you doctor about trying an anticholinergic medication such as Oxytrol or Detrol, which are used for overactive bladder (that's what this sounds like the most). If that doesn't work, your next bet might be urodynamics, although the fact that your symptoms only occur at night might make whatever disorder you have difficult to reproduce.
posted by wireless at 8:23 AM on March 1, 2007

By the way, the technical term for this symptom is "nocturia."
posted by wireless at 8:26 AM on March 1, 2007

BPH, benign prostatic hyperplasia, is very common. That's what this sounds like. Ask your doc about BPH. You're a little young for it but it is common. You'll get a PSA test to rule out prostate cancer (quite unlikely in someone as young as you are, so don't freak). If it is BPH it is easily treatable with drugs (Flomax is one, Cardura is another) that shrink the prostate. Basically the problem of BPH is a prostate gland that gets oversized and makes it hard to empty the bladder completely, and nocturia is a common first sign.
posted by selfmedicating at 8:41 AM on March 1, 2007

You may find it helpful to make sure that you've completely emptied your urethra by using a milking motion from the base to the end. You can do this after ejaculating as well.

I also suggest making a real effort to eat more vegetables, especially the real nutritional powerhouse ones like broccoli and spinach, which may help your depression as well.
posted by teleskiving at 11:20 AM on March 1, 2007

by what you've written it's not apparent you produce copious volumes of urine (in the first hour of sleep) overnight. restricting your fluid intake early evening to avoid nocturia is (generally) poor advice, certainly not best practice... a geriatric myth: don't go there. the more concentrated urine that results from such a practice is more irritating to the bladder and can exacerbate the nocturia. hydrate. you're 30-something, not an old man.

your bladder (a muscle) sounds incompetent... maybe physiological, maybe "issues", either way your bladder sounds in need of retraining. when we empty our bladders there is always a quantity stays behind. always. it's called the residual volume. for whatever reason your residual volume may be abnormally large and with the relaxation of sleep, or the stress of sitting in a theatre, you may waken in response to this volume with an urge to void. that's just one suggestion. retaining a large residual volume is termed incomplete voiding. speak again to your blank faced doctor about the possibility. give him something to go on.

take a urine specimen with you on the next visit and suggest at least the most basic of urinalysis may be appropriate and hint that urodynamic studies may be an initial option with a view to assessing bladder function and possible need for retraining. tell him your problem is significant to your wellbeing... and you'd like a referral to someone more au fait, "please".

(and if your doctor continues to draw a blank: poq.)
posted by de at 3:06 PM on March 1, 2007

Just another idea -- if the symptoms match --consult a physician for more screening.

Unfortunately we don't have enough background to make these leaps, but something that may match your symptoms --

First, I also wondered if you have nocturia as a symptom, but I can't tell - isthis is occuring more than one time per night (several times?)

Other risk factors - you link this to insomnia and interrupted sleep so --

--Are you very sleepy during the day (google Epworth sleepiness scale -- really easy assessment tool with a few multiple choice questions -- if higher than 10, excessive sleepiness and you may have an underlying sleep disorder
--Do you snore? You obviously will not know this, but a bed partner or family member can tell you if you do
--High BMI?

If you have many of these symptoms, your physician can refer you to a sleep lab -- obstructive sleep apnea
posted by Wolfster at 8:49 PM on March 1, 2007

Apples.

Ok, probably not, but it was for me. I go through periods in which I eat a very regular diet, so any the effect of any variation gets noticed pretty quickly. I added an evening apple (raw, organic, skin but no core, thank you very much) to my pattern for a while, and soon noticed that I often had to get up to urinate in the night. I'd only get up once, but even that is very unusual for me. And it wasn't usually a huge volume, but the urge could not be ignored.

When I dropped the apple from my diet, I went back to normal in a day, maybe two.

Internet citations naming apples as a diuretic are extremely thin, so I don't have much evidence other than my own experience, and my confidence born of dietary habits that establish a real baseline against which other dietary influences can be assessed.
posted by NortonDC at 7:30 PM on March 4, 2007