How do I avoid waking up in the middle of the night to go to the bathroom?
January 7, 2010 3:26 PM   Subscribe

How do I avoid waking up in the middle of the night to go to the bathroom? How do I get back to sleep afterwards?

I normally go to bed between 11 pm and midnight and wake up around 7 am. Almost every morning between 3 and 5 am I wake up for no apparent reason. I don't feel any need to urinate. But as I try to go back to sleep, I start to feel it. I can't ignore it and fall back asleep. So I get up and go, and when I come back to bed my sleep is fitful. I wake up multiple times (but do not have to go again). When my alarm goes off I do not feel well-rested.

I urinate immediately before going to bed. I try to avoid drinking anything for an hour before bed. I usually avoid caffeine in the evenings and rarely drink alcohol. Mostly I have juice, decaf tea, or soy milk in the evenings. Before bed, I take anti-anxiety medications that increase drowsiness.

I'm female, mid 30s. I've been getting up in the middle of the night since I was a child, but the falling-back-asleep difficulty has only been happening in the last six months. My life has been really stressful lately, and I'm sure some of that comes into play, but I rarely have trouble falling asleep in the first place, only when I get up in the middle of the night.
posted by desjardins to Health & Fitness (32 answers total) 12 users marked this as a favorite
I don't know but that's definitely been happening to me more frequently as I get older (42). I think to some extent your natural sleep cycle drops into a lighter mode around then and the slightest thing can wake you up pretty easily. I almost always up at about 3-4 am and also visit the bathroom even though I don't really have to go.
posted by otherwordlyglow at 3:34 PM on January 7, 2010

Restless Leg syndrome can often be a problem for Women under stress in your age group. It can be diagnosed in a sleep lab if you are having nocturnal leg movements but normally it's just the stress and moving your lags can often be a suthing way to deal with your stress. Unfortunately it also interferes with your sleep.
With regard to the feeling to urinate. Not knowing your child bareing history it's hard to rule out lose lligamentation to the uterous that can cause it to lay on the bladder and make you feel full.
To Help: There are perscription medications that can help with Restless leg syndrome, but two Tylenol are almost as effective. You may want to try that first. Also sleeping on your side rather than your back may help with the feeling of fullness in your bladder. Failing those two suggestions it may take a sleep lab to pin down exactly why you're having trouble... My2cents
posted by RENNER8592 at 3:41 PM on January 7, 2010

Don't drink any more fluid than necessary between dinner and bedtime. What comes out has to go in...
posted by Chocolate Pickle at 3:41 PM on January 7, 2010 [1 favorite]

I do not think your issue is urination. I would go to a sleep doctor and a sleep lab. Sounds like it could be a breathing issue/sleep apnea. Having worries does not help.
posted by JohnnyGunn at 3:44 PM on January 7, 2010

I guess I should have mentioned that I already know I have sleep apnea and restless leg syndrome (for which I have a CPAP and klonopin). I just didn't see how they were related to urination.
posted by desjardins at 3:49 PM on January 7, 2010

For me to actually sleep through the night, without waking up to use the bathroom, drink avoidance for an hour before bedtime isn't long enough. It's at least a couple of hours for me. I have to avoid caffeine completely (not just in the evening). I have to make sure I don't consume a lot of carbohydrates or salt during the day, since both of those make me drink a lot of water to go with them, which seems to want to come out again in that 3-5am window.

Given all that, I do often wake up during the night. The trick is getting back to sleep again. The first step for me is to avoid waking up any more than I have to, so I have my living space set up such that I don't have to switch on any lights to use the bathroom. I have those LED nightlight things in there, which provide enough light to see without triggering the "it's morning, wake up!" function in my brain.

Other than that, trouble getting back to sleep is, for me, a sign that I'm worrying about something. Often, ironically, I'm worried about how tired I'm going to be if I don't fall back asleep right now, and then of course that's exactly what happens. The only thing that works for me there is immediately jumping on those sorts of worries and temporarily getting them to go away.

Self-reassurance ("it's really not that bad if I'm a bit short of sleep"), anxiety delaying tactics ("listen, FishBike, there's no point in worrying about this now because you can't do anything about it until you are at work in the morning"), or just plain thinking of something else that is non-stressful and engaging enough to hold my interest until I get sleepy (er... details censored but I'm sure you get the general idea), are techniques that work for me when worries are keeping me awake.
posted by FishBike at 3:51 PM on January 7, 2010 [2 favorites]

Are you sure that your blood sugar levels are under control? It's a stretch, but one of the symptoms for diabetes is frequent urination. This dumps excess sugar out of the bloodstream.

Again, this is probably not it, but worth getting a fasting blood sugar level, to eliminate it as a cause.
posted by Danf at 4:08 PM on January 7, 2010

The problem isn't the waking up, which you say is normal for you. The problem is the inability to fall back to sleep. Can you tell us more about what happens when you get back into bed? Do you feel tired? Are you thinking about anything in particular? What's going on then?
posted by decathecting at 4:13 PM on January 7, 2010

Is it possible that your CPAP pressure is out of date or your mask is leaking or anything like that? That can have a significant effect on therapy.

I often woke up in the middle of the night to urinate, but as soon as I got a CPAP and set it up well, it went away completely. So there's definitely a connection.
posted by trevyn at 4:16 PM on January 7, 2010

I used to have trouble falling asleep when I woke up in the middle of the night. I mentioned this to my brother and he gave me a different way to look at it -- instead of "Oh no! I've disrupted my sleep," it's now a quick check of the clock and a "Woohoo! I don't have to actually get up for two more hours!" Maybe reframing it that way will help?

(I also have the problem where once I wake up I'm aware of needing to pee -- I just get up and pee right away and get it over with, since I know I'm going to have to anyway, and the sooner I do it, the groggier I'll be when I'm back in my bed.)
posted by Blue Jello Elf at 4:31 PM on January 7, 2010

Avoid exposing yourself to any light, i.e., do you business in the dark. I avoid the loud noise of flushing the toilet as well (just do it in the morning).

If you live in an apartment it may be that one of your neighbors gets up around that time and routinely makes a loud sound that wakes you up (e.g., plumbing). You may not be aware since by the time you are conscious, the sound would have stopped.
posted by whiskeyspider at 4:33 PM on January 7, 2010 [1 favorite]

Is the stress related to a longer workday sitting at a desk, and do you notice any swelling in your ankles or legs at the end of the day?

If you do, resting with your feet up for a couple of hours before bed will help you clear your bladder-calendar before you go to sleep. I know you said the urination is a long-standing midnight thing, but if you can stay asleep, maybe you won't have a chance for fitful sleep afterwards.
posted by Sallyfur at 4:40 PM on January 7, 2010

I'll second whiskeyspider's suggestion of avoiding turning on the lights. I've been waking up more and more during the night to pee for the last year or two (I'm just chalking it up to aging) and find that if I turn on any lights it wakes me up. I try to get from my bed to the toilet while barely even opening my eyes. I stumble and maybe my stream doesn't always completely hit the toilet bowl, but it's a small price to pay for being able to get back to sleep immediately after returning to bed.
posted by fso at 5:22 PM on January 7, 2010

My great doctor taught me that my stomach gets a little acidic through the night, so have a slice of toast to absorb the acid. Puts me right back to sleep.
posted by effluvia at 5:23 PM on January 7, 2010

if you do wake up, you want to keep your physical and mental systems as far from wakeful mode as possible.
Physical: Don't turn on any lights. Keeping your eyes unfocused can sometimes help. Close your eyes as soon as you get back to bed.
Mental: Don't read, or think about daytime things. If you can remember what you were dreaming about, keep the dream with you as a daydreamy thing and continue the story. If you can't remember what you were dreaming about, day dream.
posted by Billegible at 5:25 PM on January 7, 2010

I'm 37, and f I want to avoid getting up in the middle of the night to use the bathroom, I have to stop fluids for at least 4-6 hours before bedtime.

I try to do this almost every night, because I have to climb a ladder down from the loft in my cabin where I sleep. And who wants to be climbing a ladder in the dark half asleep with a full bladder? I'm convinced this is how I'm going to die some day, by falling off the ladder during one of these excursions.

And you wonder why they call them the "wee hours"! (Joke.)

When I finally make my way back up the ladder and into bed, my trick is to start replaying whatever I can last remember dreaming. You know how if you mentally replay a fight you had with someone, you get angry again? Turns out it works the same for dreams - for me, anyway.
posted by ErikaB at 5:35 PM on January 7, 2010 [1 favorite]

I urinate immediately before going to bed. I try to avoid drinking anything for an hour before bed. I usually avoid caffeine in the evenings and rarely drink alcohol. Mostly I have juice, decaf tea, or soy milk in the evenings. Before bed, I take anti-anxiety medications that increase drowsiness.

My recommendations, based on various boring experiences I won't relate here:

1. Stop drinking at least two hours before bedtime;
2. From dinner onward, only drink water;
3. Consider that often medications that cause us to be more drowsy will also cause us to wake up earlier in the morning than we want to, in large part because of the depth of sleep that the drowsiness caused.
posted by davejay at 5:46 PM on January 7, 2010

The only thing that gets me back to sleep after an unwelcome awakening is counting backwards. Seriously. The higher 90s seem to work best, and I have to do it slowly, in my head. It slows down my breathing and before I know it, my alarm is going off, meaning I've slept a few more hours.
posted by cooker girl at 6:27 PM on January 7, 2010

Starting about three (or four) hours before bedtime, drink a lot of plain water (a couple of pints per hour for two hours) and stop drinking water an hour (or two) before bedtime. That way you'll be nice and cleaned out by bedtime and it will be a lot easier to sleep because what little pee is still in you won't be too concentrated.

With regard to waking up and not getting back to sleep. That is often listed as sign of depression or, as you notice, stress.

Restless leg syndrome can be got rid of by eating a lower fat diet.

Very mild indigestion can also keep you awake without you actually noticing it, so try eating no food for at least four hours before bedtime and also try to become aware of any food that you might be finding indigestible.

Some of the respondents say that they've gotten worse at it as they've gotten older whereas I know people who have become better at it so I don't think it's a function of youth or of old age.
posted by y6t5r4e3w2q1 at 7:12 PM on January 7, 2010

Nthing keeping the lights out. Also, if you wear glasses, don't put them on.

(I'm blind as a *bat*, but can cross the hall and pee. It's dark anyway.)
posted by kestrel251 at 7:21 PM on January 7, 2010

Wow, who are you people that have 4 hours between dinner and bedtime? I'm just finishing eating now (9:30 pm) and I'm going to try to be in bed at 11.
posted by desjardins at 7:28 PM on January 7, 2010

I started going a bit the opposite route as people here suggest. I drink before bed, thus ensuring a full bladder if I wake up. If I wake up, I get up immediately and pee. Falling back asleep is easy because there was no coming to consciousness trying to figure out if I have to pee, and I don't wonder why I woke because I assume it was my bladder. My stress-brain doesn't have time to get started.

In my bathroom, I have a motion-detector night light, which is enough light to be useful without waking me up or needing my attention. If I make the mistake of trying to fall asleep without peeing or waiting to get up to pee, I almost always have fitful sleep after that.
posted by carmen at 8:01 PM on January 7, 2010

Do you work out regularly? Nothing helps me get a solid night's sleep like being tired from working out.

You could even get up early in the morning to do it since you're not getting that good of sleep before 7AM anyway.
posted by Aizkolari at 8:08 PM on January 7, 2010

This is very common for me (I generally wake up an hour or so before I need to get up, and have to go to the bathroom) The key really is to keep everything dark-maybe just a faint night light in the bathroom-but whatever you do try to avoid having to turn any lights on.

I don't have any other solution, but at least in my case I fall right back asleep and I'm fine.
posted by St. Alia of the Bunnies at 8:22 PM on January 7, 2010

It's possible that your very late meals (and yes, eating your final meal of the day at 9:30 is very late) are disrupting your sleep. Try eating your last meal no later than about 7, and have a small snack at 9 or 10 if you need it. That may help you sleep.
posted by decathecting at 8:32 PM on January 7, 2010

i wake up and pee in the middle of every single night. i agree with the general consensus to wake up as little as possible, but specifically: 1) as soon as you wake, go to the bathroom. don't lie there trying to go back to sleep while you slowly notice your bladder. 2) don't keep a clock facing your bed or look at a clock. seeing the time creates more anxiety about the fact that you're awake and how many more hours there are till you have to be up again. i don't know when i wake up to pee. it just happens and i take care of it and resume sleep. 3) make sure your bedroom is dark. it's extra hard if it's starting to get light out when you are trying to get back to sleep. if you can't change your environment, put an eye pillow or mask on after the bathroom trip.

another way to approach it could be to allow yourself to be awake for a bit, and engage in an activity to calm down your brain so you can sleep well. see my comment to a previous question for more on this idea. or listening to a guided visualization could be a good way to help you re-enter restful sleep.

and finally, if you can or want to go this route, there are prescription sleep aids that last all night long. ambien cr works like a charm for me.
posted by nevers at 9:33 PM on January 7, 2010

Try eating a low-sodium dinner and see if that helps. I find that when I have a salty dinner I drink lots of water to compensate and my bladder always awakens me.
posted by oceanmorning at 1:00 AM on January 8, 2010

Eating at 9:30 may be your trouble or at least a big part of it.

Remember, just because you are asleep if you've just eaten your body still has to ramp up to deal with the bolus of food you had an hour or two before going to bed. It's something your sleep doc should have told you.

Sleep hygene is very important. Eat a large meal no later than 6:00 or 6:30 if you can, don't eat anything after 8:00 or 8:30 and be in bed by 10:00 or 11:00. and yes, it's a good idea to keep the lights out (within reason) when you get up at night. Go right back to bed and stay there until you get back to sleep.

The full baldder thing is interesting though. It could be a number of things; if you're pre-diabetic you would have a high glucose and be spilling sugars making you urinate, but if I recall you said you feel like urinating not that you actually do..... you may need your clonodine adjusted or be put on another beta blocker or maybe even put on a small dose of soma. That would have a slight sedative affect and help get you back to sleep too.... It sound like you may have to go back to the lab to see what's going on. It's not easy (or professional) to try to Dx a Patient via the internet.
posted by RENNER8592 at 1:31 AM on January 8, 2010

Oh, I forgot. Drinking quinine water (sp) may help with the RLS too; I recomended it to all of the RLS patients in the lab and've had good results.
posted by RENNER8592 at 1:42 AM on January 8, 2010

If you wake up & pee mid-sleep, be sure to drink some more water to rehydrate. Not a lot, or you'll fill your bladder again, but if you are underhydrated, you will have problems sleeping.
posted by IAmBroom at 2:03 AM on January 8, 2010

Are you on hormonal birth control? During the thee years when I was using the nuvaring, it really turned me into an insomniac. I'd get up to pee in the middle of the night, but instead of just falling back asleep afterward, I'd toss and turn and eventually give up and get up for good. As soon as I stopped using hormonal birth control, I pretty much immediately regained my ability to fall back asleep.

Other than that, I just find it helpful to get up and head to the bathroom as soon as I feel the urge. The longer I lie in bed hoping it'll just pass, the longer it takes for me to fall back asleep afterward.
posted by Eshkol at 9:44 AM on January 9, 2010

Just found this article about incontinence, which I know is not what you have, but it lists things that irritate the bladder, which seems relevant.
posted by y6t5r4e3w2q1 at 7:37 AM on February 1, 2010

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