By Dr. Joan Vernikos
It is taken for granted that as we get older we will need to get up several times during the night to pee. Yet I do not believe this has anything to do with aging. Rather, it is something we can almost wholly control through a shift in one key lifestyle habit. My own experiences really turned me on to this reality as I myself passed the age 65 mark.
I was approaching retirement from NASA and was looking forward to getting a proper night’s sleep. During the years leading up to retirement I had been waking up at 5am. My routine was to get off to work early to beat the traffic, then exercise and call colleagues in other time zones before launching deeper into my new day. Yet I was anxious about my sleep. Was it a given that as I aged I would experience nocturnal diuresis – the technical name for having to get up to pee in the night? I hadn’t yet experienced it but decided to take a proactive approach to preventing this reportedly age-related consequence. If you and your sleep are bothered by these frequent episodes, and even if you are currnently not, you may wish to try it out. Imagine how much better you will feel during the day after a night of uninterrupted sleep.
There can be many reasons for nocturnal diuresis:
- Various kidney, bladder and cardiovascular disorders, prostate issues, diabetes and medications commonly prescribed for them.
- Diuretics prescribed for high blood pressure and heart conditions, also called ‘water pills’ like Lasix, Bumex, Esidrix or Zaroxolyn.
- Common non-medicinal diuretics like alcohol, coffee, milk, juice, watermelon or too much water
- Jet lag, shift-work or other day/night shift habits when the body’s day and night are confused.
- A sedentary lifestyle.
- When astronaut and cardiologist Drew Gaffney returned from his 9-day Shuttle mission(STS-40) eager for a good night’s sleep in his own bed, he was frustrated by having to get up multiple times. In space the day-night, light dark cycle is every 90 minutes leaving the body clock very confused.
Sedentary Lifestyle or Aging?
When a baby is born, its diaper is wet around the clock. When it stands up and learns to live in gravity, mechanisms develop involving Antidiuretic Hormone (ADH) that regulates the water in its body. For example drinking lots of water at one time inhibits your ADH making you need to empty your bladder.
During the day, when you are meant to move, ADH starts off low but increases as you stand up, move and are active. This is to help you preserve normal blood volume. But if you spend time lying down during the day or sitting for many hours at the office or at home in front of the TV, or go into a swimming pool, all conditions where gravity’s effect is reduced, your ADH is reduced as it is at night; you urinate more and can become dehydrated.
During the night, ADH is higher overall, reducing the urge to urinate and allowing you to sleep. Yet research has shown that unlike during the day, if you get into a pool at night the kidneys do not respond to the ADH in the same way as during the day, and you do not need to urinate. This is because a protective mechanism in your kidneys prevents them from responding to ADH at night in the same way as during the day. However, in the microgravity of space, in volunteers lying in bed continuously and in those who sit much of the day and therefore use gravity less, this kidney shut-off mechanism eventually becomes less effective. The result is the need to pee whenever you lie down whether it is day or night.
If you are like so many today and spend most of the day sitting, and especially if you sit uninterrupted for long periods, your body cannot tell the difference between day and night. So it responds to lying down at night with the same urge to pee as it does during the day when the body is expecting more frequent posture changes and movement. This has nothing to do directly with old age except that perhaps one may move less with age. Much of this is up to us.
My Solution for Nocturnal Diuresis – Move!
I adopted the following habits that have served me well for the 15 years since I retired. Some are based on reducing the challenge you provide your system overnight, and the others on tuning your system so that it functions more optimally:
- I eat my last light meal and avoid drinking anything the 3-4 hours before I go to bed.
- I empty my bladder just before I go to bed.
- My meals are low in fluids; I rarely eat soup or juicy fruit especially later in the day.
- I avoid naps, rarely read and never watch TV in the bedroom.
- Most of all I make a point of moving all day, frequently changing posture and never sitting for more than 30 minutes at a time even if I only break it up with 1 minute of standing and easy stretching.
- Find your preferred activities: For more vigorous activity I personally play tennis doubles once or twice a week and practice yoga twice a week. In the summer months I swim regularly.
Simply, to minimize the need to awaken in the night to pee we can re-tune our systems and the regulatory mechanism of ADH with frequent, all-day movement. Participate in some more vigorous exercise activity from time to time as is possible, and you most suredly will see fewer sleep interruptions and more satisfying sleep.
For more information on healthy aging habits, visit ThirdAge Health