Nocturia | Nocturnal Polyuria | Sleep

Putting on my wee willy sleeping cap, I was updating a section for the online Sleep Mastery Course around the important topic of sleep and nocturia. As I created a couple of resources and reflected further on the topic, I thought it would be worthwhile to put down some key points for you.

Nocturia is a clinical symptom (i.e., physical trip to the bathroom). Nocturnal polyuria is a medical condition in which the kidneys produce more urine than the bladder can store at night. There are several classes of nocturia (1). In collaboration with medical colleagues, we need to determine the cause(s) (e.g., kidney, bladder, or sleep issues) of the nocturnal polyuria to re-establish a near-normal sleep cycle.

The Relevance
Individuals who void twice per night have over four times the risk of developing cardiovascular disease and double the risk of early death, even when controlled for known risk factors for mortality

The Assessment

• TANGO-SF questionnaire
• Urinary Diary paper (create your own) or mobile app (see iUFLow)

The Management

Having collected information from the TANGO-SF questionnaire and delved a bit deeper using the follow-up questions (3), you are armed with the knowledge of whether you can directly assist or will need to bring in additional professional help. Our goal here is to limit urination to one episode per night, on average, to facilitate deep recovery sleep, especially during the first 4 hours of the nightly sleep cycle.

The TANGO-SF breaks down the four areas for consideration.

Cardio/Metabolic

Disruptions in this area will most likely require additional input from their general practitioner/specialist because medications are likely involved or need to be involved. The article by Bower et al. (2018) outlines the roles that different medications can play in nocturia. Our role is to identify a possible link between medication and nocturia (new medication or a change in medication) or to suspect a link between a metabolic condition and nocturia (e.g., a Global Polyuria index greater than 40ml/kg body weight, which is indicative of diabetes).

Sleep

This is our wheelhouse, and the details in the Sleep Mastery Course will provide you with assessment tools, management strategies, and education strategies to assist clients in improving sleep quality.

Urinary Tract

This is a collaborative section. Some issues are medical (e.g., enlarged prostate, urinary tract infection), but again, we can be alert to potential problems. Using the Urinary Diary, we can determine whether clients have normal or restricted bladder storage capacity. We can identify an overactive bladder (usually voiding less than 300ml and more than 8 urination events during the day), possible post-void residual volumes, educate on the amount/type/timing of fluid intake, and start urge and/or stress incontinence training while other issues are being investigated.

Wellbeing

Again, our wheelhouse. There is plenty of information in the Sleep Mastery Course to supplement your own understanding of the management of exercise prescription, relaxation training, visualisations, and affirmations. nutrition, and drugs & alcohol.

Is nocturnal polyuria something that you actively manage in your day-to-day caseload?

References/Resources

(1) Fine ND, Weiss JP, Wein AJ. Nocturia: consequences, classification, and management. F1000Res. 2017 Sep 1;6:1627. doi: 10.12688/f1000research.11979.1. PMID: 29026531; PMCID: PMC5583737.

(2) Rosen, R. C., Holm-Larsen, T., Kupelian, V., & MD, A. J. W. (2013). Consequences of Nocturia. Postgraduate Medicine, 125(4), 38–46. https://doi.org/10.3810/pgm.2013.07.2673

(3) Thanks to Ass. Prof. Wendy Bower for a great article aimed at GPs that provides a wealth of information. Bower W, Everaert K, Ong T, Ervin C, Norgaard J, Whishaw M. Questions to ask a patient with nocturia. Australian Journal of General Practice. 2018;47:465-469.