Bladder keeping you up running to the restroom all night?
Are you desperate to get a few consecutive hours of sleep but your bladder hasn’t gotten the message that this is nighttime and not middle of the day?
Why is it that your bladder becomes more active at night than during the day?
There are many reasons for frequent nighttime bladder urges, and many of them have as much to do with a sleep problem, as a bladder or pelvic floor problem. Either way, we can help you sort it out and get quality sleep again.
Some people are so busy during the day that they only get to start drinking water in the evening. For others, the difference is a matter of attention. Your attention is so focused on a million other things during the day - work, kids, endless to-dos - that after dinner is when you realize you’re thirsty, and down 2-3 glasses of water in the time between dinner and bedtime. All of that fluid certainly takes some time to be processed, and is likely to still be filling your bladder into the wee hours of the morning. Now I’m certainly not telling you to restrict your fluids - too many people are already doing that! - but to being mindful of when you drink can go a long way.
The other aspect of attention is that at night, when everything else slows down, is when your mind finally has some open space. And what does it do with open space? Same thing that any other untrained wild being would do - run wild! Run around and around aimlessly in circles! It can be difficult to tame this wild animal and quiet it down enough to let you sleep soundly. Some of these awakenings you might find if you really pay attention, may be not due to your bladder, but due to a busy mind. And what happens when you wake up and your mind switches on? You also notice any and all discomforts in your body - things that, had you been sleeping more soundly - may not have even woken you up. But now that you’re awake, you notice your bladder, and decide to get up and empty it so that it doesn’t keep you awake.
Trouble is, this response can quickly become a pattern, so that instead of waking up due to a full bladder, you’re now waking up because it’s a habit, and then reinforcing the pattern of night-time urination, by going to the restroom because you woke up. Sure, it may feel like you really really need to go, but notice this – how much urine really came out in the middle of the night? What about the second or third time you got up – how much did you produce then?
Our brain is this amazing association-making super computer, and whatever it practices, it gets better at doing more and more readily. So, if you’re repeatedly teaching your brain that 2:54 AM is the time to go to the bathroom, guess what time you’re going to wake up tomorrow night, with the urge to go? (Yes, we actually have a literal cellular clock built right in - you may have noticed this phenomenon!)
The way to stop patterns like this and retrain your body and brain to a better pattern, starts with slowing down enough to notice the automatic patterns at each point, before you actually expect yourself to try to change anything. So, my two pieces of advice both hinge on this idea, and there is one for the day and one for the night.
First, set an alarm on your phone to go off at three times during the day - 10:00 am, 3:00 pm, and 7:00 pm. At each point, take one deep breath in and out, and just ask yourself - how much fluid have I had to drink so far today? You might want to record your answer by writing it down for a few days, but this is not even necessary. It’s not even that important if your answer is very accurate. The point is having taken the pause just to notice. At this stage you are not even trying to change anything. I can’t tell you whether you’re drinking the right amount or not, or what the ideal schedule of drinking is for you. But after a week or two of this, you will have gained an awareness of what is going on that might be helpful to you. Do you see any areas of opportunity to adjust your fluid intake patterns, that might help you sleep better at night?
The second step takes a bit of discipline, when you are desperate to get every wink of sleep you can in any way possible. But it will be worth the trouble within a couple of weeks if you do it consistently. Whenever you wake up at night, before jumping up to use the restroom, I want you to take three deep breaths in and out, then ask yourself – when is the last time you urinated, and how much urine would you guess is really in your bladder right now? Again, the “correct” answers are not too important here, nor is this supposed to elicit judgment of your choices at this stage. So most of all, be kind to yourself. If you need to go, then go. Just pause first, for these three breaths and to consider these two questions. Just be sure not to switch on any lights or the TV just because you’re awake, and whatever you do, don’t check your phone or go to the computer and start working!
These two steps are meant to do two things: 1. They serve as what I will call a “pattern-interrupt.” If you’ve worked with me one-on-one lately, you may already be familiar with this concept . A pattern-interrupt is a way to break our automatic patterns that are so ingrained that we don’t even realize we are no longer making a conscious choice in these situations. 2. They allow us to question ideas and beliefs that we have taken for granted to be true, but may not be. For example, the idea that “I just have a small bladder, because my mother and sister both have small bladders too,” or “My bladder is overactive, and always becomes more overactive at night,” are both stories that we have learned to tell about ourselves. (More on this in Chapter 6 of my book, The Pelvic Floor Lowdown.) If we choose to question the “obvious”, if we allow the possibility see it differently, we are beginning to open up the opportunity for change.
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Helping women & men restore dignity and confidence in bladder, bowel, and sexual function without relying on medicines or surgery.
Deborah S. Cohen
Specialist Pelvic Health Physical Therapist