Prostate Health and Sleep

How Can Prostate Health Impact Your Sleep?

Urological diseases are a common diagnosis among Americans. Millions see a doctor each year for concerns about urinary health. Many urological diseases can severely impact sleep quality. Nocturia, when waking during the night to pee becomes bothersome, can be caused by a lot of common issues. Stress, diabetes, pregnancy, age, and fluid intake at nighttime are all attributed to nocturia. Men over 40, however, frequently suffer from nocturia because of an enlarged prostate.

With consistently interrupted sleep at night comes the potential for a lower quality of life including social and economic impact. It’s hard to maintain a healthy social and work life with chronic fatigue.

In this article, we’ll cover how nocturia can be caused by an enlarged prostate and the treatments available. We’ll also discuss the importance of quality sleep and highlight how those with an enlarged prostate can still get a good night’s sleep.

What is Nocturia and Why Does it Happen?

Waking up in the middle of the night is never ideal. It can disrupt the sleep cycle and it can often be difficult to fall back to sleep, leading to a restless night. Nocturia is defined as waking up once or more in the night to urinate. By the age of 40, 69 percent of men and 76 percent of women report awakening at least once during the night to urinate. Adults should be able to sleep for six to eight hours per night without needing to get up to urinate. Men over the age of 40 who report frequently waking up in the middle of the night to urinate could have an enlarged prostate to blame for nocturia.

Additional underlying causes of nocturia can vary, being either a physical or mental issue or sometimes both. Nocturia itself is not a disease, but a symptom of an underlying condition that makes urinating at night necessary. Doctors sometimes struggle to differentiate those who suffer from nocturia from those who awake during the night for an uncontrollable reason and choose to go to the bathroom because they’re awake. Doctors treating nocturia in men over 40 will check for an enlarged prostate.

The prostate is a gland in men that produces seminal fluid. It’s a soft, squishy gland about the size of a golf ball. It’s located below the bladder. In most men, the prostate naturally grows with age starting around the age of 25. This growth is called benign prostatic hyperplasia (BPH). It’s important to note that an enlarged prostate gland and BPH is not indicative of cancer, although the two can occur at the same time.

Since the prostate is below the bladder, an enlarged prostate can push on the bladder, leading to a feeling of urgency to urinate. It can also pinch the urethra, restricting urine flow, which makes it difficult to empty the bladder completely. Both of these effects from an enlarged prostate can lead to nocturia.

How Prostate Health Can Affect Sleep

Since the prostate is located below the bladder, an enlarged prostate can push on the bladder. This causes the capacity of the bladder to shrink and the bladder to fill faster. The pressure from the prostate on the bladder can cause a sense of urgency to urinate, even if the bladder isn’t full. An enlarged prostate can also pinch the urethra, making expelling urine more difficult. Here are the common symptoms of an enlarged prostate:

  • Frequent urination.
  • Sudden urgency to urinate, even after a recent bathroom trip.
  • Inability to completely empty the bladder.
  • A weak or interrupted urinary stream.
  • Difficulty initiating urine flow despite the bladder feeling full.
  • Dribbling at the end of urination.
  • Increase in frequency of urination at night, nocturia.

When to See a Doctor

Nocturia is defined as waking once or more per night to urinate. It’s best to see a doctor if this is a regular occurrence and one that disrupts sleep and therefore impacts the quality of life. Nocturia can be caused by a number of issues including an enlarged prostate. Other causes could be drinking too many fluids at night, taking certain medications, a bladder infection, or bladder storage problems. A doctor will be able to properly diagnose if an enlarged prostate is causing nocturia. The doctor can also recommend appropriate steps to manage an enlarged prostate.

An Enlarged Prostate and Fragmented Sleep

Dealing with nocturia from an enlarged prostate can have a significant impact on the quality of nightly sleep. Nocturia often inconveniently flares at night leading to frequent wake-ups. On top of this, an enlarged prostate makes it more difficult to fully empty the bladder with each urination so the bladder is often left still holding fluid, making the next trip to the bathroom necessary sooner than if the bladder was empty. This cycle can repeat itself numerous times during the night, leading to fragmented sleep. It’s not uncommon to have a difficult time falling back to sleep after a middle-of-the-night trip to the bathroom, cutting into vital hours of sleeping.

We know that fragmented sleep has a negative effect on quality of life. A Johns Hopkins University study showed that interrupted sleep led to a decline of positive mood by over one-third. And that was just for one night of fragmented sleep. Waking up at night with nocturia means the sleep cycle doesn’t run its course. It starts and stops often, leading to less time spent in deep sleep. Slow wave, or deep sleep, is responsible for waking up feeling refreshed. It’s common in men with nocturia from an enlarged prostate to suffer from fragmented sleep and struggle with tiredness throughout the day.

The Effects of Sleep Deprivation

Chronic and long-term sleep loss is often seen in those who suffer from nocturia. The sleep cycle is disrupted and time that normally would be spent sleeping can be lost when trying to get back to sleep after getting up for a bathroom trip. Repeated over several nights for weeks or months can lead to sleep debt, a buildup of getting less sleep than you need. As convenient as it would be to sleep in on the weekends or nap during the day, sleep debt can’t be erased or reversed. Although a mid-morning or early afternoon nap will help with alertness for the rest of the day.

Getting a full night’s sleep with enough time spent in deep sleep that is restorative and refreshing is important for everyday functions. Sleep deprivation is associated commonly with a loss in cognitive function, memory, productivity, social interactions, and positive moods. Those with nocturia from an enlarged prostate are at risk for sleep deprivation and the issues that come with not getting enough sleep. The urgency to urinate frequently flares at night so it’s not uncommon to wake several times during the night to use the bathroom.

Further Medical Risks Involved

While ignoring the need to urinate may seem like a logical solution to nocturia, it’s not recommended to hold urine in the bladder. Holding in urine can lead to further bladder complications like urinary tract infections, kidney infections, and kidney stones.

Check with your doctor before taking medications. Some common over the counter medications can make an enlarged prostate and nocturia worse. Cold and allergy medicine containing antihistamines, blood pressure medications, and antidepressants are all known to worsen the condition of an enlarged prostate.

Enlarged Prostate and Prostate Cancer

An enlarged prostate does not always indicate prostate cancer, but a symptom of prostate cancer can be an enlarged prostate. If nocturia symptoms have changed or worsened suddenly, consult a doctor to discuss enlarged prostates and screening for prostate cancer. An infection of the prostate (prostatitis) or a non-cancerous tumor could also cause an enlarged prostate and nocturia in men.

Treatments for Nocturia

Nocturia and enlarged prostates often go undiagnosed. Many men who awaken once or more in the night to urinate don’t visit a doctor for treatment or don’t consider nighttime urination to be bothersome enough to seek help.

The symptoms of nocturia can be similar to many other urinary issues, making it less clear to properly diagnose. Men who find nocturia is having an impact on quality of life should visit the doctor.

It’s important to note that some men with enlarged prostates experience no negative side effects. Although the prostate is below the bladder, some anatomical differences between men will mean an enlarged prostate won’t always push on the bladder or disrupt urethra function. Below we’ll discuss some common treatments for enlarged prostate that may alleviate some or all nocturia caused by the prostate.

Medications

Two types of medication are often prescribed for men suffering from nocturia with an enlarged prostate.

  • Alpha blockers help relax the muscles around the prostate. These don’t do anything to shrink the size of the prostate, but with the muscles relaxed, expelling urine will become easier. With this medication many men see relief from enlarged prostates and nocturia within a few days
  • 5 alpha-reductase inhibitors are drugs that shrink the size of the prostate. They inhibit activity from the enzyme 5 alpha reductase. This enzyme stimulates prostate growth. With the prostate less enlarged, men feel less symptoms of nocturia.

Both types of medication require taking them daily to maintain the benefit and less occurrence of nocturia.

Surgery

One of the most common surgeries in men is to treat enlarged prostates. Several methods exist but all relieve symptoms by removing some of the prostate tissue. In turn, this will ease or completely alleviate nocturia. Surgery is typically a last resort if other methods and medication have not been helpful.

Lifestyle care

If you and your doctor have decided medication and surgery aren’t the right fit for treating an enlarged prostate, some lifestyle changes can be implemented that may help.

  • Exercise regularly.
  • Limit liquid consumption at night, especially of alcohol and caffeine which can cause excessive urination or cause bladder irritation.
  • Eat a well-balanced diet and avoid foods known to inflame the bladder like spicy foods and alcohol.
  • Try not to hold urine. An overdistended bladder can be more difficult to empty and cause pain, as well as potentially leading to urinary tract infections.
  • Reduce stress and anxiety. Exercise and mediation can help with these lifestyle changes.

How to Sleep Better with an Enlarged Prostate

While and enlarged prostate can lead to nocturia, there are some ways to increase the likelihood of sleeping soundly through the night. The right balance of diet, exercise, and a few other lifestyle habits can lead to better quality sleep. In turn, this can lead to a better quality of life. If an enlarged prostate is causing nocturia, the following tips may help you get a better night’s sleep.

  • Avoid consuming excessive liquid at night: With less liquid being processed at night, nocturia interruptions while sleeping may lessen. Try to stay properly hydrated throughout the day but taper fluid intake a few hours before bed.
  • Avoid caffeine at night: Caffeine is a diuretic that increases urine output so it’s best to avoid with nocturia. It’s also a stimulant making falling asleep and staying asleep more difficult.
  • Avoid alcohol at night: Although alcohol is a sedative and may make falling asleep easier, it does nothing positive for the sleep cycle or REM sleep which is an important aspect of waking up feeling well rested and refreshed.
  • Exercise regularly: Light aerobic exercise like walking and anaerobic like lifting weights has been shown to have a positive impact on sleep quality. Adding either or both of these activities into your daily routine may help you sleep more soundly through the night. Sleeping better because of light exercise, about 30 minutes per day, can be seen right away. Additionally, those suffering from an enlarged prostate can benefit from the stress reduction that usually occurs with regular exercise. Since exercise releases endorphins which make us feel more alert and awake, it’s best to exercise in the morning into early evening to avoid having trouble falling asleep.
  • Maintain good sleep hygiene: Good sleep hygeine encompases several aspects of the bedtime routine. Going to bed at a consistent time each night, sleeping in comfortable bedding in a dark and quiet environment, and knowing how many hours of sleep you need each night to feel refreshed in the morning are all important. Following these guidelines will help you get the best sleep possible while dealing with nocturia.
  • Meditation: Practicing deep relaxation techniques may help with getting a better night’s sleep. This could be as simple as breathing exercises. Meditation promotes muscle relaxation, making it easier to fall asleep. Some men suffering from an enlarged prostate and nocturia are anxious and tense. Meditation, especially breathing techniques, can alleviate some of this tension. Not only does meditation help with sleep, it may help with managing an enlarged prostate. Doctors recommend those suffering from an enlarged prostate reduce stress if possible.
  • Empty the bladder completely before bed: Doctors recommend using the “double voiding” method. Double voiding is done by sitting on the toilet, urinating like usual, waiting 20-30 seconds while relaxed and repeating the urination. This helps with making sure the bladder is empty. A completely empty bladder will allow for the maximum time between trips to the bathroom at night.
  • Maintain ideal sleep conditions: Keeping the room at a comfortable but cool temperature, sleeping on a comfortable mattress that works well for your sleep position, and in clean and cozy bedding will help to get restful, uninterrupted sleep.
  • Melatonin: Melatonin a hormone our bodies naturally produce. It aids in our brain telling our bodies it’s time to sleep. The body’s production of melatonin decreases with age. Eating foods that increase the body’s production of melatonin like nuts, cherries, and bananas, or taking a melatonin supplement may help with falling and staying asleep with nocturia.

Additional Tuck Resources

If you’re looking for additional information on how to get good sleep at night despite nocturia, these comprehensive Tuck resources will help.