Urological Diseases and Sleep

Millions of Americans suffer from a urological disease (UD). These diseases of the urinary system can cause embarrassment, pain, and sleepless nights. However, their symptoms are often incorrectly written off as a normal part of aging despite effective treatments being available.

There are clear connections between urological diseases and sleep problems. UD can cause sleep dysfunction, but sleep disorders like obstructive sleep apnea can also be a factor in the development of urological disease.

In this article, we will cover common urological diseases, their treatments, and their connection to sleep disorders. We will also explain the importance of quality sleep and how people suffering from a UD can achieve a better night’s rest.

What Are Urological Diseases?

The urologic system (also known as the urinary system, the urinary tract, and the renal system) includes your kidneys, bladder, urethra, and prostate (in men). It’s how your body eliminates waste and excess fluid through urine.

Urological diseases involve one or more parts of your urologic system. They usually affect when and how you urinate, but other symptoms can be as diverse as depression, excessive thirst, and sleep disorders. Some are temporary, while others are chronic.

All ages and genders can be diagnosed with urological diseases, but rates often rise with age. Benign swelling of the prostate gland is a common cause of male urological diseases, while women are more likely to experience urinary incontinence.

Common Urological Diseases

Although there are many urological diseases, three are very common: Lower Urinary Tract Symptoms (LUTS), Urinary Incontinence (UI), and Nocturia. Many people consider these a normal part of aging. Instead, they are diseases with varied causes and effective treatments.

Lower Urinary Tract Symptoms (LUTS)

These are common symptoms which involve the urinary system: the bladder and its muscles, the urethra, and the prostate in men. LUTS is usually caused either by a blockage (such as an enlarged prostate) or a lack of coordination between the different parts of the urinary system.

Because of these different causes, there are two types of LUTS which can be experienced separately or together.

Voiding or obstructive symptoms are experienced when urinating:

  • Being unable to urinate despite feeling the need
  • Still feeling the need to “go” after urinating
  • A weak, slow stream of urine
  • Overflow incontinence, a type of urinary incontinence (see below)

Filling or irritative symptoms are related to the urge to urinate:

  • Urinating frequently
  • The intense need to urinate
  • Waking often to urinate at night, known as nocturia (see below)
  • Urge incontinence, a type of urinary incontinence (see below)

LUTS affects one in five adults and is most common in people 65 years old or older. Because of the prostate’s role in voiding symptoms, more men experience symptoms than women. However, people of any gender or age can suffer from LUTS.

Like all urological diseases, people often see LUTS as a normal part of aging. Instead, it can be caused by a variety of issues which are common among seniors but are not a natural result of growing older.

Depending on the type, these causes include an enlarged prostate, scarring in the bladder or urethra, bladder stones or tumors, bladder hyperactivity or other bladder muscle issues, and confused sensory information between the brain and the urinary tract.

LUTS is a major cause of disordered sleep among sufferers. Even when nocturia isn’t present, the pain and incontinence can cause insomnia and lack of quality sleep.

Urinary Incontinence (UI)

People suffering from urinary incontinence either urinate without meaning to, feel the urge to urinate more than usual, or find small amounts of urine “leak” from them throughout the day. This is a common problem which can have a significant impact on quality of life.

There are four main types of urinary incontinence. If you suffer from more than one kind, you are said to have mixed incontinence.

Stress incontinence refers to physical stress, not mental, even though the results can be very distressing. If urine leaks out because of movement (like running, laughing, coughing, or changing position), this is considered stress incontinence. Usually only a small amount of urine is involved, though a full bladder can lead to more being released. Weak pelvic and bladder muscles, pelvic organ prolapse, and nerve damage can all cause stress incontinence.

Urge incontinence is also referred to as having an overactive bladder. People suffering from this type of incontinence often feel as though they have to “go” even if their bladder isn’t full. This urge is both sudden and overwhelming. For some people, this leads to urinating before reaching the bathroom. Nerve damage, overactive pelvic muscles, and bladder irritation can all cause urge incontinence.

Overflow incontinence is the result of your bladder becoming too full. This stretches the muscle which normally holds in urine and causes some to flow out without you feeling the usual urge to urinate. While many people have experienced this if something stops them from using the bathroom for a long time, the chronic condition is usually the result of something (like an enlarged prostate) preventing you from fully emptying your bladder when you urinate.

Functional incontinence occurs in people who struggle with urinating normally despite having no problems with their urinary tract. For example, if your arthritis keeps you from reaching the bathroom or undressing in time, this is functional incontinence.

Between 3% and 7% of Americans regularly suffer from urinary incontinence. Some researchers believe the number might be even higher since many people are embarrassed to talk to their doctor about the problem. Below the age of 80 more women than men struggle with incontinence, but above 80 years old both men and women are diagnosed equally.

All forms of incontinence can keep sufferers from having a good night’s sleep. Absorbent bed pads provide peace of mind, but further treatment is often required to resolve the impact incontinence has on sleep.

Nocturia

Nocturia, which means waking up to urinate, is both a lower urinary tract symptom (LUTS) and a disease in an of itself. This may be surprising to some people who see it as a normal part of life or aging.

Most people are only bothered by nocturia when it causes them to wake three or more times in one night. However, waking up even once to have to go to the bathroom is considered abnormal when it happens regularly and disturbs your sleep.

Because sleep is so important, our bodies try to avoid disturbing it. When our urinary tract is functioning normally, our bodies slow the production of urine and don’t usually signal the need to urinate until we wake up in the morning.

There are two main types of nocturia, each with specific causes. If both appear together, this is known as mixed nocturia.

Nocturnal polyuria means producing more urine at night than during the day. Because you will still wake up if your bladder is full, this can lead to needing to urinate just as often (or more) at night as you do during the day. Sleep conditions like circadian rhythm disorders and sleep apnea can cause nocturnal polyuria, but so can disorders like diabetes or heart conditions.

Bladder storage problems are caused by your bladder not fully emptying during the day, or not being able to store as much urine as it should. This is common in men who suffer from prostate issues. In both men and women, it can also be the result of bladder or urethral scarring, bladder stones, and tumors.

Anyone can suffer from nocturia, but rates do increase with age. Nocturia in women under the age of 50 is more common than in young men. Above the age of 60, prostate problems make men more susceptible.

Urological Diseases and Sleep

All urological diseases can interrupt your sleep. This can have a significant impact on both your physical and mental well-being, and is one of the primary reasons why a urological disease can lower your quality of life.

The Stages Of Sleep

When we sleep, we cycle through four distinct stages:

Stage Description
Stage 1 The lightest sleep stage. During stage 1 sleep your muscles begin to relax and it is easy to wake you up.
Stage 2 Your body temperature drops, your heart rate slows, and it becomes more difficult to wake you up.
Stage 3 This is when restorative “deep sleep” occurs. If you don’t get enough deep sleep, you’ll still feel tired when you wake up.
REM Sleep REM sleep is the dreaming stage. It’s easier to wake up from REM sleep, but it will leave you feeling confused and sluggish.

Not every stage is present in every cycle, but most people go through four or five cycles in one night. This allows them to experience the full benefits of sleep.

When these cycles are disturbed by a urological disorder such as nocturia, the sleep cycle pattern becomes unbalanced. This can result in not getting enough deep sleep or REM sleep, even if you sleep almost as long as you would otherwise.

The Importance of Quality Sleep

The amount of sleep we get is important, but the quality of our sleep is equally critical. When your sleep is interrupted, its quality goes down.

Missing out on sleep stages like deep and REM sleep is a kind of sleep deprivation. Since deep sleep is what seems to reset our need to rest, nights without enough of it can leave you feeling exhausted and as though you barely slept at all.

Urological disorders can also make it difficult to fall asleep, whether initially or after waking.

We need to sleep for a wide range of reasons. Likewise, whatever the cause of sleep deprivation, it affects all parts of your life. Beyond feelings of fatigue, lack of quality sleep can impact focus, reaction time, memory formation and recall, mood regulation, and more.

These issues aren’t minor. For example, people who don’t get enough sleep are more likely to be in a car accident, regardless of whether they feel tired at the time.

Poor Sleep Health and Disease

Sleep deprivation doesn’t just dull our mental faculties. There are strong links between chronic sleep problems and an increased risk for certain diseases.

Type 2 diabetes, for example, has been linked to sleep loss in multiple studies. From a lifestyle perspective, lack of sleep leads to less of the hormone (leptin) which tells us we’re no longer hungry and more of the biochemical (ghrelin) which stimulates our appetite. For obvious reasons, this makes eating healthy more difficult when sleep deprived.

However, people who have not slept enough also process glucose more slowly. The lack of sleep disrupts our metabolism and creates a temporary pre-diabetic condition by reducing blood sugar regulation. Together, these factors create an increased diabetes risk.

Like diabetes, sleep problems factor into other diseases. Researchers link poor sleep health to heart problems, high blood pressure, obesity, Alzheimer disease, and cancer.

Sleep Disorders and UD

Urological diseases are not unique. As with other conditions, they are closely associated with sleep disorders and lack of quality sleep. While research into these factors is ongoing, we do understand the way some sleep disorders and urological diseases are connected.

How Sleep Disorders and Urological Diseases Are Related

Studies have shown a correlation between urological diseases and sleep disorders. Although some diseases associated with sleep disorders (like obesity and diabetes) can be factors leading to urological problems, studies have shown that this is not the only connection. The relationship persists throughout the daytime as well, ruling out any problems based solely on waking up throughout the night.

Even in cases where weight is a factor in both sleep and urological disorders, the two issues are not separate. Improving sleep health seems to help with urological diseases, and treating urologic symptoms leads to better sleep.

This may partially be because sleep disorders and poor sleep quality are related to more severe urological symptoms. A study focusing on people with overactive bladders (urge incontinence) found that those with poor sleep quality had worse symptoms overall.

Although the specific factors connecting urological diseases and most sleep disorders are still being researched, the connection has been proven many times.

Sleep Apnea

Researchers have a clear understanding of how sleep apnea relates to urological diseases like nocturia.

People suffering from obstructive sleep apnea stop breathing for short periods multiple times in one night. When they start breathing again, they often gasp, snort, or snore loudly. Snoring is commonly recognized as an important sign of sleep apnea, but one study found that more people with sleep apnea reported nocturia than snoring.

This may be because sleep apnea can directly cause nocturia. When someone stops breathing during sleep, their body reacts to the drop in oxygen and the rise in carbon dioxide levels. They wake up enough to breathe at the same time as their heart is releasing a protein telling their body to get rid of excess sodium and water. For many people, this feels as though they’ve woken up to use the bathroom, when in fact they woke up to breathe.

Luckily, the same study showed that treatment for sleep apnea using continuous positive airway pressure (known as CPAP therapy) also showed a significant reduction in nocturia.

Insomnia

People who have insomnia have trouble falling or staying asleep at least three nights a week. Around 20% of Americans suffer from insomnia. Around half have chronic insomnia (lasting three months or more), while the other half find their insomnia resolves in less than three months. The two subsets of insomnia are sleep-onset (difficulty falling asleep) and sleep-maintenance (difficulty staying asleep).

People who suffer from urological diseases are more likely to suffer from insomnia than the general population. In one study, men with LUTS were nearly 54% more likely to have some form of insomnia than a control group.

Nocturia is strongly associated with sleep-maintenance insomnia. A survey found that waking up to urinate was the most common reason why people wake up at night across all ages. Once awake, it can be difficult to fall back asleep.

If you have insomnia because of a urological disease, you are not alone. Overall, one out of every two patients with a urological disease is speculated to develop a sleep disorder specifically due to their condition.

UD and Mental Health

Sleep disorders, urological diseases, and mental health issues are all closely linked.

There is no one reason for this, given how interrelated the disorders are. In addition to the connections between urological diseases and sleep disorders discussed above, mental health problems can exacerbate or be caused by both issues.

Depression is more common in people suffering from urological disease as well as people coping with sleep dysfunction. Anxiety is also common for both groups, and may also be a risk factor in developing urological cancer.

Sleep disorders are also a primary symptom of depression and other mood disorders, to the extent that some researchers consider sleep disturbances part of the criteria for a depression diagnosis.

There are no linear patterns when it comes to urological disease, sleep disorders, and mental health. Because of the complexity of these relationships, the line of cause and effect remains unclear, and is arguably unique to each individual situation.

Just as treating sleep disorders can result in reduced urological symptoms (and vice versa), treating either usually helps improve mental health issues.

However, some standard treatments for urological disease can increase rates of depression and anxiety. This is one reason why it is vital to discuss any mood or mental health problems with your doctor as part of your urological treatment.

Treating UD

Finding the right treatment for a urological disease can have a cascade effect, improving many aspects of an individual’s life. Sleep problems can be significantly improved, which then has the potential to further improve urological symptoms. While there are a wide range of treatments for each urological disease, here are some of the most common.

Non-Medical Treatments

Non-medical approaches are often the first step in UD treatment. Not only can sufferers begin them immediately, but they can also reduce symptoms so dramatically that further intervention isn’t necessary.

  • The most common treatment for urinary incontinence is the use of absorbent products. These can be used day or night, and come in a wide range of styles to make them more comfortable and less visible through ordinary clothing. Improvements in absorbent technology, such as superabsorbent gels, also reduce noise and the likelihood of leaks. However, the number of styles on the market means it can sometimes take time to find one that is right for you.
  • Specific exercises can help reduce urological symptoms. Kegel exercises, or squeezing and relaxing the pelvic floor muscles, have been shown to help with both stress incontinence and an overactive bladder in women. Overactive bladder sufferers are also encouraged to train their bladder by urinating on a schedule with increasing intervals between bathroom visits. This low-cost treatment plan can calm an over-sensitive bladder muscle over time.
  • Given that obesity and diabetes are both factors in urological disease, weight loss and regular exercise are popular treatment choices. However, your diet can also have its own effect on urological symptoms. One study found that increased levels of vitamin C, vitamin A, and beta-carotene (found in vegetables like carrots) were related to lower levels of voiding or obstructive LUTS. Given that the study focused on consuming these nutrients as part of a healthy diet, not as supplements, it creates more support for dietary change as a way to treat urological disease.
  • People suffering from nocturia can often find relief through lifestyle changes. Limiting your fluid intake after dinner naturally results in less urine production through the night. Caffeine and alcohol are particularly important to avoid later in the day, as they have mild diuretic effects which encourage urine production by the kidneys.

Medical Treatments

Medical treatments for urological disease fall into three categories: medication, minimally invasive treatment, and surgery. Each comes with its own benefits and drawbacks, but your doctor will be able to discuss the right option for you.

While there are too many UD medications to cover here, many fall into three classes:

Medication Type How They Work Effect Often Prescribed For
Anticholinergics Blocks a neurotransmitter from sending messages between cells Calms bladder contractions and bladder oversensitivity Urinary incontinence, particularly urge incontinence
Alpha blockers Relaxes muscles in the bladder and prostate Improves urine flow Voiding or obstructive LUTS
5-alpha inhibitors Reduces levels of the hormone associated with prostate enlargement Slows the progress of LUTS caused by benign prostate hyperplasia (BPH) Voiding or obstructive LUTS

Some urological symptoms (such as nocturia) are side effects of medication to treat other problems. In these cases, doctors work with patients to reduce the effects or explore other medication options.

Non-invasive and minimally-invasive treatments are designed to treat UD with as little impact on a patient’s body as possible. Though they are highly specific to the disease they address, they range from using heat and microwaves to destroy excess prostate tissue causing LUTS, to breaking down urethral tissue to treat stress incontinence. These and other procedures limit pain and recovery time and can have dramatic effects.

Surgical treatment is also available when medication and non-invasive therapies prove ineffective. Some surgeries are minimally invasive themselves (like inserting a urethral sling to treat incontinence) while others (like open prostate removal for LUTS) involve a lengthier recovery time.

Although all urologic surgeries have drawbacks, they can still increase a patient’s quality of life. Many surgeries have also improved with advancing techniques and knowledge, making them viable options when patients don’t respond to other treatments.

Most UD sufferers find that the right treatment for their disease also helps them get a good night’s sleep.

Getting Quality Sleep with UD

Although effective treatments for urological diseases exist, it can take time to find the right one. In the meantime, following your non-medical treatment plan and practicing good sleep hygiene can help you get the quality sleep so critical to your physical and mental health.

If you’re unfamiliar with the term, sleep hygiene refers to your bedtime habits and rituals. Good sleep hygiene starts with going to bed at the same time every night, which is then supported by healthy bedtime routines and an environment that helps you sleep.

Sleep Routines

Whether you’re aware of it or not, you already have a sleep routine. For many people, their routine involves staying up until midnight watching TV or scrolling on their phone.

Instead, a healthy sleep routine should be relaxing, free from electronics, and the same pattern every night. This creates a ritual which signals to your brain that sleep is approaching.

Tailoring your sleep routine to your own needs is important. For example, many people drink herbal tea to begin winding down for the night. If you suffer from nocturia, your doctor may suggest avoiding fluids after dinner.

Find a calming routine which works for you, then do your best to repeat it every night.

The Right Environment for Sleep

It’s important to keep your bedroom cool, dark, and quiet. These qualities not only signal to your body that it’s time to sleep, but they also help you stay asleep once you drift off.

However, light and noise levels you’re not consciously aware of can still disrupt your sleep. Electronic LEDs (like the charging light on your phone) are a common source of bedroom light pollution, as are outside lights.

Blackout curtains and a sleep mask can help you darken your sleep environment, while white noise apps are useful if you live in a noisy area.

Electronics, Blue Light, and Sleep

Electronic screens and energy-efficient bulbs both produce light with blue wavelengths. During the day, these wavelengths boost our energy and mood. However, they also mimic sunlight. This can confuse your body’s clock, particularly when you expose it to blue light after dark. Once your circadian rhythm is thrown off, it becomes increasingly difficult to sleep normally.

Avoid blue light after dark, particularly 2-3 hours before bed. If this isn’t possible, consider purchasing glasses which block blue light. Though your body will still be affected, the reduction in blue light alleviates the impact.

Aromatherapy and Meditation

These holistic approaches to sleep health can be helpful if you struggle with sleep anxiety. (After all, it can be difficult to relax if you’re worried about how many times you’ll be waking up during the night to use the bathroom.)

Most electronic aromatherapy diffusers shut off automatically when out of water, making them ideal for use at night. Research into the effectiveness of essential oils is still ongoing, but studies do indicate that some oils (such as lavender) can provide a soothing, sedative effect.

Research also supports the use of meditation and mindfulness to decrease anxiety and promote better sleep. While there are many techniques, meditation can be as simple as focusing on a word or your breath for a set length of time.

Conclusion

Urological diseases are a common problem with a complex set of causes, symptoms, and treatments. They have a clear connection to sleep disorders, both causing and being caused by a lack of good quality sleep. Luckily, treating one issue often leads to improvement in the other.

We hope this article has helped you make sense of the relationship between sleep and urological disease. It is important to remember that you do not have to live with the symptoms of sleep dysfunction or urological disease when there are effective treatments to help you feel better.

Further information on urological diseases:

  • Urologic Diseases In America – Published by the American Urological Association, this study covers the prevalence, impact, and treatment of urological disease in America.
  • Urology Health Extra – A free quarterly magazine published by the Urology Care Foundation, its archives are a treasure trove of information.

Additional Tuck Resources

You can learn more about sleep problems and how to get a better night’s sleep by visiting our other Tuck articles below: