Ken, like many men, had been nagged into coming to see me by his wife. She was exhausted. Every time he got up in the night to go to the loo, he woke her too – and what had started as once a night had crept up to four, five or even six times.
Ken was remarkably relaxed about it. It was his prostate, he told me. All his friends got up at night too. It was just part of getting older.
It’s an answer I hear almost daily. Ask a man over 50 why he’s up at night and he’ll blame his prostate, the small gland that produces a fluid which makes up part of the semen and grows larger with age, often leading to bladder issues.
The idea is so ingrained that many stop considering anything else. More worryingly, so might their doctors.
Waking at night to urinate, known as nocturia, is incredibly common in older men. But it is a symptom, not a diagnosis. It has many possible causes, each with a different treatment – and the prostate may not be the main culprit at all.
In some cases, nocturia can be a sign of a life-threatening disease, so it should never be ignored.
And, even if the cause is harmless, you don’t have to put up with the symptom.
Ideally you wouldn’t wake at all, though once a night is considered acceptable. Anything more is worth investigating.
Waking at night to urinate, known as nocturia, is incredibly common in older men, says DR PHILIPPA KAYE. But it is a symptom, not a diagnosis.
The first step is to keep a bladder diary. For three days, note the time and rough volume of everything you drink, and every time you pass urine, day and night.
To measure the volume, keep a plastic jug by the loo and pee into this, before measuring the level and then emptying it into the toilet (just remember to rinse it out each time). It’s a hassle, but within days a revealing pattern emerges.
Usually one of two pictures appears.
In the first, you produce a normal amount of urine overnight but can’t hold much, so you go often, day and night.
This is a storage problem, and the one most likely to involve the prostate, which enlarges with age and can obstruct the bladder’s outflow.
Medication that can relax the muscle in the prostate and bladder or even reduce the size of the prostate can help. In severe cases, men are offered surgery to cut away sections of the enlarged prostate.
GP, author and broadcaster Dr Philippa Kaye
In the second picture, you produce a genuinely large volume overnight, far more than you’d expect from someone asleep. And unless you are downing two litres of water before bed, this could be due to an underlying health condition.
It could be an issue with the kidneys, the organs responsible for filtering water and waste from the blood. When damaged, the kidneys can produce too much urine.
This damage is typically caused by chronic kidney disease – a silent condition where the organs slowly stop working. It is usually triggered by lifestyle factors such as poor diet, obesity and excessive alcohol consumption.
An increased need to pee is often one of the first signs.
GPs can carry out a blood test called an eGFR, which can spot kidney disease. It is usually treated with lifestyle changes, such as regular exercise and improved diet, or, in advanced cases, medication.
Another commonly missed cause is diabetes. The high blood sugar condition often causes frequent urination. Interestingly, it is closely linked to kidney disease – many patients have both – and is treated with similar lifestyle changes and drugs. It can also be diagnosed via a simple blood test.
Medications, such as some blood pressure tablets, can also be to blame. So too can alcohol and caffeine, so it’s important to avoid drinking either in the hours before bed or in the afternoon.
However, there is a very common cause of nocturia that many men do not realise they have.
Which brings me back to Ken. His wife said it wasn’t just his needing to pee in the night that woke her up. Ken also snored extremely loudly.
When I heard this, I knew the two things could be connected. Because Ken, as it turned out, did not just have a simple snoring problem – he had a condition called obstructive sleep apnoea.
Some obstructive sleep apnoea patients chose to get something called a CPAP machine (short for continuous positive airway pressure) – a face mask worn during sleep that uses air pressure to keep the airways open
Sleep apnoea happens when the throat muscles relax during sleep and block the airway. Sufferers snore loudly, then seem to stop breathing, or gasp, before briefly waking and starting again, often with no memory of it.
It is more common in men, especially in those who are carrying extra weight or are later in life.
Crucially, sleep apnoea drives nocturia. This is because straining to breathe against a blocked airway creates pressure in the chest that stretches the heart’s upper chambers. These release a hormone called atrial natriuretic peptide, which tells the kidneys to dump excess water just when the body should be conserving it.
The result is a combination of symptoms that disrupt the sleep of countless men and their long-suffering partners.
But the condition is more than just annoying. It can also be deadly as, over time, sleep apnoea raises the risk of heart disease.
The good news is that treating sleep apnoea reduces nocturia.
Some patients choose to get something called a continuous positive airway pressure (CPAP) machine. This is a face mask worn during sleep that uses air pressure to keep the airways open. However, it isn’t a cure, meaning patients have to wear it every night.
Moreover, it is cumbersome and loud – so most patients would prefer not to use a CPAP machine if possible.
Instead, for many patients, losing weight is one of the most effective means of beating sleep apnoea. This is because, when patients slim down, there is less pressure on their airway, easing symptoms.
And when this happens, patients are also less likely to suffer nocturia – improving sleep for patients and their partners.
Broken sleep night after night takes a real toll on physical and mental health. So don’t shrug it off as your prostate. Start that diary, make some changes and see your doctor.
