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In This Episode:
Dr. K talks with geriatrician Shachi Tyagi, MD, Assistant Professor of Medicine at the University of Pittsburg. Her research focuses on two common issues in older adults, insomnia and having to urinate at night (nocturia). They discuss:
- Why nocturia becomes common as we age
- Common health problems that may be related to nocturia
- The relationship between nocturia and sleep problems
- How nocturia should be assessed and how it can be managed
- “Brief behavioral treatment” and other recommended insomnia treatments that can also improve nocturia
- Why sleep medications should be avoided in aging
- How to reduce the risk of nighttime falls related to nocturia
- Options for addressing nocturia and sleep issues in dementia
- Tips on tracking bladder and sleep symptoms, and how to get help from your health providers
Related episodes:
032 – 5 Top Causes of Sleep Problems in Aging
088 – Interview: Avoiding Inappropriate Prescribing in Aging & What to Know About the Beers Criteria
Related Resources:
- Studies published by Dr. Tyagi
- American Urological Association: Urology Care Foundation
- National Sleep Foundation
- BHWA
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ALFREDO LEISER says
HI AND THANK YOU FOR YOUR COMPREHENSIVE REVIEW OS SLEEPING DISORDERS.
MY PROBLEM:
I AM A 85 YEAR OLD PHYSICIAN SPECIALIST IN INTERNAL MEDICINE AND GASTROENTEROLOGY.
SINCE CHILDHOOD I AM A NIGHT SLEEPER WITH DIFFICULTIES TO WEAK UP IN THE MORNING, I ALWAYS PREFERRED TO STUDY AT NIGHT WHEN MY EYES ARE WIDE OPEN AND I AM ABLE TO LEARN WELL. IN THIS DAY I AM TRYING TO SLIP EARLIER AT NIGHT AND CAME UP EARLIER IN TH MORNING BUT WITH NO GOOD RESULT. I GO TO SLEEP PREFERIBLE AT 4AM AN WAKE UP AT 11,30 OR 12 AND I LOOSE HALF OF THE DAY. I AM TAKING MELATONIN AND GO TO SLEEP AT 2 AND SLEEP QUITE WELL AND WAKE UP AT 10,30-11 AM. I TRIED TO REVERSE MY TIME TO GO SLEEPING AND WENT TO SEEP AT 11 AN WAKE UP AT 6 BUT SLOWLY IT GO BACK TO MY USUAL TIME OF LATE SLEEPING, I DID THI A FEW TIMES BUT IF DIDN’T STAY IT ALWAYS RETURNS TO THE LATER SLEEP HOURS. I WOK ABOUT 40 MINUTE EVERY DAY, I AM IN A GOOD PHYSICAL CONDITION, I AM RETIRED FROM MEDICINE, I HAVE A HOBBY -WOODTURNING- BUT I HAVE ALGO GAIT PROBLEMS WHILE WOKING DUE PROBABLY TO CEREBRAL SMALL VESSEL DISEASE.
IS THERE A POSSIBILITY TO CORRECT THIS SLEEPING PATTERN ?
THANK YOU IN ADVANCE
Nicole Didyk, MD says
Many older adults have unusual sleep patterns related to their working lives (physicians, shift workers, entertainers). Some just accept it and adapt their lifestyles accordingly.
If it bothers you, I think there’s a very good chance you can change your sleep hours with cognitive behavioral therapy for insomnia (CBTi). You can learn more about it in this article: /wp-admin/post.php?post=2390&action=edit Most people who do CBTi are having trouble falling asleep, but the principles are the same if you’re looking to change your sleep phase times (i.e. go to bed earlier and wake earlier).
Another good resource is the website: http://www.mysleepwell.ca. Best of luck and thank you for commenting!
Jini Coolen BRIGGS says
I am not quite certain how this works. BUT …. here goes.
I am a 92-year-old woman who has difficulty with “turning off my “thoughts at night”.
All the things one should do – we’ve done (married 30 years – 8 years younger great guy but does not understand this lol). Health? Cardiologist “You are Phenomenal”. Other Doctor “I suppose you get tired of people saying you don’t look 92″….. MY ONLY son, died of cancer 08/10/20, We were very close – spent his 21st birthday on an Alp in Switzerland when he was in the arms. He lived close,
and we had Sunday coffee for the last several months of his life. Almost all friends are gone or not in good health…. I’ve been active most of my life. 45 yrs. working, volunteering, exercising taking classes (still do). Cannot drive because I do not see well enuff.. Even though I don’t get 7 hrs. sleep – I wake up, shower, fix breakfast, do dishes, wash clothes or the floor, dust – etc. ?? Then nap – kinda…. BUT cannot sleep at night. Jini
Nicole Didyk, MD says
I’m sorry to hear about the loss of your son and your friends.
It sounds like you’re physically active and fully engaged in life, and I can understand having a lot on your mind. Dr. K has a good article about causes of insomnia that you might find helpful: /top-5-causes-sleep-problems-in-aging-and-proven-insomnia-treatments/. I’m glad you aren’t taking sleeping pills, and perhaps some mindfulness or relaxation exercises could help!
Joanne Miller says
My 85 yr old husband is in home Hospice care. He does not have frequent urination in daytime but has me up every 1-2 hrs at nite to get him to the bathroom. He wears a diaper at nite but prefers toilet. I am exhausted from lack of sleep. I suspect he is not emptying his bladder completely when he goes at night but does not have problem during days. Hospice sympathetic but no help.
Nicole Didyk, MD says
That does sound frustrating for both of you. Ideas can include offering him a urinal or bedside commode so the trips are less complicated.
Scheduled toileting during the day might promote an empty bladder at bedtime, for example getting him to go every 2 hours while awake.
I’d also look at his medications to see if he’s taking a “water pill” or diuretic in the afternoon, and if that could be switched to the morning.
Finally, if there is any way to get overnight help, even once in a while to give you a break, I’m sure it would make a big difference.
Sylvia Crosby says
Just listened to you and Ast Professor Tyagi on nocturia – thank you, it was an very good interview and Professor Tyagi was excellent at explaining things; I wish she was in the UK so I can visit her!
I am 82 years old and suffer from nocturia but my problem is that I cannot empty my bladder fully, haven’t been able to for years and years, my mother had a same problem in her old age. I also have problems sleeping so I am an excellent example of what Professor Tyagi described.
Nicole Didyk, MD says
I’m so glad you enjoyed that podcast! It’s one of my favorites. I’m sorry to hear about your difficulty with bladder emptying, and this can be a common issue, often in those with diabetes. What a urologist usually recommends is a schedule of regular voiding to try to keep the bladder as empty as possible. If a lot of urine is left in the bladder, some individuals use a catheter intermittently. I hope you find some relief and thanks again for listening.
LP says
Hello,
My grandma frequently urinates in her sleep and my family tries to wake her in the middle of the night for a bathroom visit to either change her depends pad or so that she doesn’t go in it in the first place. Sometimes she’s compliant but other times she’s not and says she’d rather sleep (even though we know this means she could potentially be sitting in a soaked diaper for many hours. She typically sleeps from 11pm to 2pm the next day).
Is it better to let her sleep and have her sit in a wet diaper for up to 10+ hours? Or continue attempts at changing her/taking her to the toilet at regular time intervals (Ie every 5ish hours) even though it means breaking up her sleep and potentially causing agitation?
She is 94 and has early dementia. She also has vocalizations from time to time that may contribute to lack of sleep.
Thank you!!
Nicole Didyk, MD says
Thanks for sharing your story and I’m sorry to hear about the nighttime difficulties that your grandmother is having.
In a situation like the one you’re describing, it seems inevitable that a person who is in bed for 15 hours will need to get up and urinate at some point, and staying in a wet diaper is a risk factor for skin problems and infection. But as with many things in Geriatrics, this would likely be a bit of trade-off and waking someone from sleep for any reason risks that they will have trouble getting back to sleep and be cranky.
One approach is to try to make the trip to the toilet as short and simple as possible, for example, using a bedside commode. If an older person with dementia wakes up with vocalizations, going to the toilet might help to calm the person down and promote getting back to sleep. It would also be helpful to review medications to determine if there are any that are contributing to over-sedation. Sometimes incontinence medications can help with nighttime urination, so that might be worth discussing as well.
Minal mehta says
Hi my mother is 85 and she has to urinate or is having to use the washroom every 45 min so is there any soliciting to this place advice ASAP
Nicole Didyk, MD says
Urinary frequency is invariably complex to sort out. My approach is to start by ruling out any reversible problems, like a urinary tract infection, high blood glucose or blood calcium level, medications, or lifestyle habits. After that, it’s a matter of reviewing the person’s symptoms in detail and looking for specific patterns that can give clues to the cause of the frequent urination. In short, there usually isn’t an ASAP answer, but taking a careful and thorough approach, as we do in Geriatrics, is most likely to get results.
In says
85 year old just cannot sleep with diapers on. As a result he is not sleeping in night or day. Any solutions
Nicole Didyk, MD says
For some older adult males, a condom catheter can be more comfortable than a diaper, believe it or not. This involves putting a condom on the penis, which is then connected to a catheter that is connected to a bag. The person can stay dry without a diaper, They aren’t foolproof but might be worth exploring in a situation like the one you describe.
Danielle says
You mention “reassuring them it’s ok to use the diaper” is easier said then done. Any tips besides sharing that we are unable to safely get them in and out of bed at night, and that this needs to be a team effort and there using the diaper is their contribution.
Nicole Didyk, MD says
Hi Danielle. You’re right that there’s no easy answer to such a complex and exhausting challenge. I have heard from my patients’ care partners that there can be a lot of trial and error with finding an incontinence product that doesn’t leak and feels comfortable, and that may help. Sometimes it’s necessary to insert an extra product into a brief for example. Knowing your family member best, there may be another key phrase that makes it acceptable for them to urinate in the product rather than get up. Don’t give up.
Kailah says
Hi! My grandma kept telling me how hard for her to sleep when it is passed midnight. I didn’t gave it attention because I thought it was just because she sleep early. However just today, she told me thay she didn’t get any sleep at all. She also been peeing on her pants recently. I just wanna know if she’s struggling from an illness or it’s normal for aging adults.
Looking forward for your immediate response.
Nicole Didyk, MD says
Hi Kailah. In general, people require less sleep as they get older, probably between 6 and 8 hours is sufficient. There can be many reasons why a person is having trouble sleeping, and needing to urinate at night can be one of them.
Incontinence of urine isn’t a normal part of aging, but it can be more common in older adults. Here’s a video that might be helpful.
Alex says
My dad is 93 year old he suffer with light form ofdementia and he will not sleep during the night. He keep getting up all the time to go to the bathroom up to 50 times a night and keep forgetting that he has already been. He can’t walk by himself so my brother has been looking after him for over a year now. He been taking sleeping pills really strong but not effecr on him. We don’t know what else to do. My brother he is getting ill. Please anyone can advise me something. Thank you
Leslie Kernisan, MD MPH says
This can be a tough situation. As Dr. Tyagi mentions in the article, normally the ideal would be to evaluate his urinary frequency, to try to determine what’s causing it and to see if it’s possible to help him need to urinate less at night. For instance, we would check to see if he is often retaining urine in his bladder, and only having frequent very small pees. (If this is the case, finding a way to more substantially empty his bladder each time might help.) Sometimes making changes to medications can help with this. There are also other behavioral approaches to try to adjust a person’s urination schedule.
From a practical perspective, some approaches families sometimes use include:
– putting the mattress on the floor, so that the person can’t get up and fall as easily
– encouraging a bedside urinal
– having the person wear an adult diaper at night, and reassuring them it’s ok to use it
I also have more suggestions on sleep and dementia here: How to Manage Sleep Problems in Dementia. good luck!