Is your nocturnal urinary frequency normal? | Peter Attia & Ted Schaeffer

[@Zoet50]

I’m 67 and my night time urination frequency is directly tied to my daily activity. If I row, bike and run hard on a given day I sleep through the night like a baby . If I don’t workout at all I get up usually twice .

[@shaleel]

Any difference between easy cardio and hard cardio?

[@andersonstl]

I'm 50. I have noticed the same about sleep.

[@MNaeem5]

I get up once normally at age 52 but like you if I workout hard that day I sleep through the night but if I drink too close to bedtime might get up twice .

[@blazedehart2748]

Wtf. Dude. Same here! On training days I sleep through. Off days I will wake up to pee. That’s crazy that I never connected those!

[@b.hornetiii.6771]

Yes, because your metabolism speeds up and gets rid of the excess fluids during the day.

[@scraps4019]

Waking during the night isn't necessarily caused by a need to pee. It can be normal to awaken during a lighter phase of sleep. Often we don't even realize that we've awaken since we fall right back to sleep. When we do actually wake up we will become aware of a need to pee, which might not necessarily be the cause of waking up. However, there are causes, as mentioned in the video and comments, where waking to urinate is related to something physiological. This is something that I've tried to sort out with a sleep specialist, but since I wake up usually only once per night I'm not that worried at the moment. (At my age, 63, an "all-nighter" is when I don't wake up during the night to pee. Very rare.)

[@CP-so4hg]

There is a psychological component at play as well. The mind can create the feeling of urinary urgency as a byproduct of worrying and fear.

[@MrCockFiesta]

I can attest to this. Whenever Im stressed I feel the urge more often

[@joeyr4869]

I was just taking an exam yesterday and throughout the whole thing I felt like I needed to pee despite going right before it started

[@kennixox262]

That as you say and then the inability due to pee shyness in stress situations such as public bathrooms, airplane lavatories are the worst for me. It can be debilitating to where I limit travel.

[@alansmith4655]

That's the fight or flight response. Tells your body to empty its contents.

[@petermalmgren1207]

Stress

[@boiswilson564]

One of the things I'm not seeing anyone talking about is the difference between waking up because you have to pee versus waking up and then feeling you have to pee. I thought the need to pee was what was actually waking me up, but then I made some corrections to help me sleep better (stress release, massage, timing, probiotics etc) and I slept through. Now I notice that if I wake up in the night, and I feel like peeing, I might still be able to just roll over and go back to sleep. BUT, if I can't fall back asleep right away, the need to pee becomes more and more urgent.

[@boiswilson564]

Just to complete this thought - using my Garmin watch, I can tell that on the nights I do not get up to pee, I have been sleeping much more deeply and often with more rem. So part of the solution, I think, is to do things to get you to sleep more deeply. Consequently, some of the comments below about cardio ... part of it (besides the sweat) may be the fact that it causes deeper sleep.

[@magenta2616]

Perfectly said. That’s what I also figured out. Drinking very little before bed etc. had no effect on awakening

[@YourWellnessJournal]

This is very interesting. You know there is a link between nocturia and poor sleep.

[@mikesekula3949]

I had to pause this twice to pee.

[@PathsOfReason]

🤣

[@jimdandy8996]

In your pants?

[@colinhowell2777]

mike - classic 👍

[@johnshry2062]

😂

[@michaelvayan9682]

Phone in one hand....

[@dant.6364]

This whole podcast was brilliant. The best I’ve heard by Attia.

[@DCA55]

At 68, I am up to three times a night and started curtailing fluids after about 6pm long ago. My Dr for the last 25 years was pretty accurate in his prediction about how quickly that frequency would increase starting in my 50's. His math of about one more time per night every 5 years or so was pretty accurate . I take no medication or supplements for anything but after a suggestion by my Dr and reading about it online, I decided to try saw palmetto. Since about a week after I started I'm down to two times a night, consistently. I'll take it!

[@trevorregay9283]

Placebo effect?

[@DCA55]

@@trevorregay9283 Unlikely since I have no control over my bladder when I'm sleeping but it's possible that I'm drinking even less than before. Trust me, I believe that all supplements are scams, so I was hesitant to try this but with no downside, I gave it a shot. If it drops to once a night then there is definitely something there.

[@nik07nik]

No, its a supplement for the prostate.@@trevorregay9283

[@mamalovesthebeach437]

Thanks for feedback on SP. I’m starting my husband on it today.👍🏻

[@jerseyjim9092]

Studies say it's useless but what do they know. I wasted my money too😢

[@slr856]

I am a 59-year-old female. In 2019, I had a surgery to remove a large, benign tumor from my pituitary gland. After that, I was prescribed Desmopressin Acetate nasal spray. Be informed- within 2 years, I was hospitalized for dangerously low sodium levels (118). That could have resulted in seizures or death. Under my endocrinologist’s supervision, I stopped cold turkey; that was hell week. After that, it took a year for things to normalize with my need to pee. I did start a bladder supplement from Naomi Whittel that helped me a lot. I can go places now without worrying about finding a bathroom. I hope this may help some others who have similar symptoms!🙏🏻

[@NancyGriffith-rq5li]

Naomi w bladder supplement

[@trail.blazer]

I have impaired sleep and I used to get up a few times a night. I changed my sleep schedule so now I go to bed around 9:45pm and get up around 6am. The result was that I get more deep sleep earlier in the night. Because of that, I still have the same impaired sleep, but I almost never need to get up to pee. I might have had to get up maybe once in the last 12 months, it is that rare. I am 59 years old. I suspect it is deep sleep increasing the release of vasopressin anti-diuretic hormone.

[@segua]

Check for sleep apnea. - sleep doctor

[@segua]

Nocturia is a symptom

[@someguyusa]

Nighttime urination is a big reason why I cannot workout later in the day. If I exercise later in the day, then I need to drink more fluids to replenish from sweating which leads to either waking to pee or waking thirsty from not drinking enough.

[@bruceb5481]

When you sweat you loose salt and other minerals so you have to replace both. Adding some Himalayan pink salt or Redmands salt directs the water to the cells.

[@someguyusa]

@@bruceb5481 My man, that’s irrelevant to drinking too late in the evening. You will still need to piss at night if you do that too late in the day.

[@6681096]

Limit fluid intake before bedtime Limit intake of mild diuretics (eg, caffeine, alcohol) especially several hours before sleep. Limit intake of highly seasoned foods Avoid constipation Loss Weight Kegel exercises when you feel the need to pee. Things to try: attempt to empty the bladder based on a time interval rather than by the usual sensations. urinate “by the clock” (every 90 to 120 minutes during the daytime) Try a second attempt at peeing within a minute or two of the initial void. Saw palmetto very likely does NOT work here are some that MAY work: beta-sitosterol Pumpkin seed oil Pygeum bark, Pine bark extract Pycnogenol lycopene Cranberry powders or extracts

[@loveandleisure]

Thanks so much for these tips. I've been using them and they've really helped me a lot.

[@tomlyons2049]

13:56 ​@loveandleisure have you being using all of them or particular ones and what dosage rate? Thanks.

[@tomlyons2049]

What dosage do you use and have you ratings on good to least good ?Thanks. Tom

[@wellthi]

Yep cranberries work great Dr.Greger have a vid about it

[@loveandleisure]

@@tomlyons2049 The 3 that have helped the most are limiting fluid intake before bedtime, kegels when I need to pee, and using the bathroom based on a schedule not every time I have the urge.

[@sargewam]

I'm 41 and have had to pee at least 4 times a night, usually 5-6, at least since I was 18. (Yes, you read all that right.) This is true even though I've been taking imipramine nightly since 2016-when I run out of it before the next order has filled, I get up to pee more like 7-10 times a night. I have tried every behavioral modification in the book, including cutting out caffeine and alcohol entirely and "dehydrating" myself for many hours before sleep. I have kept intake and urination logs for long stretches, showing that I do not hydrate more than I should. My prostate is not enlarged, I don't have diabetes, I don't have sleep apnea, lab tests have found no hormonal issues, I am sexually healthy, I eat an incredibly healthy diet, I am lean, and I exercise 5-6 days a week. I have tried cognitive therapies specifically targeting the issue, as well as targeting anxiety that may be linked to my urinary frequency, but my urinary frequency has not decreased. Both general and specialist docs are baffled by how often I pee and have not been able to discover the root issue(s) or find a treatment plan that works. I shudder when I think about the years that never sleeping more than a couple hours in a row has probably taken off my life, or how much more present and energetic I would be during the day if I could cut my nightly urination frequency down even to just 3. Btw I need to pee a lot during the day, too, even when I drink so little that I feel dehydrated, but I can hold it for hours without much discomfort (and, at a urologist's recommendation, I often do this on purpose, in hopes of training my body to go longer without peeing). I also have issues, both at night and during the day, with incomplete emptying-sometimes I pee in the upstairs bathroom, go right downstairs, and promptly pee again in the downstairs bathroom. Other times I pee, wash my hands, and then realize I need to pee some more. I'm ready to try just about anything. Definitely going to find out more about the most recent generation of meds that Dr. Schaeffer mentions in the video.

[@davidfarrar2454]

I have something similar, in my case it is down to having a small bladder. Have you had your bladder capacity checked?

[@rebecca7410]

I have been the same as you since my late teens...like you I will pee, then in a minute need another pee. I actually have a plastic toilet by my bed for night pees. I will often pee in my bathroom, get in bed, then need two additional pees within twenty minutes (sometimes less) of getting into bed. My partner has never seen anyone like me lol- I have issues with being outside the house etc due to this. I had a bladder scan last year-all looked fine. Another doc said perhaps my IBS is causing pushing on my bladder

[@chrandersonful]

Measure the volume of your visits, you should be 350-500ml a go else you’re likely overactive bladder (“let me have a wee even though I don’t need one, just in case”). You’ve reset your bodies full switch.. I was able to increase volume and reduce frequency by safely holding it and slightly extending the visits. Easy to relapse though.

[@kirklong1246]

Make sure you cut out all dairy. That helped me the most.

[@francescoschettino5726]

get botox for your bladder it's the by far best method trust me,. I am baffled so few know this !

[@Michelle-w8g3o]

For all the women: For 20 + years I was peeing every hour during the day and up to 20 times at night. Went to urologist and he put a scope in and found out I had something pushing on my bladder. Turned out to be a very large fibroid on my ovary. I wasn’t interested in surgery or medication so I went the natural route and mixed castor oil with frankincense and massaged it every night on my lower abdomen. 2-3 months later I am no longer peeing so often. I pee 5-6 times a day now and never at night. Thought I’d share what worked for me.

[@joeyr4869]

I’m very glad this intervention is helping you! By what mechanism do you think this treatment works?

[@rebecca7410]

Thank you- I will try this

[@KristinEatsPlants]

Can they find that on an ultrasound? I'm 4 months postpartum and I had a ton of ultrasounds both before and during pregnancy and once postpartum and no one said anything. I pee a ton day and night but I also drink a TON of water because I'm breastfeeding... it didn't start until pregnancy so assuming that's what it is but your comment is super helpful!

[@Michelle-w8g3o]

I drink a lot of water too.I got an ultrasound and it didn’t see it. However , they can see how full your bladder is and then I would go pee and they could tell my bladder wasn’t completely empty afterwards. The gynaecologist found my fibroid by doing an internal examination. I also found if I wasn’t eating fairly healthy then my body wasn’t absorbing the water. Also, another thing I was told was to strengthen your “pee”muscles. Write down on a journal the times you pee. If it’s 7am, the first day hold it till 7:30am, the next day it would be 8am, etc. Hope this helps.

[@davemcjunkin7452]

​

[@sashafroyland]

The top drugs within the alpha-blocker class, which are commonly used to treat benign prostatic hyperplasia (BPH) and improve urinary symptoms, include: 1. Flomax (Tamsulosin): • Mechanism: Relaxes muscles in the prostate and bladder neck, making urination easier. • Usage: Commonly prescribed for BPH. • Side Effects: Dizziness, orthostatic hypotension, and retrograde ejaculation. 2. Rapaflo (Silodosin): • Mechanism: Similar to Flomax, Rapaflo relaxes muscles in the prostate and bladder neck to improve urine flow. • Usage: Also commonly prescribed for BPH. • Side Effects: Retrograde ejaculation, dizziness, and low blood pressure. 3. Hytrin (Terazosin): • Mechanism: This alpha-blocker helps relax blood vessels and the muscles around the prostate, improving urine flow. • Usage: Used for both BPH and high blood pressure (hypertension). • Side Effects: Dizziness, fatigue, and fainting, especially when starting the medication. 4. Cardura (Doxazosin): • Mechanism: Similar to Terazosin, it relaxes both the bladder neck and the blood vessels, helping with BPH and lowering blood pressure. • Usage: Prescribed for BPH and hypertension. • Side Effects: Fatigue, dizziness, and risk of fainting due to low blood pressure. All four of these drugs work by relaxing the smooth muscle in the prostate and bladder neck, which helps relieve urinary symptoms in men with BPH. The specific choice between them may depend on an individual’s health profile, tolerance to side effects, and whether they have additional conditions like hypertension that may benefit from these medications.

[@cesargil5997]

It's the first time I hear something different from "drink less water". Very deep knowledge and admirable.

[@slimpickens8589]

Surprised Peter didn't talk about high insulin levels resulting in urinary frequency. If you eat a high carb meal or drink something loaded in sugar, your kidneys increase urinary output. Try cutting carbs a few hours before bedtime and you'll urinate less.

[@concisecontenttv]

The exact opposite works for me. Protein dinner = lots of episodes. Snack on carbs or sugar (chocolate) before bed and I go from 3 to 5x per night to 0 to 2

[@walterh.3170]

@@honey...salguod Okay honey…🥴

[@randalbladel2817]

It’s not high insulin levels that lead to more urine, it’s high glucose in diabetics that the kidneys can’t retain, and it pulls more water with it. You could say it’s actually either the lack of enough insulin to lower the serum glucose, or the lack of insulin sensitivity in type 2 diabetics.

[@endgamefond]

Yeah so true. I noticed this too in my sleeping habits. Yeah no high carbs/high fructose fruits 4-5 hours before sleeping. But before those hourse I need to digest some carbs n protein so I can fall asleep.

[@joerenner8334]

Not at my age. I don't eat 4 hours before bed. No drink probably 3 outs before. Yet up to it are at least twice anyway

[@henrypham-gq8xi]

Alfuzosin (Uroxatral) is not a prostate specific alpha blocker. It is used also as an antihypertensive similar to doxazosin and terazosin and carries the risk of orthostatic hypotension. The only two prostate specific alpha blockers are tamsulosin (Flomax) and silodosin (Rapaflo). Rapaflo has been out for over a decade now and is available in generic. Silodosin is slightly more potent than tamsulosin but also carries the side effect of retrograde ejaculation. The generic versions of Flomax and Rapaflo have slightly more orthostatic hypotension due to the fact that the drugs are not as clean as the branded version. Solifenacin (Vesicare), which Dr. Schaeffer mentioned is not an alpha blocker. It is an overactive bladder medication with anticholinergic side effects and should not be used men with enlarged prostate symptoms due to the anti-muscarinic effect, which can cause acute urinary retention.

[@timskolnik3819]

I threw all of those away when I heard that they cause dementia.

[@andreagerardi5320]

Are you a pharmacist?

[@henrypham-gq8xi]

I am a urologist practicing in the Sugar Land, Texas area :)@@andreagerardi5320

[@technomation1992]

Thanks for the fact check and dispelling the disinformation that we see in so many of these KZbin health videos!

[@chaz6399]

I tried 1 pill of Alfuzosin and it gave me a massive hangover the next day - felt like a zombie. So yeah, for me the effects went far beyond the prostate.

[@JeffCahill-tp8ik]

Wow, Peter, I haven't watched your content for a long time. No particular reason. You have improved exponentially as an interviewer! I found that a year or so ago, maybe a couple of years ago? ... you talked over your guests a lot, not in a disrespectful way, but just something they said would trigger a thought and you would interject. Now you give them much more space and it makes the interview much more enjoyable and informative. I'm trying to train myself to be more like you are now.

[@petermalmgren1207]

He probably likes this Doc

[@joezunenet]

7:50 is spot on. If you go to pee multiple times a night, make sure to check if you suffer from sleep apnea as many people either don’t know or don’t treat it. It can lead to significant health problems including stroke and heart attack. Silent killer.

[@mcbryant2]

Not so silent if you snore 😂

[@robmccance]

Sleep apnea is a toughie. Gotta wonder how many people are sleeping "better" with all that crap strapped to their face. That really seems like some fix that was invented in 1930, primarily to profit.

[@JoeSmith-ge8bz]

@@robmccanceit really does work the hard part is getting comfortable with the machine and finding a comfortable fit took me like 2 months but now I don’t even think about it get 8 hrs regularly

[@louielouboogie]

@@robmccancei got used to my cpap within a week and I use a full mask. It helped me stay asleep and not have to get up to pee multiple times a night to pretty much zero. I only sometimes wake up before my alarm goes now

[@gaylemathews1327]

I was getting up 3x a night. I have no health issues. Started taking electrolytes with no added sugar. Now I get once and occasionally not at all.

[@realitywinner7582]

thanks - will give them a try..remember my doc' saying excessive magnesium can affect electrolytes . God Bless !

[@endgamefond]

I notice a change. I used to wake up from sleeping n go to pee but i exercise 3-4 days a week for 30 minutes n if i drink glass of water like an hour before sleeping, I will pee in the morning not really during sleeping time. What I eat before sleeping affects too. High carbs effects me.

[@PierreLaBaguette]

so you're saying that the exercise made the difference for you? do i get it right?

[@endgamefond]

@@PierreLaBaguette yeah exercise and not eat high carbs close to bed time.

[@stevec3872]

I'm 71 and pee a lot at night, but then this first started nearly 50 years ago. I went to my dr. and he did all kinds of tests and finally came back and said, "Steve, you have tb". "TB???" "Yes, he said. Tiny Bladder." And so it's been over the decades. I've been checked twice, years apart, by urologists at different hospitals who could find nothing wrong. I have a 2 hour bladder fill and it is like clockwork where when I go I know it will be 2 hours when I wake up again with an urge to pee that can't be ignored. Taking a BP diuretic doesn't help either.

[@heavenlymonkey]

If you have high blood pressure, the first thing to try is losing weight, that is the most likely cause of high blood pressure.

[@scratchfg212]

That is a weirdly young looking photo you have in your profile there, for a 71 year old person…

[@stevec3872]

@@heavenlymonkey I lost 40 pounds 3 years ago on keto & have kept it off. At that time I got off from 3 of my 4 BP meds. It's not a weight problem.

[@stevec3872]

@@scratchfg212 Simple answer: that photo is 14 years old, but even at 71 it's highly doubtful you would guess my age since my hair is still mostly more dark than grey.

[@stevec3872]

@@MoSec9 Then the picture shouldn't matter, should it? I've just never changed it. Odd that I get more responses about my picture than my peeing or high BP.

[@wallastricks]

Also please try Reishi mushroom tea before bed it helps a lot, I used to pea at least once, now none at all and it gives you long night sleep.

[@jimdandy8996]

So does black seed oil.

[@robbiemoir929]

Im a 34 year old male, without significant prostate enlargement last time it was checked, but for many years now i have been waking up frequently 2 and sometimes 3 times to urinate during 1 sleep (6-8 hours) a good night for me is only 1 urination. 0 is unheard of. This bothered me for a while and i tried behavioural changes like reducing fluid intake after a certain time at night, and although i noticed obvious improvement, the issue still exists. I've started to believe that this is just normal for me. I also noticed others in my family also urinate frequently during the day (i work beside 2 family members) Really just wondering if this is normal or not, or if this is something i should further investigate. I would LOVE to sleep a full night without waking up, as ive been trying to improve my sleep quality for a long time, and i feel this waking to urinate effects that.

[@cl1496]

2 suggestions that weren't mentioned. They may help you as they helped me: 1) take a sauna in the evening. 20 minutes at 180 degrees will drain a substanial amount of fluid 2) 500mg sodium tablet before bed And in the food area, try to time your carbs to be eaten in the evening. A baked potato or white rice has an anti diuretic effect. Obviously, avoiding fluids in the evening is a must for these techniques to be maximally effective.

[@GaryL3803]

Had the same symptoms in my early 40s and lived with it for years with significant effects on my lifestyle. Stay away from antihistamines all types, Benadryl, Sudafed and such, they have a very significant effect on prostate enlargement and I think it was the basis for my very large prostate. I tried many homeopathic medications, Saw Palmetto and the like, all manner of the type mentioned in the video with very little effect. I relented and had a Urologist examination followed by Greenlight Laser surgery and got very good results. 20 or so years later I still have to avoid antihistamines, but otherwise no symptoms. So, if you have chronic symptoms that can't be controlled I would heartily recommend Greenlight Laser surgery,

[@RemyDelaCruz]

@@kylegusekhi. I am the same way. Would get muscle cramps if I stop too early drinking water. And sometimes need to drink some electrolytes during the day to help me stay hydrated. May I ask you what mix of creatine and electrolytes you take? Or you get them separately?

[@JasonActualization]

@@cl1496 A+ advice, thank you!

[@drkarladpt3038]

One thing that wasn't mentioned, was being evaluated by a pelvic health physical therapist. This is a common symptom when the pelvic floor muscles are overworking. I am a pelvic health PT and I see this often in all ages with the ability to find resolution without taking medication.

[@andrewwilkins3014]

Cutting back artificial sweeteners has been big for me, was chewing gum like a fiend for many many years. Had me peeing like 20 times a day. Nothing else wrong blood work was good. Cut that out recently and I feel normal again.

[@michaeltipton526]

Just to clarify, do you think the artificial sweeteners in the gum played a role?

[@ppumpkin3282]

Yes, I've heard many times that artificial sweeteners, while they don't have the calories have the same effect on the body as sugar. They can increase insulin and blood sugar which causes you to pee more often. Also some people just react that way to sweeteners.

[@m-hadji]

Dear Dr. Aptia I read your amazing book and found it so helpful and useful and most importantly reasonable. What did to mentioned in book is mostly common sense. I changed my behavior since two years ago and interestingly very close to what you suggested in book before I even read it and lost almost 50 lbs and my diabetes went away. I am totally new person with much less medication and much more energy. It’s all about common sense. By the way now I have useless CPAP machine in my closet 😂

[@christophergregory2734]

I’m a 40 y/o male and I’ve been waking up 4 or more times a night to pee. For the past 2 months. I’ve been to the urologist and was put on Desmopression, but I still get up at least 2-3 times to pee. Im going for a full Renal ultrasound next month and I’m hoping to get some answers and relief

[@jimdandy8996]

Try a clothespin.

[@wallyevans4228]

It would be interesting to see studies on blue zones/nocturia

[@drkarladpt3038]

For many people, being evaluated by a pelvic health PT is extremely helpful without the need for medication.

[@FredBerger11.11]

This is true 👍🏼 Thanks

[@niorduo]

What is long for pelvic health PT?

[@alexperez5448]

This has worked for me!

[@richardkennedy8481]

How much water should we drink in a day?

[@peterpan8147]

What about having carbs at night and being thirsty all night and peeing? And waking up at 4am without being able to go back to sleep?

[@chaz6399]

Getting thirsty at night is a sign of diabetes. It's rare but a person can have a normal fasting glucose and still have diabetes. Ask your doc to run an A1C test.

[@auricgoldfinger8478]

Had a prostatectomy 10 years ago. Cancer limited to the prostate. Haven’t gotten up to pee since then. I can pee like a teenager. Hurrah!

[@graememudie]

67 year old. Have been getting up 3am every evening for at least 2 years. Had to go go within minutes of drinking a cup of anything. Always paid a visit before leaving anywhere. 4 weeks ago went to a a massage therapist who fixed my tension elbow in 10mins after 10 months of pain. I had muscle pain in my hip I needed seen to. She found a very tight muscle in my back which, when she was working on it, gave me a sensation in my bladder. From that day to this I have never had to get up and can go for hours before having to go for a pee. She said she had never heard of this happening. But it worked for me. 👍

[@boiswilson564]

Yes, I find it helps me to sleep through the night if I use a percussion massager on my lower back and hip area.

[@lazysk8er]

What is the name of the socks mentioned in the video

[@imhoteptruekingofegypt4307]

ted stockings

[@randywinters688]

Best informational video I have ever watched. I don’t drink anything after dinner. I void well just prior to bedtime. I wake up around 2am. I feel like I have emptied my bladder. I then wake up at 5 with a full bladder. Makes no sense. I am 71, with a slightly enlarged prostate. I am in excellent physical shape. Could it be a hormone issue? Thanks

[@stanley2837]

sounds like you have an inflammed prostate, prostatitis, I would recommend checking if your bladder completely voids after each trip to the restroom through your doctor.

[@KJSvitko]

Stop eating and drinking 4 hours before you go to sleep. You will sleep better. It takes 4 hours to digest your last meal. You want your body to switch from the digest phase to the rest and repair phase when you sleep. This will be much easier if you have not eaten or had anything to drink in those last 4 hours before bed. The quality of your sleep will improve and you will wake up more rested in the morning.

[@stevend481]

4 hours is a lot. I would be hungry and thirsty. Protein before bed is also good for satiety and muscle synthesis

[@mbrochh82]

@@stevend481 it is actually perfectly possible. you'll get used to it after a few days.

[@wocket42]

@@stevend481 you are hungry 4 hours after your last meal? maybe try eating zero carb/high fat.

[@wildflower-web]

2 hours works for me. I'm a 45 year old male. I drink a lot of green tea and water during the day and urinate every couple of hours throughout the daytime.

[@stevend481]

@@wocket42 i eat about every 3 hours. I lift weights

[@diegohidalgo9088]

I get up twice almost every night, if not three times. I try not to drink, even if I feel a little bit thirsty, but I've found out that what I eat in the afternoon and the time I eat, it's more important than drinking half a cup of water. Fruit, vegetables and the high amount of dairy I take, is made up of 80% water minimum.

[@Mike-vu1rn]

I am a 42 yr old male and I wake a minimum of one time per night, every night, to pee. It doesn’t seem to matter if I taper my fluid consumption at night. I rarely consume caffeine after noon and also rarely drink alcohol. If I do drink alcohol, it’s several hours before going to bed. I experience occasional edema, yet don’t know the root cause. Are there any specific labs to ask my physician to order to find out what could be causing edema, or any treatments you’d recommend to reduce the prevalence of edema? Thanks, Dr. Atilla.

[@MAGNUM2F]

This is fairly normal.

[@TheRealBrook1968]

I quit eating starches and I don't wake up in the middle of the night, anymore, to urinate. I think it is also irritation in the urinary tract (such as grains, hence beer) as a person ages.

[@chrisbellomo2763]

Like so many others, I take lisinopril for blood pressure. It has a diuretic component intended to lower BP. What to do?

[@eugeneano285]

No mention about bladder possibly pressured by tense muscles. Some comments below suggest psychological habituations as possibility.

[@ALLTogetherAcademy]

Thoughts on Patrick McKeowns (Oxygen Advantage) theory that nose breathing/mouth taping at night and it’s effect on vasopressin can have positive effects for managing night peeing (among others)? My experience has been that it’s helped but perhaps anecdotal / variables not isolated.

[@paulwalsh6817]

Would be interested in Peter interviewing this guy, I have zero knowledge on the subject but he seems legit, would love to get Peter's take on the science though.

[@ALLTogetherAcademy]

Yes the theory is compelling and seems to be research based but curious if it’s more self serving research or peer reviewed . Me and my kids have gotten great results practicing it, though. One of my suns completely outgrew asthma as he built the capacity to suspend his breath out for 80 steps at age 9!

[@JasonActualization]

@@ALLTogetherAcademy What does "80 steps" refer to?

[@ALLTogetherAcademy]

@@JasonActualization My son built the capacity to suspend his breath OUT, at the end of the exhale, for the duration it took him to do 80 steps, which results in incredibly robust physical and emotional health benefits including outgrowing a bunch of common symptoms

[@JasonActualization]

@@ALLTogetherAcademy Did he do that entire exhale without swallowing or holding his breath?

[@f.k.6151]

I started making my own sports drink when I picked up CrossFit three years ago. On the nights when my workout is later in the afternoon I wind up waking up many times to go to the bathroom. Tonight is the first night that I have not had the frequent need because I did not add the electrolyte in my workout water. The ratio of sodium to potassium in both electrolyte brands I have been taking are pretty much in the 1:2 and 1:3 range, which should not cause an imbalance problem even if they are not taken during exercise. Could it be that the potassium part of it is not getting absorbed in the cells thereby causing the imbalance that would require secretion of excess sodium?

[@nikbiz]

How is salt intake not mentioned once in this clip?

[@petermoore5124]

Interesting relationship: This year, I finally cleared up decades-long nasal congestion and focused on changing from mouth breathing to nasal breathing for the first time. Suddenly, I'm not thirsty all the time, so I'm drinking less. Should we discuss the relationship between mouth breathing and thirst?

[@Cathy-xi8cb]

Wow; this doc left out A LOT of information older folks need to know. If you have OSA, you need to treat it seriously. He did not make it clear how very helpful it can be. If you don't your brain doesn't slow urine production during your crappy light sleep. If you have congestive heart failure, you need to plan your diuretic dosage timing throughout the day going; get that fluid out before you lie flat and your circulatory system sends that fluid to your kidneys at night. DO NOT wear regular graduated compression hose to bed. TED hose are specific for inactivity. And you might not be able to get them on and off yourself so don't end up with them stuck on your legs. Your food matters as much as your drinks to reduce nocturia. Spicy food, acidic food (tomato, citrus) and very high water-content foods (watermelon, anyone?) will either increase urine production or make your bladder lining irritated, increasing that sense of needing to pee. Finally, learn how to get yourself back to sleep after you pee, or being awake will make your brain trigger more kidney filtration of your blood. And THAT is when you have to deal with optimizing your sleep environment, but also emotions around frustration and worry. I do lectures on this subject. Not a doc. But a clinician with training in both medicine and sleep therapy.

[@robrae14]

I use CBD chew to get back to sleep frequently. It works.

[@davedewsnap288]

It’s a clip.

[@Kermit_T_Frog]

No words of caution about chronic dehydration. Kidney disease is a LOT more serious than the nuisance of getting up at night to pee.

[@rafaelgelpi2718]

I’ve heard that Kegel exercises, for men, help limit the nighttime need to get up to urinate. Any truth to this? Thanks for the above thorough explanation

[@Cathy-xi8cb]

@@rafaelgelpi2718 I don't think stronger pelvic muscles will make nearly as much of a difference as the things I mentioned. A good idea, but I would not count on it to reduce frequency or urgency. Forgot to mention the benefit of never being constipated. Ever.

[@nh64uk78]

I'm a complete layman in regard to this subject but I thought the main cause is the number one poison SUGAR? My understanding is that water follows sugar. Please correct me if I'm wrong! Thanks.

[@YourWellnessJournal]

Water mostly follows salt. High sodium diets make you retain more water.

[@mpavoreal]

What about the impact of alpha blockers on the brain?

[@kennixox262]

When I get into stressful situations, I have to use the toilet often, such as travel, especially airline travel which I find exceptionally stressful. Then, I go the opposite direction and can't go. Horrible.

[@Fedor526]

For years I have noticed that when I pee frequently at night, it is because my body is in a cutting phase (I'm a weightlifter/bodybuilder). Granted I drink a gallon of water at the gym alone but when I'm eating enough carbs to at least maintain the same fat percentage, it's usually only once per night instead of 3-4 times.

[@squashduos1258]

What has worked for me was to simply add some Celtic sea salt (not Himalayan which has more iron and sodium) as my last water intake since most water filters are reverse osmosis filter which strips the water of all minerals which in turn makes the ph of the water acidic. Perhaps a bit overly intellectualized conversation about a simple thing as to add a pinch of sea salt in your last water intake…

[@sathya999]

One type of salt cannot have more sodium than another. All common salt is Sodium chloride. Of course Potassium chloride is also a "salt", but not commonly used.

[@squashduos1258]

@@sathya999 there are a bunch of lab results you can find which compares the two….

[@sathya999]

@@squashduos1258 Table salt is Sodium Chloide. Basic chemistry. One type of sodium chloride cannot have more sodium than another sodium chloride. Anyway, sodium is not evil and has no effect on HBP. It's the sodium/potassium balance.

[@squashduos1258]

@@sathya999 it’s not table salt I am talking about! If you are eating table salt good luck to your long term health

[@sathya999]

@@squashduos1258 I stopped eating that crap in the 80's. Himalayan salt contains around 98% sodium chloride and 2% trace minerals, including calcium, magnesium, and potassium. Sodium is NOT an issue for HBP. Sodium must be balanced with potassium for health

[@syndromeee]

33m. I’m normally up to urinate at least two times per night. I try to hydrate normally (~80-90 oz per day), but have had to consciously stop drinking prior to bed. I stop all fluid intake 4+ hours prior to bedtime, and I’m still waking to urinate. I also stop all caffeine intake by noon each day, I don’t have sleep apnea, and I don’t consume alcohol. I can’t remember the last time I slept through the night without waking. What can I do to stop waking up to urinate?

[@JakeRoselli]

Me too brother. Was hoping to find an answer

[@ronlugbill1400]

Breathe through your nose. All day. Every day. It really helped me.

[@JasonActualization]

Try consuming 800-1000mg worth of sodium via salt tablets right at bedtime.

[@rolandlickert2904]

I drink first 1 glass of water in the morning have one or two Decafe expresso w.almond milk and drink during the day water or herbal tea and stop drinking at 7 pm .Still have to get up 2 or 3times during the night.Im 75 years old Sometimes have a glass of red wine at noon only As my home is in the tropics one drinks more fluieds

[@Jeffopar]

This would have been a great time to discuss mouth taping. Since I started several years ago I dont get up to pee anymore. I went from about two times per night to maybe once per week.

[@KoryMacKinnon]

Wow! I didn't know there would be a coloration. My son is a mouth breather and he gets up almost every night to pee! I wonder what the connection is?

[@davedewsnap288]

You just contradicted yourself, and that’s not science.

[@Azola69]

@@KoryMacKinnon lower carbon dioxide can cause bladder to contract

[@resultsfitnesstexas]

Same here. Never wake up with dry mouth. Get up to pee much less often since started taping

[@KittyBootie]

Read about mouth taping in Breath by James Nestor. He explains why it decreases nighttime trips to the bathroom.

[@YourWellnessJournal]

Thank you fot this video. Very easy to follow tips. You are tight, behaviour modification is really helpful.

[@Therealmathilda]

I have bph. Some nights I was up 4-6 times a night to pee. My urologist told me that antihistamines can amplify bph symptoms. I was taking one or two certrizines daily for allergies. I stopped this about a month ago and so far I haven't gotten up overnight more than once or twice a night. I ended up having a mild reaction to flomax so I got Cialis which shrinks the prostate. 🎉🎉

[@maxbrownbrown3557]

I’d like to know if there’s a link between my tinnitus and having to get up every 2 hours at night? I’m very fit and meditate twice a day.

[@mcarroll78]

I wake up 1-2 times a night to go pee. I’m 45 and fairly healthy. Not on any medication. Exercise 3-5 days a week. Really bothered by the frequency of waking

[@Sbannmarie]

Is this for men and women?

[@Journeyman-Fixit]

Great, I had a UTI and now am being told to drink more water?

[@salobaid9652]

The Mechanism of Nocturia in patient with obstructive sleep apnea is mediated through the increased level of BNP at night. As patient get into airway obstructive phase of sleep the increased airway resistance lead to increased Intrathoracic pressure which in turn leads to increased left atrial pressure and this causes BNP level to rise and promote increased urine output., Nocturia from osa has high urine volume,where nocturia from prostate problem has low urine volume per void. By measuring night time urine volume we can have good idea of the cause. People with nocturia due to edema,most of them has osa which contribute to nocturia by it self.

[@dadams1707]

good grief. Its as if he (or they) completely dismiss the fact that BPH is REAL. If your prostate is enlarged, no amount of routine changes is going to solve the problem.

[@PierreLaBaguette]

eric berg once spoke in one video about BPH and prostate cancer being correlated with low zinc levels. i looked it up and zinc really is very much concentrated in certain type of prostate cells. they say pumpkin seeds have a lot of zinc.

[@johnmenzies6865]

One of the more serious and one of the most common causes of nighttime urination is Sleep Apnea. Indeed nighttime urination and strong thirst in the morning or during the night is a key symptom and almost diagnostic symptom of Sleep Apnea. Needless to say if you drink a lot of water prior to sleep, or take a diuretic you will likely need to urinate. If however its a persistent issue and you don't have some serious pathology try this - mix two tablespoons of flax seeds with water and quicky drink it - add more water as necessary. This will not only absorb all the water that you added to the flax-seeds but will absorb excess water in the duodenum and likely you kidneys wont have excess water to process and form urine. This video failed to mention Sleep Apnea - do some research. Other symptoms which may indicate Sleep Apnea may include, very dry lips, a very dry throat, light live blood in the mouth, loud snoring, disturbed sleep, your partner noticing that you stop breathing, difficulty in waking or even getting out of bed, and persistent exhaustion during the day. In more serious cases the endocrine system is disturbed and you might experience wild fluctuations in heart rate and blood pressure which may be triggered by caffeine and fluctuations in body temperature. Besides resolution of metabolic dysfunction and weight loss - sleeping on your side and stopping mouth breathing at night can resolve most if not all of these issues. CPAC machines are IMHO largely unnecessary and other interventions are far easier, less intrusive and far less costly.

[@YourWellnessJournal]

True! More people should be aware of the connection between the two.

[@bradstell2146]

Does the same protocol apply to BPH?

[@wrusty3767]

Great video and totally relevant for my situation, thanks. I've been advised by my GP to drink at least 1.5l of water every day to ease my constipation, and some of this is done during the evening, which in turn leads to me waking up to pee 2 or 3 times during the night. So, I guess I'll have to either cut back on the water volume or drink it predominantly during the daytime?

[@timskolnik3819]

I wish they would have addressed the risk of dementia that comes with many of these bladder medications

[@freespirit6209]

Yes, likely all cholinergic medications.

[@PierreLaBaguette]

also desmapressin?

[@patrickklepper3641]

I'm 42 and it's been many years since I've slept all through the night. I typically get up at least once, sometimes twice a night. I work out almost daily and have a pretty good diet. I've tried stopping fluid intake a couple hours before bed and it makes no difference. Actually, from my testing when I stop drinking earlier in the evening it makes it worse. I have diagnosed mild sleep apnea which I'm sure doesn't help anything. It seems like my body overly produces urine while I sleep which makes no sense unless I have something going on with my body producing the anti-diuretic hormone they spoke about. I don't know what to do

[@michaelhimes8778]

I wonder if Peter not having to pee at night as a 50 year old has something to do with his stated routine of a dry sauna before bed.

[@aquamarine99911]

For me, at ~15 years older, some kind of sweat before bed is mandatory. Usually I do my one hour of Zone 2 on the elliptical 3x per week starting sometime between 10 and 10:30 at night which works up a good sweat. Other nights, I'll do a Zone 0-1 light exercise that still makes me sweat, or use my wet sauna. People say you shouldn't do cardio before bed, but I find it makes my sleep better, and urinate less, and get back to sleep faster if I do have to get up. Timing of fluid intake makes no difference for me. I'll generally stop drinking water at 6 pm, just on principle. But it means nothing if I don't sweat.

[@aamsergie]

Please Dr. Attia read this comment - the human beings were meant to sleep undisturbed with no problems. While what you consume may impact you, there is one thing GUARANTEED to impact you. Breathing while you sleep. If you have disturbed breathing due to 100s of causes, the chances you wake up and pee is almost guaranteed. The term you are looking for is ARRISAL THRESHOLD Please refocus your efforts on talking about this. I am a dentist and I help many patients manage this from recommending ent proceedures, oral volume assessments, sleep hygiene etc

[@KoryMacKinnon]

I'm definitely going to research this! My son is a mouth breather and is up 1-2 times per night...

[@smooth_pursuit]

I believe it’s “arousal threshold”, but yes.

[@aamsergie]

@@KoryMacKinnon if your son is a mouth breather, he needs min two evaluations - ent and orthodontist. Third may be myo functional therapist

[@aamsergie]

@@smooth_pursuit I have no clue why autocorrect changed the spelling but yes - AROUSAL THRESHOLD

[@JasonActualization]

@@KoryMacKinnon Look into using 3M micropore tape at night, it's truly lifechanging!

[@renzo6490]

What are TED stockings and why are they called that?

[@chaz6399]

You can't get a new patient appointment for 6 to 8 weeks, but it's the same with all the urologists on your insurance plan so you make the appt. 6 weeks later, you drive 30 minutes to see this guy. You show up on time, then fill out 10 pages of history & insurance forms and releases, then you spend 90 minutes in the waiting room, waiting to be seen. They mispronounce your name when they call you. You get your vitals measured. Doctor comes in and asks what the problem is. You tell him you're getting up to pee 3x per night. He advises you to drink less water. On the way out you get the bill for $150. What a deal!

[@rebella5769]

What I think I heard was that there are now some great, safe medications for men with Nocturia but he did not suggest any remedies for us ladies. 😢

[@JasonActualization]

Try consuming 800-1000mg worth of sodium via salt tablets right at bedtime.

[@shantinaturechild3239]

I recently heard it's due to parasites unless we drink heaps or eat juicy produce or diuretic produce or fruit before bed.

[@Socalarborist]

I’m up 2-3 times a night, definitely needed this!

[@lcmlcm2460]

What will you do differently

[@marjoriebaker7447]

I have high BP ichange my medication but i still wake5 to 7 times my last in take of liquid but it happening weather get cold or raining it worst lost weight fr 210 to 150 why

[@CahoonHollow]

Thank you for addressing sleep apnea as a cause. It is my understanding that because you never get to sleep properly that you do not reach a “hyper nation type state” which slows down your metabolism when sleeping.

[@TheAmazingSpaghetti]

Sleep apnea can also be the cause, my urologist didnt even know that. A ton of people have apnea and don't know it. Apnea causes stress on the heart while sleeping, and the heart may make your body pee to relieve the pressure.

[@YourWellnessJournal]

This. More people should know this.

[@larrycrevier9630]

Rub magnesium oil on the bottom of your feet just before you go to bed …. It will stop an overactive bladder. … it really works, at least it does for me.

[@davidstrong7854]

Have you tried yarrow Tea early in the evening?

[@mimelendez]

I go to the bathroom pretty much every night all my life (literally) as I remember going to the bathroom when I was a little girl. My mom used to be in the same way. For this reason, I consider that, in my case is simple genetics. To me, it would be very strange not to go.

[@gkcima007]

I couldn't finish watching this… had to go pee !!!🤣

[@hosseinzeinalifard3454]

So, how should we pee less?

[@PorteñaCali]

I limit liquid intake when I have to travel by plane because I really dont want to use those plane restrooms, and same for my young daughter, I limit her liquid intake during trips

[@allenf.5907]

I like this - with the behavior modification(s) - it depends on when, how much, and what I consume. BEST is water. Anything else could be more often. For me, once is enough.

[@asprinklingofclouds]

I rarely get up to pee more than once in the night but when I do it is usually associated with having a heavy resistance training session the day before. My theory is that that this is caused by the breakdown of muscle tissue, thus releasing the associated 75% of water that the muscle contains.

[@LK-bz9sk]

Huberman says sipping versus gulping water also influences frequency

[@Kk-bq8sw]

I drink a lot of water , even a mug of green tea after 9pm, then a glass of water 20 minutes later. 3 times a night when I do that.

[@MarufoVega]

Thought that a number of recent studies concluded caffeine is not a diuretic.

[@robmccance]

Thanks for sharing Docs. The use of the word profound is profound in this video. Also, the guy in the wife beater needs to stop interrupting and talking over the smart guy Schaeffer. We all know you're there Pete.

[@young749Au]

Decreased night time urinary frequency over 50% by completely cutting off all sources of caffeine, that is coffee, tea, chocolate, etc. Time between urination was around 1 1/2 hours before cutting off the caffeine. After being caffeine free for a week, this time went up to over 3 hours and sometimes as high as 5 hours. When I cut the caffeine, I was also totally free of drinking alcohol for 2 1/2 years. I am 72.

[@segua]

Obstructive sleep apnea. - nocturia is one of main signs of OSA. Mind boggling as a sleep physician this is never discussed. Usually once a urologist is completely lost, they send them to me.

[@YourWellnessJournal]

Yes! This. There is definitely a link between sleep apnea and nocturia.

[@worldsystemsarereal]

Personal experience :Ginger and citrus can trigger frequent urination and/or incontinence.

[@Worldstreetphotos]

You never touched my problem or even came close, at night I have to pee up to 5 times mainly at night my pee alarm goes off when I only have 1-2 ounces of pee later in the morning I do not have to go pee until I have 6-12 ounces of pee you never mentioned this.

[@kufguyvh]

It would help if you printed/show the spelling of all the drugs you name.

[@aritchie56]

do we get dehydrated when we sleep

[@JasonActualization]

Slightly.

[@davidnevin7801]

When Dr. Attia's guest repeatedly uses the phrase 'behavior modification' in the setting of an academic urology clinic, I begin to wonder is he, for example, simply informing the patient that liquid intake before bed contributes to nocturia expecting patient behavior to change or are their staff to help guide the patient. The Northwestern University Urology Program (lead by Dr. Schaeffer) website doesn't mention these simple measures instead focusing on a myriad of procedures.

[@CP-so4hg]

Yes. Behavior modification is first-line "treatment" and is about what you can do to mitigate symptoms without medication or, forbid, surgery. Behavior modification includes: fluid in take restriction training, diet modification, PT and even cognitive training. This ofcourse, happens if you've ruled out other possibilities like diabetes or sleep apnea. They see how behavioral modification goes, and then you can decide, with the Urologist, whether medication is necessary if symptoms continue to be persistent or bothersome.

[@moontrack4625]

Teds all day and night OR just Teds at bedtime/nighttime? Thanks !

[@steveareeno65]

I have to get up once a night. I know it's because I drink too many fluids right up till the time I go to bed. I also know that in enlarged prostate can exacerbate this because you don't empty your bladder out completely.

[@welcometoreality3450]

What do these new generation of drugs have for side effects? Does it affect anything else like robs vitamins minerals etc...?

[@CharlesOffdensen]

I used to have this problem. I think it was because I had the habit of peeing to often during the day. I used to pee every 2 hours, so naturally I would wake up 2-3 times during the night as well.

[@Jean-ni6of]

Sounds reasonable.