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

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Watch the full episode: • 273 ‒ Prostate health:...
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This clip is from episode #273 ‒ Prostate health: common problems, cancer prevention, screening, treatment, and more
In this episode, Peter is joined by Ted Schaeffer, M.D., Ph.D., an internationally recognized urologist who specializes in prostate cancer.
In this clip, we discuss:
- Behavior modifications to decrease urinary output
- How caffeine input affects fluid output
- What’s a “normal” amount of times people should get up to pee at night
- Other lower urinary tract symptoms
- And more
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About:
The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 70 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.
Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.
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[@mikesekula3949]

I had to pause this twice to pee.

[@PathsOfReason]

🤣

[@jimdandy8996]

In your pants?

[@colinhowell2777]

mike - classic 👍

[@johnshry2062]

😂

[@michaelvayan9682]

Phone in one hand....

[@cesargil5997]

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

[@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.)

[@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.

[@dant.6364]

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

[@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

[@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.

[@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.

[@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.

[@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 😂

[@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

[@Socalarborist]

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

[@user-qd5hm5ml8k]

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.

[@user-ch1np8tv7x]

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!

[@user-ch1np8tv7x]

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]

​

[@wallyevans4228]

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

[@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.

[@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.

[@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😢

[@eugeneano285]

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

[@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

[@phoebelee55]

Thank you

[@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.

[@jh230377]

Great info thanks 👍

[@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

[@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?

[@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!

[@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.

[@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.

[@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?

[@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.

[@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.

[@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.

[@bradstell2146]

Does the same protocol apply to BPH?

[@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 !

[@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?

[@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.

[@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.

[@Appleblade]

I just drink less starting around 10pm (bedtime is midnight) ... and always drink water with a 2 to 1 concentration potassium chloride to sodium chloride mixed in. Just a half teaspoon in 8 or 10 oz. I imagine that's just replacing the H2O I lose through evaporation here in Denver (very dry) over the course of 6 or 8 hours; on keto, I lose sodium like mad because my insulin is so low. If I don't add the electrolytes I will have an irregular heart beat. Salt fixes that in about 2 minutes.

[@richardkennedy8481]

How much water should we drink in a day?

[@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

[@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

[@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 !

[@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.

[@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.

[@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.

[@shantinaturechild3239]

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

[@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

[@Journeyman-Fixit]

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

[@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.

[@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.

[@worldsystemsarereal]

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

[@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.

[@markotrieste]

I can't avoid drinking at night, I'm thirsty!

[@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.

[@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.

[@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.

[@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,

[@kylegusek]

I'm 31 now, and I had a similar issue for a couple of years. 1 - 2 times a night, down to 0 - 1 times if I made sure to stop drinking 2 hours before bed. I also had a bit of an extra dribble at the end of each stream which seems to be reduced lately.. I was having a bunch of compounding issues, but overall it felt like my body was dehydrated and not effectively using the water I was taking in. I set up a proper exercise plan, started going for regular massages (drinking lots of water after), and I make sure to get at least 3L a day, pacing myself. This routine was slowly ramped up over the span of a few years. It helped, I got to a point of only needing to get up to urinate every 2 or 3 nights. Since last July I started on an electrolyte/creatine mix, electrolytes to help carry nutrients, creatine for water retention and cognitive benefits. Since then my muscles have felt less fatigued, and I actually can't remember the last time I've had to get up to go in the night. Take this info as you will, it's all been trial and error for me. I hope this helps.

[@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?

[@kylegusek]

@@RemyDelaCruz Yeah I buy them separately and mix them. For electrolytes I've been back and forth between Skratch and Gatorade powder. Then just mix in unflavored creatine monohydrate. Make sure you lay out a proper exercise routine too though. I have a playlist with a bunch of saved videos if you want to check it out.

[@mpavoreal]

What about the impact of alpha blockers on the brain?

[@LK-bz9sk]

Huberman says sipping versus gulping water also influences frequency

[@scotturner3178]

Get Roundup (glyphosate) out of your diet. This was a game changer for me and wasn't easy to do. Basically eat an all organic diet except for meat and dairy. Took 15-20 years off my peeing. Went from dribble to stream.

[@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.

[@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.

[@nikbiz]

How is salt intake not mentioned once in this clip?

[@lazysk8er]

What is the name of the socks mentioned in the video

[@imhoteptruekingofegypt4307]

ted stockings

[@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

[@RiteOn]

I'm happy to share that my "getting older" pee routine is no longer. I used to get up at 3a.m. every morning to pee. No longer happens and, on top of that, I do not need to pee as often. Overall . . . I can go for a multi HOURS drive without having to find a pee stop. life is so much better.

[@gabardjean-paul3779]

How did you get to that ?

[@RiteOn]

@@gabardjean-paul3779 Started keto 2020, switched to carnivore 6 month in and have been high protein, high fat, no carb ever since.

[@Sbannmarie]

Is this for men and women?

[@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

[@ATAtherapytools]

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.

[@ATAtherapytools]

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]

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

[@ATAtherapytools]

@@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]

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

[@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.

[@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!

[@davidstrong7854]

Have you tried yarrow Tea early in the evening?

[@Balalaika10]

I drink 4 liters of coconut water daily! I stop drink at latest 22.00! I never tried coffein or alcohol in my entire life and never will! 💗

[@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.

[@moontrack4625]

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

[@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

[@MarufoVega]

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

[@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.

[@dailyhacks4634]

Add more salt may seen strange solution but does work for a good number

[@hosseinzeinalifard3454]

So, how should we pee less?

[@renzo6490]

What are TED stockings and why are they called that?

[@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.

[@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.

[@robblankenstein6825]

A trick I use now is to not go back to sleep straight away and like 5 minutes later go again.

[@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.

[@gaston.]

My friend who is an engineer pointed out that his West Highland defied physics. Its urine output exceeded its fluid intake.

[@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.

[@stuffstuffstuffyay]

I get up twice in the night to pee, 48f. It nis annoying. I alreadyb stop drinking anything by 8pm, I'm going to try stopping even earlier to see if it helps.

[@sonjaforrester9255]

I'm 50 and have stopped water at 3 but it's so hard I'm thirsty. I drink a lot.

[@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.

[@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.

[@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!

[@steveapollon1839]

This dialogue is not for the layperson. This video is medical professionals. I got almost nothing out of this.

[@MyPaulclark]

I drink 3L of water a day and pee every hr, I have a sleep tea 1hr before I go to bed and get up once a night to pee. Hate the feeling of being dehydrated

[@gkcima007]

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

[@Ianm3247]

I've noticed foods with Diphosphates in makes me pee in the night more. Anyone else noticed?

[@ThinkTwice2222]

Shocking stuff here \s

[@davidedsall9362]

what is the answer ?? what is normal nocturia ? in your 70's twice 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

[@franbailey]

Not his usual quality of interview. Schaeffer never answered the question about what is normal.