Nocturia better defined as the need to awaken ≥1 time per night to urinate.¹ Nocturia is divided into two main categories: upper urinary tract and lower urinary tract dysfunction.  Nocturia is the leading cause of sleep deprivation and has a detrimental effect on general health and quality of life.  It also may be associated with an increased risk of morbidity and mortality.  While nocturia is a urinary frequency that occurs during nighttime sleep, it is not necessarily driven by a lower urinary tract dysfunction involving the bladder, prostate, or urethra; other factors may cause it.  Here are some of the common underlying “causes” of nocturia[i]:

Urologic Conditions	Nonurological Conditions
Overactive Bladder	Chronic heart failure
Neurogenic voiding dysfunction	Diabetes
Bladder cancer	Sleep apnea
Benign Prostate Obstruction	Multiple sclerosis
	Inadequate fluid intake
	Depression
	Chronic pain

Common Types of Frequent Urination

• Polyuria: when your body makes too much urine in 24 hours
• Nocturnal polyuria: when your body produces too much urine during the night.
• Bladder storage problems: when your bladder doesn’t store or release urine well.
• Mixed nocturia: when more than one of these problems is happening.

Who is Impacted?

Although its prevalence is generally underestimated, nocturia is a prevalent condition affecting men and women of all ages.  Almost 69% of men and 76% of women (aged ≥ 40 years).  The proportion of men aged 20 to 30 years reporting ≥ 2 per night was 2% to 17%, rising to 29% to 59% in men aged 70 to 80.[ii]

Natural Approaches to Reduce Symptoms

According to the Urology Care Foundation, these are some suggestions to help reduce the chances of having issues when you sleep:

Lifestyle Changes

• Restrict fluid intake at night.
• Drink plenty of fluids during the day (especially water), but limit fluids to 2-4 hours before sleep.
  • Avoid alcohol and caffeine
• Manage your use of diuretics
• If you must take a diuretic, do so at least 6 hours before you sleep.  This will help reduce the number of times you urinate during the night.
• Elevate your legs or use compression socks.
• Some people experience fluid build-up in their legs.  Elevating your legs helps to redistribute fluids back into the bloodstream, reducing the need to urinate.  Elastic compression stockings help by putting pressure on your legs to prevent fluid build-up.

Supplements Can Help

A few essential supplements—beta-sitosterol, pygeum bark, and lycopene—can help reduce LUTS symptoms and help with nocturia.

• AGEprostTM (Ageratum conyzoides) is a 5-a-reductase inhibitor, thereby blocking the conversion of testosterone to DHT with subsequent reduction in prostate size, improving urine flow. A recent study with AGEprostTM showed it reduced the symptoms and urinary frequency of day and night.
• Beta-sitosterol- This ingredient is known to help support the reduction in age-related prostate enlargement.  In addition, reducing prostate size can help with improving urine flow.[iii]
• Pygeum Bark- Clinical trials have shown a reduction in the frequency of nighttime urination.[iv]
• Lycopene- Studies with lycopene show it can be helpful in several areas, which may impact nocturia: Bladder health[v], prostate health[vi], and decreased inflammation.[vii]

Sleep Assistance

Sleep is not an underlying risk factor for nocturia, yet taking sleep support supplements can help with the negative impact on the quality of life that nocturia can cause.  Here are a few of my favorites.

• Saffron (affron®)- Studies with affron® show improved sleeplessness scores, restorative sleep, feeling more energized/awake after sleep, and overall sleep quality.
• PEA (Levagen^®+)- Decrease Pain, Increase NREM sleep[i]
• Xylaria nigripes/Cuscuta chinensis/Panax notoginseng (Zylaria®)- Research with Zylaria has shown it impacts the natural production of GABA, increasing REM sleep
• Zea Maize (MaizinolTM)- Maizinol^TM has been shown to improve sleep quality by increasing deep and total sleep time.

Hitting Nocturia Head-On

Since many underlying factors can cause nocturia, the best approach for those who suffer from it should be:

1. First, speak with your healthcare provider to ensure everything runs smoothly.
2. Address those lifestyle areas that are in your control.
3. Supplement with lycopene and perhaps one other ingredient mentioned.
4. Consider a sleep support supplement to aid your ability to get a better night’s rest.

This isn’t rocket science, which means addressing nocturia should not be complicated. As mentioned above, take care of those areas within your control, and then take your supplements for extended periods. Supplements are not drugs and can take months to show their effects. Consistency will go a long way in getting you the desired results.

 

 

 

 

References

[i] Rao A, Ebelt P, Mallard A, Briskey D. Palmitoylethanolamide for sleep disturbance. A double-blind, randomised, placebo-controlled interventional study. Sleep Sci Pract. 2021;5(1):12. doi: 10.1186/s41606-021-00065-3. Epub 2021 Sep 10. PMID: 34522787; PMCID: PMC8428962.

[i] Weiss JP, Blaivas JG, Bliwise DL, et al.  The evaluation and treatment of nocturia: a consensus statement.  BJU Int.  2011;108:6–21.

[ii] Coyne KS, Wein AJ, Tubaro A, et al.  The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety, and depression: EpiLUTS. BJU Int.  2009;103(suppl 3):4–11

[iii] Berges RR, Windeler J, Trampisch HJ, et al. Randomised, placebo-controlled, double-blind clinical trial of beta-sitosterol in patients with benign prostatic hyperplasia.  Beta-sitosterol Study Group.  Lancet 1995;345:1529-32

[iv] Breza J, Dzurny O, Borowka A, et al. Efficacy and acceptability of tadenan (Pygeum africanum extract) in the treatment of benign prostatic hyperplasia (BPH): a multicentre trial in central Europe.  Curr Med Res Opin. 1998;14(3):127-39

[v] Helzlsouer KJ, Comstock GW, Morris JS. Selenium, lycopene, alpha-tocopherol, beta-carotene, retinol, and subsequent bladder cancer.  Cancer Res. 1989 Nov 1;49(21):6144-8.  PMID: 2790827.

[vi] Schwarz, S., Obermuller-Jevic, U. C., Hellmis, E., Koch, W., Jacobi, G., and Biesalski, H. K. Lycopene inhibits disease progression in patients with benign prostate hyperplasia. J Nutr 2008;138(1):49-53

[vii] Cha JH, Kim WK, Ha AW, Kim MH, Chang MJ. Anti-inflammatory effect of lycopene in SW480 human colorectal cancer cells. Nutr Res Pract.  2017 Apr;11(2):90-96. doi: 10.4162/nrp.2017.11.2.90. Epub 2017 Feb 15. PMID: 28386381; PMCID: PMC5376536.