Waking often to urinate linked to increased death risk

Many people every night wake up in the middle of the night for a trip to the bathroom, and in most cases they think nothing of it. When it happens multiple times a night, there’s new reason to be concerned. New research shows nocturia, or frequent overnight urination, signals a higher risk of dying.

The study released by the American Urological Association found the elevated risk applies to men and women of all ages.

Death rates were highest for men with nocturia aged 20 to 40. Women between 50 and 64 were also among the most at-risk.

The authors at the New England Research Institutes discovered the relationship by comparing mortality rates to responses about nighttime urination in a national survey conducted between 1988 and 1994.

The data was adjusted to account for a number of confounding risk factors, including diabetes, cardiovascular disease and hypertension.

The authors suggest the increased risk of death may be due to any combination of outside risk factors causing sleep disruption. In some cases using the bathroom may happen after waking up for reasons other than needing to urinate.

For instance, people with obstructive sleep apnea may wake because of a pause in breathing and make a trip to the bathroom. Individuals with insomnia may also get out of bed frequently, possibly due to anxiety.

Both insomnia and sleep apnea have been linked to higher mortality rates.

Further research is needed to determine exactly why people who frequently wake up to urinate have a higher risk of death.

Lying Awake & Sleeping in Two Shifts

Waking up in the middle of the night and being unable to return to sleep is one sign of insomnia. But a recent story on NPR’s “Morning Edition” suggests that this wasn’t always the case.



A period of wakefulness in the middle of the night used to be the norm. At that time there were no lights to turn on at night. When it got dark outside, it was just as dark inside.

A winter night can bring 14 hours of solid darkness. That’s a long time to spend in bed.

So what would happen? There are reports that people would sleep in two shifts through the night. In between, they would lie awake for a period of time.

But this wasn’t a frustrating, anxious, tossing and turning kind of awake. It was more of a relaxing, late-night pause before the early-morning sleep shift.

The story even cites a 1993 study that simulated this long, dark winter night. Fifteen volunteers spent 14 hours in bed in a sleep lab. The lights were turned out from 6 p.m. to 8 a.m.

Sure enough, they slept in two shifts. In the middle was a period of wakefulness lasting a few hours.

"You might think that lying awake for two hours would be a kind of torture," study author Thomas Wehr told NPR. "But it wasn't at all."

This news might be a comfort for older adults who tend to have more fragmented sleep. They may have a more flexible schedule that allows them to spend a long winter’s night in bed.

But 14 hours in bed? That’s close to impossible for most people today.

Yet you can implement a less extreme version of the two-shift sleep method. One proponent of the split-night sleep schedule is Dan Henning, who is 67 years old. He is the offensive coordinator for the Miami Dolphins.

The Palm Beach Post reports that he goes to bed by 9 p.m. Around 2 a.m. he likes to wake up for about 45 minutes of “personal time.” Then he returns to sleep.

So in a perfect world, what would be your sleep schedule?

Ongoing Debate: The Best Way to Get Your Baby to Sleep

What’s the best way to get your baby to sleep through the night?

Most new parents are desperate to know the answer. The AASM reports that bedtime problems and frequent night wakings occur in about 20 percent to 30 percent of young children.

But the advice that parents receive can be contradictory. And the subject is a source of debate, both in the U.S. and abroad.

The Herald Sun reports that recent research has stoked the debate in Australia. The research supports using the “controlled crying” technique for babies who are older than six months of age.

This method often is attributed to Dr. Richard Ferber. He advocates teaching infants how to go back to sleep on their own.

This is often called the “cry it out” technique. A more technical term is “graduated extinction.”

On the other side of the debate is Dr. William Sears. Instead of the “cry it out” method, he is a proponent of “attachment parenting.”

A 2006 study in the journal Sleep compared the advice found in 40 parenting books. Sixty-one percent of books endorsed “crying it out”; 31 percent opposed it.

Also in 2006 the AASM published practice parameters for bedtime problems and night wakings in young children and infants. A task force of experts reviewed all of the current research on this topic.

The report recommends graduated extinction as an effective therapy. You can read a summary of the recommendations on SleepEducation.com.

Discuss any ongoing sleep problems with your child’s doctor. He or she may refer you to an AASM-accredited sleep center for help.

Learn more about sleep and children.