‘Our findings open an important target for nocturia treatment that lies beyond the bladder.’

Interview by Alyx Arnett

Nocturia, the frequent awakening to urinate at night, is a prevalent and vexing issue among older adults, often coinciding with sleep disturbances and insomnia. Behavioral therapy has demonstrated efficacy in treating insomnia in this age group, but its potential impact on nocturia had not been thoroughly explored. 

Geriatrician Shachi Tyagi, MD, MS, University of Pittsburgh Medical Center, and coinvestigators conducted a study to assess the effects of brief behavioral treatment for insomnia (BBTI) on sleep and nocturia in older adults. “As a geriatrician, when I would inquire about the cause of nighttime awakenings, patients would report frequent nighttime awakenings to void but were unable to say if nocturia was the cause or consequence of these awakenings,” says Tyagi. “This made me realize the bidirectional relation between poor sleep and nocturia, and these are mutually exacerbating conditions.”

The study involved 56 community-dwelling older adults with a mean age of 72±6 years experiencing nocturia at least twice per night. Participants were randomly assigned to either the BBTI group or the information-only control group. Using a three-day voiding and sleep diary, as well as an objective in-home sleep assessment with a Zmachine single-channel EEG device by General Sleep, the researchers monitored changes in sleep patterns and quality.

Tyagi discussed the study, which was presented at SLEEP 2023 and is currently under peer review for publication, with Sleep Review over email.

[Editor’s Note: Read the abstract, Behavioral treatment of insomnia with concurrent nocturia, in Sleep.]

What led you to investigate the impact of behavioral sleep treatment on older adults with nocturia? 

It was commonly accepted that nocturia causes sleep interruption resulting in poor sleep. But to explore the role of poor sleep in nocturia precipitation, I decided to do a secondary analysis of a study by Daniel Buysse, MD, et al assessing the efficacy of a novel behavioral sleep intervention, BBTI,¹ and found that improving sleep improves nocturia without addressing any underlying bladder etiology.

What were the main findings of your study?

In this prospective study, we were able to replicate our findings of the secondary analysis of Buysse’s study. We found that BBTI not only improves sleep in older adults but also improves nocturia. In addition, an important finding is that this improvement in nocturia frequency is related to a decrease in nighttime urine volume. Increased volume of urine production is the most common cause of nocturia among older adults. Our study is the first to indicate the role of poor sleep in the etiology of increased nighttime urine production and a change in the diurnal rhythm of urine production with sleep improvement.

What are the clinical implications?

Urine is produced in a diurnal rhythm with a decline in nighttime urine production that can be stored in the bladder overnight without causing awakening to void. Disruption in the diurnal rhythm of urine production with increased nighttime urine production is the most common cause of nocturia among older adults. This is prevalent but without an effective treatment. The available pharmacologic treatments have limited efficacy with significant side effects. Our findings indicate an effective behavioral treatment for this prevalent condition among older adults without the risk of side effects.

How does this study contribute to the existing knowledge of the management of nocturia?

Our findings open an important target for nocturia treatment that lies beyond the bladder. Sleep problems are prevalent in older adults, and so is nocturia. The management of both these conditions is being studied and managed in silos. Our study bridges the gap between the two fields with the possibility of the development of more synergistic treatment options.

How might the findings influence the development of clinical guidelines or recommendations for the management of nocturia in older adults?

Our findings support the addition of sleep as an integral part of nocturia assessment and management.

Based on your findings, what future research should be done?

Future research should explore the options for synergistic treatment options combining behavioral sleep treatment with bladder-related treatment to address this prevalent issue that is otherwise difficult to treat among older adults.

Reference

Buysse DJ, Germain A, Moul DE, et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med. 2011 May 23;171(10):887-95.

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