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Sleep problems in later life

Going to the toilet in the night

A lot of the people we talked to about their poor sleep said that one of the main reasons they slept badly was because they woke up to go to the toilet in the night. For some people it was only once a night, and not every night, but others reported having to get up several times in the night on most nights of the week. This, naturally, left them feeling very tired during the day. Although some people knew that needing to go to the toilet was waking them up, others weren’t always clear why they had woken up, but decided to go to the toilet anyway. There was a feeling that if they went to the toilet when they woke up that this would mean they wouldn’t have to get up again in the night.
 

John isn’t sure whether he is waking up because he wants to go to the toilet, but wonders whether...

John isn’t sure whether he is waking up because he wants to go to the toilet, but wonders whether...

Age at interview: 67
Sex: Male
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…it is not a big feature snoring. Although I do occasionally it is not a big feature. So that is something.
 
And you don’t stop breathing or anything?
 
Oh I am not aware I do, because I wake up and just want to go to the loo. I get a bit of a tingle and think oh God here we go.
 
Yes, because sometimes it’s difficult to tell, so wanting to go to the loo is what wakes you up, rather than you waking up and then realising you want to go to the loo?
 
I don’t know. I don’t know the answer to that. Invariably when I do wake up it is because I want to go to the loo. But whether that is waking me up or it is just by chance. I tend to think there is something telling me that I want to go to the loo. But I take a water tablet every morning, because of water retention. Now it should only last four or five hours. I am wondering if the residue carries on longer. I don’t know. He assured me it’s a mild dose and it shouldn’t last more than four hours.
 
So it shouldn’t be taking you into the night?
 
Well it shouldn’t no. Because I take it first thing in the morning, so by lunch time I should okay.
 
It should be out of your system. How long have you been on that?
 
Oh about a year. yes. So I have just been before you came so I am going to sit here without discomfort for two hours.
 
So how many times in the night do you think you get up to go to the…?
 
It is only ever once.
 
Only once?
 
That is about three times a week.
 
Yes, because that was one of the questions on the, that questionnaire that you filled in. a lot of people are saying you know, three or four times a night?
 
Oh Gosh if that is that bad then they ought to go to the doctors. You talk about prostate cancer if you do that. Gosh.
 
I think people accept it as part of the aging process. It is acceptable?
 
The doctors says if it is more than once a night you need to be looking at maybe why, but four times a night you are definitely possibly in trouble. Yes. yes, I mean it is a feature. I have been checked out so …I think I am okay on that score.
 

Mary isn’t sure whether she is waking because she needs to go to the toilet, but will go anyway...

Mary isn’t sure whether she is waking because she needs to go to the toilet, but will go anyway...

Age at interview: 72
Sex: Female
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So you talked about going to bed about 11.30 and then getting up at about 7. So that’s like seven and a half hours, but you have a break as well, is that every night? You said you go to the loo?
 
No, not every night, but lots of nights. I turn over and I think I might as well go to the loo now.
 
Right so are you aware of needing to go to the loo? That’s waking you up or is it you are awake?
 
I don’t know, sometimes I wonder about that.
 
But you will go to the loo anyway just to make yourself comfortable?
 
Yes, because I can go back to sleep quickly then.
 
Is it upstairs the loo?
 
Yes, oh just a step away you know. 
Many of those who woke up to go to the toilet then couldn’t get back to sleep, the main reason being that they started to think about problems and worries that they had, or sometimes it was just thinking about what they had to do the next day. Some of the worries people talked about were simply whether they may need to get up and go to the toilet again that same night, which they knew would leave them very tired the next day.
 

Roy tries to relax when he gets back into bed after going to the toilet, but then he starts to...

Roy tries to relax when he gets back into bed after going to the toilet, but then he starts to...

Age at interview: 82
Sex: Male
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So you fall asleep, you are in bed by about half past ten, and you fall asleep by about eleven but then you wake again about oneish is that what you are saying?
 
Sometimes. Yes.
 
Or sometimes you will go. So that is your two hours of the four you think?
 
Hm.
 
How long are you awake then, when you wake up at one?
 
Well I have to get up to go to the toilet, you see and I think that is the reason why I do wake up.
 
That is what I was going to ask you, that is what prompts you to wake up?
 
Yes. And usually I find when I get back into bed, I feel very relaxed then. Just the action of having to get up and change position, but that feeling of relaxation doesn’t seem to last, it only lasts about, you know, ten minutes or so and I feel so beautifully relaxed but then the old thoughts come in or tensions or whatever.
 
And that is what keeps you awake is it, those worries that you mentioned?
 
Usually, if I have to get up at one o’clock or fairly early I do go back to sleep fairly soon. It is the second session when I get up say at half past five, when I can’t usually get back to sleep. 
 
People gave several reasons for why they might need to get up so often in the night to go to the toilet. One explanation was that it was just a natural part of getting older, and men in particular blamed their frequent visits to the toilet on prostate problems, which are more common in older men. Whilst some men had been diagnosed with prostate problems, a few believed this was the cause of their visits to the toilet, whether it had been diagnosed by a doctor or not. Some of the men had received treatment for their prostate problems which helped reduce the number of trips to the toilet in the night. Although Otto found it made no difference at all, despite going back for further treatment.
 

Fred has noticed a big improvement in the number of times he has to get up to go to the toilet...

Fred has noticed a big improvement in the number of times he has to get up to go to the toilet...

Age at interview: 67
Sex: Male
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Fred'   Yes, because obviously that was one of the main reasons for going to see him (doctor) was getting up four or five times during the night and all this sort of thing, but apart from that I never sort of worried about it really.
 
Wife'   You just probably thought you were getting that way because you kept going to the loo, because if you feel your bladder is full up, I mean even me, it is very, very rare that I will get up to go to the toilet.
 
Fred'   Oh very rare.
 
Wife'   But I mean if I have got to go, you have got to go, you know, so with him, you know, it was quite serious really. Because he had to keep getting up all the time.
 
Fred'   Well it was annoying. Because also I was working at the time then as well. because I had the problem for a long time, and you are actually tired when you have got to go to work and you have to force yourself and this that and the other, and because it may be psychologically thinking about it, might have something to do with it, the fact that I used to be like that they did something instead of me, that really you don’t want to go to bed yet, because you will only be getting up to go to wee. But I have had the operation now so that is fine. But thinking about it that way, which I haven’t done, before it may be something psychological there telling me that if I go to bed I will be waking up. But I know I am not now, because I have had the operation.
 
Fred'   Well we basically go up at the same sort of time. Round about elevenish. We never used to go to sleep till… sorry we would never go later then say ten o’clock half past ten when I was working. But because of this problem about not being able to sleep, I said well it would be probably be better if I go later when I would be more tired. So we tried that and it didn’t make any difference. I mean I could be sitting down here and I would sit and do the crossword, if there wasn’t much on the television, I used to do Sodoku puzzles as well and then I would go out for a last cigarette, and go upstairs, into bed and by that time I am really feeling tired. I can get into bed and just for some reason I will lay there and initially the first five minutes, lovely, snuggle down like you do, and then all of a sudden, something just seems to wake me up and then I just turn over this side, turn the other side, lay on my back, I can’t sleep on me back or me left hand. I always go to sleep on the right hand side, on my right. And when that doesn’t work, I start to get frustrated then. And, well this is no good, just laying here I am not getting anywhere. Then I come downstairs in the garden, have a cigarette, about twenty minutes or something like that, then pop upstairs again and eventually I would go off.
 
But it just takes such a long time and then I possibly go to toilet, about say 2 o’clock, because it is only about a year I had prostate operation because I had a bladder problem you know, and that’s made a hell of improvement. It really has, from the point of view of not getting up during the night. But once I do wake up, then it’s a job to get back to sleep again.
 
Other illnesses, such as diabetes, affected people’s need to go to the toilet frequently during the night. Ronald had been advised to drink more water to help his gout, which in turn was increasing the number of times he needed to get up during the night.
 
Although several of the people we spoke to lived on their own, some lived with partners or wives. Anne explained how both she and her husband often got up to go to the toilet in the night. They also both woke up immediately when either one of them got out of bed, and she felt that this prevented them both from sleeping deeply. Part of Robert’s role in caring for his terminally ill wife at home was helping her to go to the toilet during the night.
 

Robert’s sleep was disturbed often because of helping his wife to go to the toilet in the night.

Robert’s sleep was disturbed often because of helping his wife to go to the toilet in the night.

Age at interview: 77
Sex: Male
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It was when she had the last major problem and radiotherapy which induced and the steroid she took, she had to take a lot of steroids, it caused her to lose her hair, and they also brought on this type II diabetes, which mean since we didn’t going on to start with at one time, six times a night I would get up to go to the toilet, and waking, waking all the rest of the time, and in fact when we got that under control it would probably go down to three times a night. And then it went up again after Christmas. It was only two or three times a night but each time would take half an hour literally to get her up there or to get her onto the commode and so I used to dread nights.
 
People had several strategies for getting back to sleep in the middle of the night and one of them was actually going to the toilet. This was to help them feel more comfortable and they believed it would reassure them that they wouldn’t need to get up again. Sue B. said she goes to the toilet several times before she goes to bed to try and prevent her having to get up in the night and this does, on the whole, seem to work for her.
 

Mike felt if he went to the toilet just in case, it would make him feel more comfortable and help...

Mike felt if he went to the toilet just in case, it would make him feel more comfortable and help...

Age at interview: 66
Sex: Male
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What about having to go to the loo. Do you have to do that in the night?
 
I don’t normally, I often get up about 3 or 4 o’clock perhaps 5 o’clock but just once normally. And it’s not usually desperate it’s just probably well I feel a little bit more comfortable perhaps almost.
 
So you don’t think it’s something that’s waking you up?
 
No I don’t really. No I don’t think so.
 
Is that something that you wake up and think oh I might as well go to the loo now?
 
Yes, almost. Yes, almost. I’m awake and I think oh I might as well go, you just feel a little bit more comfortable for a little bit longer. 
 
Others tried restricting the amount of drinks they had during late afternoon and evening. The time they stopped drinking varied from between 4.30 pm or within an hour or so of going to bed. Sometimes people told us they were aware that what they drink affects if or how frequently they go to the toilet, but still continue to drink. At one point Otto stopped drinking anything after 4.30 pm to avoid having to get up in the night, but then became concerned when he read somewhere that going without fluids made you feel weak. He started drinking more, but still won’t drink after 5.30 pm.
 

Val is aware that if she drinks tea after 6 o'clock this may mean she has to get up in the night...

Val is aware that if she drinks tea after 6 o'clock this may mean she has to get up in the night...

Age at interview: 65
Sex: Female
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Do you ever eat in the night. Do you get hungry in the night. Because you can, can’t you, if you are awake?
 
I've never gone to eat anything.
 
Just drink tea?
 
Just drink tea.
 
And do you get up to go to the loo in the night?
 
Yes, I do. A couple of times. Because I am drinking tea isn’t it!
 
Yes, yes, it would do. But do you have any perception of whether you are waking up to go to the toilet or whether you wake up and think I will go to the toilet?
 
No I wake up wanting to go to the toilet.
 
Okay and do you stay awake after that. Does that keep you awake then?
 
Not all the time. Sometimes I go back and I am going to the toilet half asleep like a zombie. And I go back into bed and I am gone. Another time, yes, it wakes me up.
 
It triggers you awake and then you stay awake?
 
I stay awake for a couple of hours.
 
And is that whether you are here or wherever you stay?
 
Wherever.
 
It is always the same. And do you know how long you have been following that pattern. Getting up to go to the loo in the night?
 
What going to the toilet? That must be I should think for the last couple of years.
 
I find if I have a cup of tea about 7, 8 o’clock then I know I am going to get up in the night, but sometimes I, like last night I didn’t get up because I didn’t have a cup of tea. My last cup of tea was about, I don't know, half past five, six o’clock and that is all I drink. I don’t drink coffee. I don’t drink.
 
Alcohol?
 
No. I only drink tea, quite boring really! 
 

John tried drinking a milky drink to help him get to sleep, but found that he then had to get up...

John tried drinking a milky drink to help him get to sleep, but found that he then had to get up...

Age at interview: 67
Sex: Male
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Really, what causes that do you know?
 
I have no idea. I've tried reading books. I used to go out for walks, but people were attacked in the church yard a couple of times and I think may be…
 
Really.
 
Oh yes, we have had two women attacked in the church yard and that is early evening. And there are a few yobs about so I thought well, I don’t know. In the summer may be, I don’t mind when it is daylight, but not this time of the year. So I have got one of these things you jump up and down. I do stretching and stuff. I have tried Horlicks but the trouble with Horlicks is the liquid in my body tends to want to come out. So I try and cut down on drinking after six. And the Horlicks you have got to have before you go to bed. So it is a two way thing. I do sleep better with Horlicks but then I wake up wanting to go to the loo. So I would say my average sleep is between five and a half and six hours a night.
 
And would you that say that five and a half or six is pretty unbroken. Or are you disturbed in the night?
 
I occasionally go to the loo. Occasionally.
 
Okay and can you get back to sleep straight away?
 
A quarter of hour, twenty minutes usually. I would say if people looked for seven hours a night I am nowhere near it. My seven hours is as I say about once or may be twice a month.
 
 
 
 
Nearly all of the people who complained of having to get up in the night said that a perfect night’s sleep would be one without the interruption of having to go to the toilet at all. Or for those who are used to going several times in the night, a perfect night’s sleep would be going just once. But overall, most people accepted this change to their sleep pattern because they saw it as a part of getting older, and felt that there was nothing they could do about it.

Last reviewed October 2018.

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