I take care of a woman who is 100 years old. I help take care of her at home. She is very, very fragile and incapacitated, but not incontinent. She needs assistance. She demonstrates normal toilet function during the day, but has very frequent calls to urinate at night. She will not rely on the absorbent pants she wears. 30 minutes before retiring, she is given a plant-based relaxant, and after one or two calls, she is given 5 milligrams of Zolpidem Ratiofarm (Tartrato) to induce sleep. This may function for up to 4 hours or it may not work at all. Her day is roughly 8 a.m. to 9-10 p.m. on a sofa or chair with the feet raised, with intervals of bed rest. She eats well. Before spending a week in the hospital for circulation problems and lack of iron, she slept through the night.
Doctors Answers (3)
Nocturia has many causes. At 100 years of age it is difficult to recommend an extensive evaluation including a urological consult. But, don't exclude the possibility. I assume there is no obvious relationship between her nocturia and starting any medications. As a sleep specialist I equate nocturia with obstructive sleep apnea. During apnea the heart secretes a diuretic to help reduce our body fluid level. This is a protective mechanism. A home sleep study could be arranged. The reduced iron level is often a cause for leg movements and restless leg syndrome which may be associated with nocturia. Treatment is available.
Nocturia has a broad differential. Most frequently in elderly is related to overactive bladder, untreated urinary tract infections, or just plain old incontinence. Sleep breathing disorder such as sleep apnea can also make it worse. Sometimes medicines such as diuretics can also contribute.
There are many causes of nocturia including blood pressure problems, heart failure, kidney disease and bladder disease, overhydration, medication effects and side effects as well as sleep apnea. Depending on the primary or secondary causes other medicine and behaviorual strategies can be employed to hold urine in the bladder for longer periods of time so as not to disrupt or fragment sleep.