Insomnia, Nocturia and Waking Up to Pee at Night: Which Comes First, the Waking or the Urination?

Quick Summary

• People with insomnia have roughly twice the odds of getting up to urinate at night, a condition called nocturia, according to a review that combined seven studies of more than 5,000 middle-aged and older adults (Verbakel et al., 2025).

• Nocturia adds extra time awake for people with insomnia: people with both conditions spend more time awake in the night than people with insomnia alone, with more frequent and longer awakenings (Zeitzer et al., 2013).

• Treating insomnia appears to reduce night-time bathroom trips. Behavioural therapy, a dietary programme and melatonin each cut nocturia episodes in small studies (Tyagi et al., 2014b; Tan et al., 2016; Park et al., 2020).

• Nocturia is easy to overlook in insomnia, so the review’s authors recommend routinely asking adults with insomnia about it, because treating nocturia could improve overall sleep quality.

Insomnia And Waking To Pee

It’s 3 a.m. You’re awake, staring at the ceiling, and you need the bathroom. You get up, go, come back to bed, and then lie there for the next hour wondering whether you’ll ever fall asleep again.

But which came first? Did a full bladder wake you, or were you already awake, and the bathroom trip was simply something to do? For most people this feels like a chicken-and-egg question with no clear answer. For researchers, the relationship between insomnia and nocturia, the medical term for waking up to pass urine during the main sleep period (Hashim et al., 2019), turns out to be a surprisingly open one.

Plenty of research shows that nocturia can cause insomnia, because every trip to the bathroom breaks up the night (Ancoli-Israel et al., 2011). Far less was known about the reverse: whether people who already have insomnia are more likely to develop nocturia.

A team of urologists and sleep researchers led from Ghent University in Belgium set out to find out, in the first systematic review and meta-analysis on the question (Verbakel et al., 2025). A systematic review gathers all the published research on a question, and a meta-analysis combines the numbers from those studies into a single overall result.

So what did they find?
Well, first up, let’s consider how common each condition is.

How Common Are Insomnia And Night Time Urination?

Insomnia and nocturia are both common, and both become more common with age. Somewhere between 30% and 50% of adults report at least one insomnia symptom, and around 5% to 15% have symptoms persistent enough for a diagnosis of insomnia (Ohayon, 2002). Nocturia affects about 30% of adults (Burgio et al., 2010).

Nocturia is not a minor nuisance either. Nocturia lowers quality of life (Kupelian et al., 2012) and has been linked to falls (Parsons et al., 2009), fractures and a higher risk of death in older adults (Nakagawa et al., 2010).

So given the risks with nocturia, does insomnia contribute?

Are People With Insomnia More Likely to Get Up to Pee at Night?

Yes, people with insomnia have roughly twice the odds of reporting nocturia compared with people without insomnia. When the Ghent team combined seven studies covering 5,396 middle-aged and older adults, those with insomnia had about double the odds of nocturia, with a combined odds ratio of 1.96 (Verbakel et al., 2025). An odds ratio compares how likely something is in one group against another, so a value of 1 would mean no difference and 2 means twice the odds.

The individual studies told a consistent story.

All seven pointed the same way, with odds of nocturia ranging from about 1.6 to 3.1 times higher in people with insomnia, although in one smaller study the difference was too small to rule out chance (Ayoub et al., 2014).

The largest study followed 1,478 older men in the United States (Endeshaw et al., 2016), and the highest figure came from older women attending a clinic for older people (Dutoglu et al., 2019). Overall, the link showed up across countries, settings and both sexes. The review also found no sign of publication bias, the tendency for studies with exciting results to be published while dull ones sit in a drawer.

The link between insomnia and nighttime urination also survived some obvious explanations. According to the review’s authors, the link held even after the researchers took other common causes of night-time urination into account, such as age, diabetes, heart disease, kidney function and diuretics (medications that make you pass more urine) (Verbakel et al., 2025).

In other words, the link isn’t simply explained by both conditions being common in older people with health problems.

So if the two conditions go together, what happens to sleep when someone has both?

How Does Nocturia Affect Sleep in People With Insomnia?

Nocturia makes insomnia worse, adding extra time awake in the middle of the night. Two studies in the review used actigraphy, a wristwatch-like device that estimates sleep and wakefulness from movement, to compare older adults with insomnia who did and did not have nocturia.

In the first study, people with insomnia and nocturia spent about 77 minutes awake after first falling asleep, compared with about 54 minutes for those with insomnia alone (Zeitzer et al., 2013).

That’s an extra 23 minutes of lying awake each night, roughly the length of a television episode.

The people with nocturia also woke more often, about 36 times a night against 28, and each awakening lasted a little longer, around two minutes on average. Each waking is brief, but together they add up.

The second study found a smaller gap of about nine minutes of extra wakefulness, while total sleep time was nearly identical between the groups (Tyagi et al., 2014a). Sleep efficiency, the percentage of time in bed actually spent asleep, was slightly lower with nocturia in both studies.

So does the bladder wake you up, or does insomnia wake you and send you to the bathroom?

Does a Full Bladder Wake You, or Do You Wake Up and Then Go?

Researchers don’t yet know whether people with insomnia wake up because they need to urinate, or wake up for another reason and then use the bathroom out of habit. The review’s authors point out that none of the included studies recorded whether each trip was driven by urgency or simply by convenience (Verbakel et al., 2025).

The distinction is important to understand for where to target treatment. A “convenience void” happens because you’re already awake: you notice you’re up, so you might as well go. Hot flushes in women going through menopause or the early-morning waking common in depression could easily wake someone, who then heads to the bathroom before trying to sleep again. If that’s what’s happening, the bladder is a symptom rather than the cause.

Other research suggests the bladder often is the trigger. In a study of people seeking treatment for chronic insomnia, nocturia was one of the most common causes of waking during the night (Krakow et al., 2012).

Both routes are plausible, and the studies so far can’t tell them apart.

So could insomnia itself actually make the body produce more urine at night?

Can Insomnia Make Your Body Produce More Urine at Night?

Possibly. The review’s authors propose that insomnia could increase night-time urine production through its effects on the body’s stress system, although this explanation has not yet been tested directly in people with both conditions (Verbakel et al., 2025).

The authors suggest the chain starts with stress hormones (Verbakel et al., 2025). In their proposal, insomnia keeps the body’s stress response switched on, raising blood pressure and activity in the “fight or flight” nervous system.

Normally, blood pressure dips at night. When the night-time dip doesn’t happen, the kidneys respond to the higher pressure by passing more salt and water. The missing dip can also reduce antidiuretic hormone (ADH), the hormone that tells your kidneys to hold onto water overnight. This hormone is why most people can sleep through the night without needing the bathroom.

A second possible route runs through blood sugar. Higher levels of the stress hormone cortisol can interfere with how the body handles sugar. High blood sugar pulls extra water into the urine. Over time, diabetes can also damage the nerves that control the bladder, making it more irritable. Diabetes and nocturia are already known to go together (Fu et al., 2022).

Think of insomnia’s possible effect on the kidneys like a tap left slightly open overnight. Insomnia may not cause a flood, but a body that stays on alert could keep the kidneys running when they would normally slow down for the night.

These explanations are plausible, but for now they remain hypotheses.

If insomnia does contribute to nocturia, though, the next question is an encouraging one: does treating insomnia help?

Can Treating Insomnia Reduce Night-Time Bathroom Trips?

Early evidence suggests that treating insomnia can reduce nocturia. The review found three studies that tested an insomnia treatment and also measured night-time urination, and all three found a statistically significant drop in nocturia episodes (Verbakel et al., 2025).

That finding fits with earlier research in people whose main complaint was nocturia rather than insomnia. Behavioural therapy (Johnson et al., 2005) and melatonin (Drake et al., 2004) have both been shown to help people with nocturia, which hints that the two problems share some of the same machinery.

Each of the three treatments worked in a different way, so it’s worth looking at them one at a time. What did behavioural therapy achieve?

Does Behavioural Therapy for Insomnia Help With Nocturia?

Yes, a short course of behavioural therapy for insomnia (a shortened form of CBT for Insomnia) reduced nocturia in older adults. In a trial of 79 older adults with chronic insomnia, four weeks of behavioural treatment cut night-time bathroom trips from about 1.5 to 1.0 per night, measured with a two-week sleep diary (Tyagi et al., 2014b). The improvement was larger than in a comparison group who received general sleep information only, and the difference held after accounting for how often each person was getting up beforehand.

The same behavioural treatment improved overall sleep quality and reduced the time spent awake in the night (Tyagi et al., 2014a). Going from one and a half bathroom trips a night to one may sound modest, but over a month that’s around 14 fewer times being dragged out of bed.

Behavioural therapy works on how you sleep. Could changing what you eat do something similar?

Can Changing Your Diet Reduce Nocturia?

A six-month diet programme reduced both nocturia and night-time awakenings in men with insomnia symptoms. The study followed 49 overweight and obese men aged 30 to 65, comparing those on a structured diet with a comparison group (Tan et al., 2016). Bathroom trips fell from about 0.8 to 0.5 per night, and overall awakenings dropped from about 2.3 to 1.8.

The diet group also fell asleep faster than the comparison group (Tan et al., 2016) when measured with a home sleep monitor. Other sleep gains in the diet study were less clear-cut, because they didn’t hold up against the comparison group.

There’s an unanswered question here, too. The diet study (Tan et al., 2016) didn’t separate men with and without nocturia, so it’s impossible to say whether the men woke less because they were urinating less, or because the diet improved their sleep in other ways (Verbakel et al., 2025).

What we eat and drink, and when, affects how much urine the body produces, but the exact mechanisms are still being worked out (Alwis et al., 2020).

What about melatonin?

Does Melatonin Help With Nocturia?

Melatonin reduced nocturia in one small study of older men with both an overactive bladder and chronic insomnia. After 12 weeks of slow-release melatonin, the men’s night-time bathroom trips fell from about 2.9 to 2.1 per night (Park et al., 2020). Their sleep quality scores also improved.

The melatonin study was small, though (Park et al., 2020). Thirty-seven men enrolled and only 26 finished. And even after treatment, the men’s average sleep quality score still fell in the “poor sleeper” range (Verbakel et al., 2025), so melatonin helped but didn’t solve the problem.

How does melatonin help?

Melatonin may help through two routes: the body clock and the bladder muscle. Melatonin is best known as the hormone that signals darkness and helps set the body clock. Melatonin also relaxes certain muscles, including the muscle in the bladder wall. In animal studies, melatonin increased how much the bladder could hold and reduced urine volume (Matsuta et al., 2010).

All three treatments help, then. But if someone has both problems, which one should be treated first?

Should You Treat the Insomnia or the Nocturia First?

The evidence hints that nocturia may need attention first, or at least alongside insomnia treatment. In the behavioural therapy trial, people with nocturia improved, but by noticeably less than people with insomnia alone (Tyagi et al., 2014a). The improvement in sleep quality scores told the same story: a clear gain in both groups, but a smaller one when nocturia was present.

The review’s authors suggest one explanation: in people with both conditions, nocturia may be disturbing sleep more than the insomnia itself (Verbakel et al., 2025). If so, treating insomnia without addressing the bladder is like bailing out a boat without plugging the leak. The smaller benefit could also simply reflect the small number of people in the behavioural therapy trial (Tyagi et al., 2014a), so this remains a suggestion rather than a firm conclusion.

What the review’s authors are clear about is the practical step. Nocturia is often overlooked in insomnia care, partly because many insomnia studies don’t report on it. The authors recommend that whenever an adult seeks help for insomnia, nocturia should be checked for as a matter of course, because treating it could improve overall sleep quality (Verbakel et al., 2025).

So what does that mean if you’re the one getting up every night?

Where To From Here?

If you’re waking up to use the bathroom and then struggling to get back to sleep, you’re dealing with two common, closely connected problems, not a personal failing. Nocturia adds extra time awake to an already broken night, and this review found that people with insomnia face roughly double the odds of night-time urination.

The encouraging part is that both problems respond to treatment, and treating one may help the other. We have worked with a number of people that have found their medication designed to reduce nighttime urination unnecessary once their insomnia improved.

A good starting point is a thorough assessment with a Behavioral Sleep Medicine specialist, who can map out what is actually happening across your nights: how often you wake, what wakes you, and whether you’re getting up because of your bladder or out of habit once you’re awake. From there, treatment becomes an individualised programme that targets the specific patterns keeping you awake, rather than one-size-fits-all sleep advice. Where the bladder itself is part of the problem, that work can run alongside a medical review with your GP or a urologist.

Night-time bathroom trips, and the long wait to fall back asleep afterwards, are both treatable.

Frequently Asked Questions About Insomnia, Nocturia and Waking Up to Pee at Night

Q1: Can insomnia cause you to pee more at night?

A1: Insomnia may contribute to night-time urination, but the cause has not been proven. People with insomnia have roughly twice the odds of nocturia, according to a review of seven studies in middle-aged and older adults (Verbakel et al., 2025). The review’s authors propose that insomnia keeps the body’s stress system switched on, which could raise night-time blood pressure and urine production, although this explanation is still untested.

Q2: Why do I wake up to pee and then can’t get back to sleep?

A2: Waking to pee and then lying awake is common when nocturia and insomnia occur together. In older adults with insomnia, those who also had nocturia spent about 23 more minutes awake each night and woke more often (Zeitzer et al., 2013). Each bathroom trip is another chance for an alert, wakeful brain to stay switched on, so returning to sleep becomes harder.

Q3: How many times is it normal to get up to pee at night?

A3:  Getting up to pee once a night is common, and two or more times is where nocturia starts to affect quality of life. The International Continence Society defines nocturia as any waking to pass urine during the main sleep period (Hashim et al., 2019), but research often uses two or more trips a night as the cut-off, because quality of life drops noticeably from that point (Tikkinen et al., 2010).

Q4: Does melatonin help with waking up to pee at night?

A4: Melatonin reduced night-time urination in one small study. In 26 older men with an overactive bladder and chronic insomnia, 12 weeks of slow-release melatonin cut bathroom trips from about 2.9 to 2.1 per night (Park et al., 2020). Melatonin may work by helping set the body clock and relaxing the bladder muscle, but larger trials are needed before it can be recommended.

Q5: Can treating insomnia reduce nighttime urination?

A5: Treating insomnia appears to reduce nocturia. In a trial of 79 older adults with chronic insomnia, four weeks of behavioural treatment cut night-time bathroom trips from about 1.5 to 1.0 per night, more than in a comparison group (Tyagi et al., 2014b). A six-month diet programme also reduced bathroom trips in men with insomnia symptoms (Tan et al., 2016).

Q6: Should I treat my insomnia or my nocturia first?

A6: Nocturia may need attention first, or at least alongside insomnia treatment. In a behavioural therapy trial, people with insomnia and nocturia improved less than people with insomnia alone (Tyagi et al., 2014a). The review’s authors recommend routinely checking for nocturia in adults seeking help for insomnia, because treating it could improve overall sleep quality (Verbakel et al., 2025).

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Written By Dan Ford, DBSM, Sleep Psychologist

Published By The Better Sleep Clinic