I’m a GP and sleep expert. This is why you keep going to the loo at night

My patients often assume their frequent bathroom trips are an inevitable part of ageing, however it could be signalling a health issue.

I often see patients who assume their increasingly frequent midnight trips to the bathroom are an irritating but inevitable part of getting older. Yet many people don’t realise that getting up two, three or even four times a night isn’t necessarily normal, and can sometimes signal an underlying health issue.

In fact, during his final year in the White House, Joe Biden was reportedly getting up to urinate seven times a night, according to a new book by his wife, Jill Biden. Concerned that it could indicate a medical problem, she alerted his doctor. Then in May 2025, four months after he left office, Biden was diagnosed with stage four prostate cancer.

The need to wake during the night to pass urine (known medically as nocturia) is extremely common and becomes more prevalent with age. Often, the cause is harmless, such as drinking too much water in the evening. But, as with Biden, that’s not always the case. Here are some of the most common reasons you keep going to the loo at night – and what you can do about it.

1. Drinking too much before bed

One of the simplest explanations is also one of the most common. Drinking large amounts of fluid in the evening can leave your bladder working overtime while you’re trying to sleep.

Water, tea and other soft drinks can all contribute, particularly if consumed in the hour or two before bed. Alcohol and caffeine can have an even greater effect because both act as diuretics, increasing urine production. That late-night whiskey or espresso may be more disruptive than you realise.

Staying hydrated is important – most adults should aim for around six to eight glasses of fluid a day – but timing matters. I advise patients to drink most of their fluids earlier in the day and cut back in the hour before bedtime. Doing so can reduce the amount of urine produced overnight and help minimise unnecessary sleep interruptions.

2. Prostate problems

As was likely the case with Biden, many men find themselves waking more often to urinate as they age because of an enlarged prostate.

The prostate naturally grows throughout life and, over time, can begin to press on the urethra – the tube that carries urine from the bladder. This can make it harder to empty the bladder fully, leading to more frequent trips to the loo, particularly at night.

In most cases, this enlargement is benign and a normal part of ageing. However, similar symptoms can sometimes be caused by prostate cancer. If you’re waking repeatedly to pass urine and also notice difficulty starting urination, straining, a weak flow, or a sudden and urgent need to go, it’s worth speaking to your GP. If necessary, they can carry out further assessments, including a physical examination or a PSA (prostate-specific antigen) blood test.

If benign prostate enlargement is the cause, simple measures such as reducing fluid intake before bed can help. There are also effective medications available. Some work by relaxing the muscles around the prostate and bladder neck, making it easier for urine to pass, while others help shrink the prostate over time.

3. Sleep apnoea

While most people associate sleep apnoea with loud snoring and excessive daytime tiredness, nocturia is another important symptom that is frequently overlooked.

Sleep apnoea is a common but often undiagnosed condition that occurs when the upper airway repeatedly narrows or closes during sleep, briefly disrupting breathing and causing the brain to wake the body just enough to reopen the airway. As a result, sufferers can wake dozens – or even hundreds – of times a night without being fully aware of it. This makes it difficult to achieve the deep, restorative sleep needed to feel refreshed the next day.

During deep sleep, the body reduces urine production, allowing us to sleep uninterrupted for longer periods. However, people with sleep apnoea spend less time in this stage of sleep, meaning the body’s usual overnight reduction in urine production is impaired. The physical effort of trying to breathe against a blocked airway creates significant pressure changes within the chest. This places stress on the heart and circulation, triggering the release of hormones that signal the kidneys need to produce more urine.

If you regularly wake to use the toilet and also snore heavily, wake gasping for breath, or feel excessively tired during the day, it may be worth discussing the possibility of sleep apnoea with your GP. Identifying and treating the condition is important, as the condition has been linked to an increased risk of high blood pressure, heart disease, stroke and type 2 diabetes.

4. Diabetes

Frequently waking to use the toilet can be an early sign of diabetes. When blood sugar levels become too high, the kidneys struggle to filter all of the glucose, and some spills over into the urine. This then works by osmosis to draw even more fluid into the urine, increasing the volume produced and making trips to the toilet more frequent, both during the day and at night.

This process can also leave people feeling unusually thirsty. As a result, they often drink more fluids, which can further exacerbate the problem and create a cycle of thirst and frequent trips to the loo.

Other diabetes symptoms include persistent tiredness, increased thirst or unexplained weight loss. A simple HbA1c blood test can assess your average blood sugar levels over the previous two to three months and help determine whether diabetes may be the cause.

5. Hormonal changes

Hormonal shifts can also play a role in nighttime urination, particularly for women approaching perimenopause and menopause.

As estrogen levels decline, the tissue lining in the vagina can become thinner, less elastic and more sensitive. This can increase urinary urgency and make women more likely to wake needing to use the toilet during the night. Hormonal changes may also affect the body’s ability to concentrate urine overnight, leading to greater urine production while sleeping.

However, age-related hormonal changes are not exclusive to women. In both men and women, the effect of the antidiuretic hormone (ADH) naturally declines with age. ADH helps the kidneys conserve water overnight by reducing urine production. As the body’s sensitivity to ADH falls, the kidneys produce more urine, increasing the likelihood of nocturnal bathroom trips.

While these changes can be very common, there are ways to reduce their impact. Again, simple measures such as limiting fluids before bed, and avoiding caffeine and alcohol in the evening can help minimise nighttime trips to the bathroom.

For women whose symptoms coincide with perimenopause or menopause, it’s also worth speaking to a GP about treatment options. Vaginal oestrogen can be particularly effective in improving urinary symptoms by restoring the health of tissues around the bladder and urethra, while pelvic floor exercises may help improve bladder control and reduce urgency.

6. Medication

Such as caffeine and alcohol, some medications can increase urine production. While high blood pressure does not usually cause frequent nighttime urination, medication for the condition can. This is particularly common with diuretics (water tablets), which are often prescribed to treat high blood pressure, heart failure, and certain kidney conditions.

Thiazide diuretics, commonly used for high blood pressure, work by reducing the kidneys’ reabsorption of sodium and water. This lowers blood volume and helps relax blood vessels, reducing blood pressure.

Loop diuretics are more potent, fast-acting medications used to remove excess fluid in conditions such as heart failure and some forms of kidney disease. They work on a section of the kidney called the loop of Henle – a U-shaped tube located in the microscopic filtering unit of the kidney – increasing the amount of salt and water excreted in urine.

If diuretic medication is affecting your sleep, speak to your doctor rather than changing the dose yourself. In some cases, taking the medication earlier in the day can help minimise night-time trips to the loo. Your doctor may also be able to adjust the dose, alter the timing, or consider an alternative treatment if appropriate.

Why your night-time trips to the loo may be harming your health

Frequently waking to use the toilet can reduce both the quality and duration of your sleep. These interruptions can prevent your brain from spending enough time in restorative deep sleep and REM sleep, leaving you feeling tired and less refreshed the next day. Research has linked chronic poor-quality sleep with an increased risk of a range of health problems, including high blood pressure, cardiovascular disease and type 2 diabetes.

Even if you spend seven to nine hours in bed, fragmented sleep can lead to brain fog, poor concentration, slower reaction times and memory problems. Over time, disrupted sleep may also increase the likelihood of irritability, anxiety and low mood.

Dr David Garley is a GP, sleep specialist and director of The Better Sleep Clinic.

As told to Ella Nunn