What do your pre-bed/sleep habits have to do with the pelvic floor? Well, not a TON but, I promise to make the connection. As a pelvic floor physical therapist, I teach that it is not a healthy sign if you have to get up to pee in the middle of the night. When a patient reports that they do get up once, twice, three times per night to go pee I will discuss things like bladder irritants, hydration intake before bed and teach habits to “retrain” the bladder. These things are all very important to continue working on but there’s another aspect to why we shouldn’t be getting up in the middle of the night to pee; it’s a sign that we are not reaching the very important REM (rapid eye movement) cycle! 

A lot of great things happen in our body during REM. It is a very important stage of sleep that influences learning, memory and mood. It is also one of the times when antidiuretic hormone (ADH) is released. ADH’s most important role is to conserve the fluid volume of your body by reducing the amount of water that is passed out through the urine. When fluid needs to be conserved and not expelled, ADH secretion increases and we urinate less. When we are properly hydrated, ADH secretion decreases and we urinate at the normal amount (every 2-3 hours and the flow should be strong for 8-12 seconds). 

ADH plays an important role in hydration but it also plays a huge role in our ability to sleep through the night! A well-hydrated adult should need to urinate every 2-3 hours. So, how are we supposed to be able to sleep 8+ hours straight without urinating? ADH! When we fall into REM sleep, ADH release is increased which decreases the amount of urine that is produced, we do not have to pee as much and, voila! We are able to sleep without peeing! 

The takeaway:

If you rarely fall into your REM sleep cycle, your ADH secretion will not increase, you will continue producing urine at the “daytime” rate and you will inevitably have to pee during the night. 

What to do about it:

Practice good sleep habits so you can fall into your REM cycle, increase your ADH production and NOT have to get up in the middle of the night to pee! If you chug a 32 ounces of water an hour before bed then inevitably you may have to get up to pee. Also, alcohol prevents ADH release which will cause an increase in urine production and dehydration. So, if you had a glass of wine before bed, this most likely will cause you to have to pee during the night. 

Healthy Sleep Habit suggestions: 

1. Set a consistent sleep schedule - go to bed at roughly the same time each night. 

2. Have regular bedtime rituals - take a bath, listen to music, meditate. These should be relaxing activities and so that you cue your body that it is time to go to sleep. 

3. Get regular exercise but make sure it is at least 2 hours before bedtime. 

4. Limit caffeine and avoid nicotine - these are stimulants and will interfere with your sleep. Try to stop caffeine intake after 12. Withdrawal from nicotine will initially interfere with sleep. However, once you are past the withdrawal phase, you should be able to sleep better (studies show).

5. Don’t eat a meal right before bed. Try to eat dinner at least 2 hours before bedtime. A light snack before bed has been shown to promote sleep however. 

6. Avoid alcohol - although alcohol is a sedative and initially promotes sleep, it will interfere with the quality of sleep; you will wake more often and might have increased nightmares.

7. Keep naps short to increase your “sleep debt” during the day to help you fall asleep easier. 

8. Use your bedroom for sleep (and sexual interactions) only! Try not to eat, watch TV or use other electronics in bed. You want to associate your bedroom with sleep and not other things that might trigger stress. 

9. Stop screen time 2 hours before bed - using screens (TV, cell phones, tablets, laptops) can damage our biological clock. The light emitted “confuses” our brain and makes us think its daytime.

10. Make sure your bedroom is cool, quiet and comfortable!