Your Aging Advocate
Helpful tips for family caregivers

Is twice a night too much?

Many older adults complain of having to get up several times in the night to pee. Some of this is a normal part of aging. Our bladder capacity gets smaller, so we need to void more often.

But frequent trips to the toilet can have a serious impact on sleep. Nocturia—the medical name for getting up more than once a night—and insomnia are intimately related. Getting up often understandably leads to fatigue. But your loved one is also at higher risk of depression, falls, and car accidents because of the insomnia.

If the person you care for complains of getting up often in the night, have him or her

• stop drinking fluids 2–3 hours before bedtime. Kind of obvious, but a good first step.
• halt caffeine consumption after noon and limit or stop alcohol in the evening. Both drinks have a diuretic effect, stimulating urination.
• take any prescribed diuretics in the morning. Ask the doctor or pharmacist about optimal timing for “water pills.”
• watch for fluid buildup at ankles. Fluid that gathers at the feet all day gets processed by the kidneys at night because lying down returns it to the upper body. Compression socks during the day and raising the feet a few hours before bed can help.

Suggest your relative keep a log for a week, such as the one offered by the National Association for Continence (nafc.org). You may observe patterns. Plus, it’s helpful information for a doctor.

Nocturia can be a symptom of many conditions, from diabetes to sleep apnea or an enlarged prostate. For someone over 65, getting up twice a night is not uncommon. Consult a doctor if it’s more often or is disrupting sleep or mood. And definitely seek medical attention if there is burning, blood in the urine, fever, or urgency with small output. This could be a sign of an infection.

Cooling down to make a decision

Our fight-flight-or-freeze reactions are deeply embedded in our body and brain. In intense situations, they take over. As a family caregiver, it’s easy to feel overwhelmed by the many decisions that must be made. And the responsibility. This is especially true in times of great stress and uncertainty. We become emotionally flooded and enter a reactive “hot” state of mind. It’s not the best for making wise decisions for yourself or for loved ones you care for.

Fortunately, we can use our mind to bring ourselves from a physical “red zone” into a cooler mental state. Even if time is of the essence, a few minutes to find calm in the center of the storm can give you confidence and mental clarity. Decisions made in this state are more robust and stand the test of time.

The first step is to notice and recognize that you are revved up, emotionally “hot.” Then, make the internal commitment to shift to a calmer state. Here’s how:

• Breathe in for four counts and exhale for eight. Repeat this for 5–10 breath cycles. Feel your heart slowing down. This type of prolonged exhale engages your parasympathetic—calming—nervous system.
• Imagine a situation where you felt supported, that you deeply belonged. Kindle that feeling inside. Let it glow and become stronger. You’ve felt this before. You can feel it again, generated now from within, simply by remembering.
• Relax your body. Notice specific tight places. Give them a stretch and breathe the tension out with each breath.
• Address your basic physical needs. When was the last time you ate? Had some water? Went to the bathroom?

Feel the difference? Ah. Now that you’re out of the red zone, you are better able to take the broad perspective on your dilemma and focus on what most needs to be done. Such calm will also extend to others around you.