INTRODUCTION

Nocturnal urinary frequency increases with age and isthought to be one of the main causes of sleepdisturbance in middle-aged and elderly people.Treatment for this condition, however, has not yet been established. In this study the treatment of nocturnal urinary frequency following asleep–micturition chart was evaluated.

SUBJECTS AND METHOD

Six males and one female without any extraordinaryunderlying diseases which might cause nocturnalfrequency were selected for this study. The agesranged from 69 to 79 years (mean 74 years). Asleep–micturition chart was recorded by each subjectfor 3 days before treatment (Fig. 1). Sleep conditionwas evaluated subjectively by the patients. Eachvoiding in 3 days was passed into a measuring cup.From analysis of the charts the patients were dividedinto three diagnostic categories: two came into the

small bladder capacity group in which nocturnalbladder capacity was below 200 mL; four into thesleep disorder group diagnosed by their histories; andone into the large nocturnal urinary volume group inwhich nocturnal urinary volume was more than 100mL/h. The three groups were treated by anti-cholinergic agents (Propiverine 10 mg after dinner,Oxybutynin 2 mg H.S.), sleeping pills and restrictionof water intake at night, respectively. The treatmenteffects were analyzed from the sleep–micturitioncharts for 3 days, 2 weeks after the start of thetreatments.

RESULTS

The average nocturnal urinary frequency decreasedfrom 3.5 to 2.6 times per night. The average disturbedsleep time, the total time spent dozing or awake in bed, decreased from 2.8 h to 1.7 h although theaverage of total sleep time also decreased from 8.7 h to 8.3 h. Overall, however, sleep efficiency wasimproved. With administration of anti-cholinergicagents the average nocturnal bladder capacityincreased from 166 mL to 202 mL without changes innocturnal urinary volume. By the restriction of waterintake at night the nocturnal urinary volumedecreased from 127 mL/h to 98 mL/h without changesin nocturnal bladder capacity.

Psychiatry and Clinical Neurosciences (1999), 53, 277–278

Sleep Disorders

Systematic treatment for nocturnal urinary frequencyfollowing a sleep–micturition chart

Y. YAMAO,1 A. KAWAUCHI,1 Y. TANAKA,1 H. WATANABE,1 T. KITAMORI,2

N. IMADA,3 AND S. SHIRAKAWA4

1Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, 2Department of Urology, MaizuruNational Hospital, Maizuru, 3Department of Urology, Nishijin Hospital, Kyoto and 4National Institute of MentalHealth, National Center of Neurology and Psychiatry, Chiba, Japan

Abstract Seven patients complaining of nocturnal urinary frequency were treated following asleep–micturition chart. By clinical analysis of the data, the causes of nocturnal urinary frequencywere divided into three diagnostic categories: a small bladder capacity group, a sleep disordergroup and a large nocturnal urinary volume group. The three groups were treated by anti-cholinergic agents, sleeping pills and restriction of water intake at night respectively. With theadministration of anti-cholinergic agents or sleeping pills nocturnal bladder capacity increased.By restriction of water intake at night nocturnal urinary volume decreased. In all patientsnocturnal urinary frequency decreased and sleep efficiency was improved.

Key words nocturnal urinary frequency, sleep micturition chart.

Correspondence address: Y. Yamao, Department of Urology, KyotoPrefectural University of Medicine, Kyoto, Japan.

278 Y. Yamao et al.

DISCUSSION

Middle-aged and elderly people often come to theurological clinic complaining of nocturnal urinaryfrequency and sleep disturbance. Urological diseases,such as benign prostatic hypertrophy, prostatic cancer

and neurogenic bladder may be the cause ofnocturnal urinary frequency. By treating thesediseases, nocturnal urinary frequency can be reduced.However, it is well known that people without suchdiseases also complain of nocturnal urinary frequency,which also increases with age. A suitable treatmentconcept for them has not yet been established. Saitoet al.1 treated patients who complained of daytimepollakisuria by the administration of anti-cholinergicagents or restriction of water intake according to afrequency–volume chart. This study revealed thatsystematic treatment according to a sleep–micturitionchart reduced nocturnal urinary frequency andimproved the sleep state.

CONCLUSION

Systematic treatment for non-disease-relatednocturnal urinary frequency improved the sleep state.A sleep–micturition chart is useful for evaluating thecause of nocturnal urinary frequency and selectingthe appropriate treatment.

REFERENCE

1. Saito M, Kondo A, Kato T et al. Analysis of frequencyvolume chart in elderly people with pollakisuria. Jpn J.Urology 1991; 9: 1446–1451.

Figure 1. Sleep–micturation chart (example).