A multi-center trial to improve nocturia and sleep in older adults - PROJECT SUMMARY
Nocturia (waking to pass urine during the main sleep period) occurs two or more times per night in
nearly 50% of older adults and is among the most bothersome urinary symptoms, due to its potentially severe
impact on sleep. However, nocturia in older adults is often viewed solely as a urological condition even though
it is also a sleep condition since it involves disturbances of the “main sleep period.” Bladder, prostate, and
antidiuretic medications, fluid restriction, bladder training, and pelvic floor muscle exercises are often
prescribed, but the effectiveness of all treatments is limited and medication side effects including delirium and
falls are concerning in older adults. The long-term goal of this research is to develop a safe, cross-specialty
treatment that will improve the lives of older adults with nocturia.
One explanation for the high rates of nocturia despite available treatments is that current approaches
overlook non-lower urinary tract factors that contribute to nighttime awakenings. For example, cognitive
hyperarousal and decreased homeostatic sleep drive from daytime napping may increase the tendency to
arouse and sense the urge to void; and maladaptive compensatory behaviors may lead to excessive time in
bed, thereby increasing opportunity to sense the urge to void. Cognitive behavioral therapy for insomnia
effectively reduces nighttime wakefulness and early evidence suggests it also reduces nocturia. Unfortunately,
nocturia treatment crosses specialties, and delivering urological and sleep therapies in a coordinated manner
is a treatment barrier.
The overall objective of the proposed project is to determine whether a coordinated, integrated non-
pharmacological, non-surgical treatment that simultaneously addresses both the urological and insomnia
factors contributing to nocturia is efficacious for improving nocturia, sleep, and daytime function. Results from
our NIA-supported R34 multisite planning grant demonstrate the feasibility of the novel Nocturia Insomnia
Program-Integrated Treatment (NIP-IT) program, which integrates best practice behavioral treatment strategies
for nocturia and cognitive behavioral therapy for insomnia components to reduce awakenings and urinary
frequency during nighttime awakenings due to other reasons. The rationale for the proposed research is that
addressing hyperarousal, conditioned responses, and maladaptive thoughts/behaviors and increasing
homeostatic sleep drive are critical to reducing nocturia frequency and nighttime wakefulness and improving
overall nocturia-related quality of life. We now propose a randomized trial (n=192) comparing NIP-IT to a
health education control program in adults aged > 60 with nocturia and insomnia symptoms to provide
rigorous, definitive evidence of the efficacy of the NIP-IT program to reduce both nocturia episodes and sleep
disturbance. We will also assess impact on nocturia and sleep-related quality of life.
