Most people would agree that waking up in the middle of the night is at the very least a disorienting and unpleasant experience, and perhaps far worse. For those who find it hard enough to fall asleep at the beginning of the night, a disruption at midnight or later may result in hours spent tossing and turning, unable to return to a restful state. Many nocturnal interruptions are external: a sick child, or a dog demanding to go outside. But all too often the wake-up call comes from our own full bladders. The majority of people will experience a form of nocturia, the condition of regularly waking up at night to urinate, at some point during their lives. This means that, for most people, nightly interruptions and their negative consequences wind up being a terrible fact of existence.
Clinically meaningful nocturia is defined as having two or more voiding episodes a night. There is a growing understanding that this condition can be severely detrimental to patient’s overall health. More than a mere source of irritation, regular interruptions to sleep can result in reduced energy, reduced psychomotor functions, and decreased cognitive function, as well as long-term consequences such as depression and increased susceptibility to somatic and cardiovascular disease. Therefore, ways to effectively diagnose and treat patients with clinically relevant nocturia are vital. Even getting nocturia diagnosed is a challenge, as around two-thirds of patients are embarrassed or reluctant to discuss their symptoms. Others believe that nocturia is simply a natural part of the aging process. Additionally, more than a third of medical professionals fail to offer treatment to those patients who do consult a doctor about their nocturia. Healthcare providers need education on talking to their patients seriously about nocturia.
Once nocturia is diagnosed, the next hurdle must be overcome: medical practitioners must find its underlying cause or causes in order to determine the best course of treatment. Nocturia has both multifactorial and multidisciplinary causes. Establishing the cause of any specific case will often require getting a full medical and surgical history of the patient, performing a focused physical examination, having the patient keep a 24-hour voiding diary, and lab work. It is important to determine the etiology, since standard non-neurogenic overactive bladder (OAB) and benign prostatic hyperplasia (BPH) therapies do not address all sources of nocturia. Regardless of the cause, voiding at night results from a production of nocturnal urine that exceeds the capacity of the urinary bladder to comfortably store it.Treatment must focus on decreasing fluid production, increasing bladder capacity, or improving emptying. Studies from the past decade have shown that behavioral therapies (i.e. restriction of fluid intake, moderate daily exercise, staying warm in bed, reduction or avoidance of caffeine, alcohol, and salt, and leg elevation) can benefit patients with nocturia of varying etiologies. It is advisable to initially treat patients with these behavioral therapies, but in order to best serve those patients for whom lifestyle change is not enough, healthcare providers should also be aware of some emerging pharmacologic approaches to treating nocturia and nocturnal polyuria.
Through this activity, we intend to educate physicians and other healthcare providers on how clinically meaningful nocturia affects patients and how to determine the underlying causes of nocturia in patients. We will discuss treatment methods, going into particular detail about new research and the drug desmopressin. By educating physicians and healthcare providers, we hope that more and more patients will be able to sleep through the night. A good night’s sleep is invaluable, and we are not the same without it. Nocturia leads to too many interrupted nights, and we have the prerogative to combat it to the very best of our abilities.
Matt T. Rosenberg, MD
Medical Director, Mid Michigan Health Centers
Gregg Sherman, MD
Chief Medical Officer, NACE
This activity has been accredited by the National Association for Continuing Education for the following dates:
Start date: March 16, 2020
End date: March 15, 2021
Format: enduring webcast
At the end of this activity participants should be able to:
- Describe nocturia’s impact on affected patients.
- Evaluate symptoms of nocturia in affected patients in order to determine the source of symptoms.
- Assess current pharmacologic and nonpharmacologic nocturia management strategies.
- Differentiate the mechanisms of action and safety and efficacy profiles of available and emerging therapies for nocturia.
This activity has been developed and is intended and designed for primary care physicians, urologists, and other healthcare providers involved in the treatment of patients with nocturia.
The National Association for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation Statement
The National Association for Continuing Education designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
NACE Policies on Commercial Support and Conflict of Interest
NACE operates in accordance with the ACCME Standards for Commercial Support. These standards are designed to ensure that continuing medical education activities are planned and designed independent of commercial support.
- NACE’s CME activity planning process ensures that the purpose of the educational activity is to further the education of physicians, health care providers, patients, and the public to enhance their ability to care for patients.
- NACE warrants that the educational activity is based on valid content, is independent of the commercial interest, is for scientific and/or educational purposes only, and will not promote any particular product, directly or indirectly, either in the content or selection of topics.
- NACE ensures that the educational activity will be planned and implemented in accordance with ACCME Essential Areas and Policies. NACE abides by the ACCME Standards for Commercial Support of Continuing Medical Education.
This activity was supported by an educational grant from Ferring Pharmaceuticals.
Faculty Disclosure Policy
Policy on Faculty and Provider Disclosure: It is the policy of the National Association for Continuing Education to ensure fair balance, independence, objectivity and scientific rigor in all activities. All faculty participating in CME activities sponsored by the National Association for Continuing Education are required to present evidence-based data, identify and reference off-label product use and disclose all relevant financial relationships. Individual disclosures are provided below. Potential conflicts have been resolved through NACE’s content review process.
- Matt T. Rosenberg, MD, discloses he has served as an advisory consultant and/or speaker, receiving honorarium, for Avadel, OPKO, Astellas, and Ferring.
- Gregg Sherman, MD, Chief Medical Officer, NACE course reviewer, planner, and director, has nothing to disclose.
How to Complete the Course and Obtain CME Certificate
This course is divided into three sections:
The pre-test will consist of 5 multiple choice questions. Once the pre-test has been completed, select “Click Here to Continue” to advance to the lecture. After watching the entire lecture, select “Click Here to Continue” to advance to the post-test. The post-test will consist of 6 multiple choice questions. Once the post-test has been completed, select “Click Here to Continue,” and you will be redirected to the course page, where the option to “Print Your Certificate” will be available. You will also receive an email with the CME Certificate attached once the course is completed.
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