Are your IC symptoms keeping you up at night, causing you to feel as tired in the morning as you do when you go to bed? Nighttime is hard for IC patients. We lie in bed with nothing to distract us from the pain and have to get up to use the bathroom one more time – a few times. Or we fall asleep and then wake up two, six or eight times at night to trudge to the bathroom.

In fact, a study released in the Urologic Nursing Journal in 2011 found that of the 407 women with IC who participated in the Web-based study, 100 percent of them had poor sleep.(1)  One study in 2009 had a different slant and found that improving IC symptoms improved sleep, showing a strong relationship between IC symptoms and sleep.(2) Even more interesting, a study in March of 2014 examined the relationship between obstructive sleep apnea and the risk of developing IC and found that patients with diminished sleep from OSA had a definite increased risk for then developing IC.(3) All of these studies combined with patient anecdotes tell us that sleep and IC are closely related, whether the IC symptoms come first or second.

And sleep is as strongly connected to health as diet and exercise. It’s just as important to understand why we’re struggling and how we can help improve our sleep to be the best it can be. We’ve also got to remember that IC may not be the only issue affecting our sleep. Along with other health conditions, our habits may be wreaking havoc with our slumber.

Problem 1: Pain & Discomfort

As you might expect, discomfort is one of the most common reasons IC patients can’t sleep. Discomfort can come from bladder pain, bladder pressure, hip pain, low back pain and more. Unsurprisingly, hurting people have trouble sleeping. And I’m not even including the trips to the bathroom. That is a whole other issue.

Solutions to try:

  • For many patients, nighttime flares are the result of poor dietary choices during the day. Even the smallest cheat, such as a small cup of coffee, could trigger nighttime discomfort. So, if you are struggling with sleep, review the IC diet and make sure that you aren’t accidentally triggering irritation!
  • Set yourself up for more success with a bed that is as comfortable for you as it can be, and that includes making sure it is large enough to accommodate your needs. According to Consumer Reports, a mattress usually lasts about 10 years.(4) If yours is older, it might be time to replace it, which could help ease some discomfort. Look for Low-Voc mattresses to avoid chemical exposure!
  • Make sure you are taking medicine correctly. For example, if you take an over-the-counter or prescription medicine pain, take it according to directions with or without food and timing it so that the medicine is most effective when you are ready to sleep. Pills are usually digested within 20 to 30 minutes, so taking medicine meant to help with pain 30 to 60 minutes before bed could be best for you.(5) BUT, medicines dissolve and work in different ways, so ask your doctor when is best to take medicines designed to help with nighttime pain.
  • Consider over-the-counter medications such as AZO Urinary Pain Relief tablets, AloePath, CystoProtek, Cysto Renew, ProSirona, or Tiger Balm.  If these don’t help, talk with your doctor about taking something stronger.
  • Use pillows to help you get into different positions. Some patients find it helpful to prop a pillow under their knees to tilt the pelvis. This requires some trial and error for what works best for you.

Problem 2: Nocturia

Nocturia is the medical term for getting up at night to urinate, and it is a big issue for many IC patients. While completely eliminating the need to get up overnight may not be possible for some patients, there are some solutions to at least help reduce the number of trips to the bathroom.

Solutions to try:

  • While it seems like drinking less would result in urinating less, that can actually be just the opposite for IC patients. The more concentrated and less diluted the urine is, the more irritating it can be, which makes our bladders feel all that much more like we need to urinate. But hydration is a 24-hour issue. Drink plenty of water throughout the day and then you should be hydrated enough to slowly taper off drinking a couple of hours before bed. Some patients find, though, that drinking a bottle of water at bedtime can actually help them dilute their urine more and sleep more. It is a trial and error sort of situation and patients usually just need to find a system that works for them.
  • Follow the IC Diet! Foods containing acid and/or caffeine can irritate the bladder wall, triggering pain, urinary frequency and urgency. It’s ALWAYS important to review the foods and drinks that you are eating! Learn about the IC Diet here! 
  • Consider talking to your doctor about medication. The National Association for Continence lists various pharmaceutical treatments for nocturia, including oxybutynin, darifenacin, tolterodine, trospium chloride and solifenacin.(6) If those medications don’t work, a second-line of drugs could help, including desmopressin, imipramine, furosemide and bumetanide.(6) Another consideration is medications that can help IC symptoms, yet also have a side effect of drowsiness such as anti-histamines, nerve pain medications and antidepressants. Taking such medications at bedtime can also result in deeper sleep and fewer trips to the bathroom. (But, as always, talk to your doctor about when to best take your medications.)

Problem 3. Being wide awake.

Sometimes no matter how tired you are, sleep is just hard to come by. Maybe you can fall asleep just fine at bedtime but after that first trip to the bathroom, you toss and turn. Or maybe you can’t fall asleep for hours after you get in bed. While this is annoying to anyone, it can be incredibly difficult for IC patients who are suffering from lack of good sleep anyway. But, there are some solutions to try – many of which are just good sleep practices in general.

Solutions to try:

  • Be consistent with the times you go to bed and wake up. If you have trouble getting to bed around the same time each evening, consider setting an alarm to remind you it is bedtime.(7) And while sleeping in on the weekends might seem luxurious, it can make good sleep that much more difficult. In fact, even if you’ve been up later than usual the night before, it is better to not sleep more than an hour longer than usual and instead make up for lost sleep with an afternoon nap.(8)
  • Speaking of napping, it can actually be helpful to your sleep at night as long as you nap responsibly. The general recommendation from experts is to nap for only 20 to 30 minutes and not close to bedtime.(7)
  • Be aware of what you’re putting into your body all day long! For IC patients, diet can play a big role in symptoms. Avoiding trigger foods and drinks throughout the day can help you feel better and rest better overnight. But watch out for other things, too. Caffeine consumed after lunch can negatively affect your sleep, as can eating a heavy meal just before bedtime.(7) Drinking alcohol near bedtime can also be a sleep detriment, because when the buzz wears off later in the night, it wakes you up.(7) And if you need another reason to quit smoking once and for all, this is it. Nicotine works as a stimulant like caffeine, so smoking can disrupt your sleep.(7)
  • Keep your room dark and cool. Be aware of even small light sources, like the glow from your alarm clock or your phone charging on the nightstand. Using electronics at bedtime can have the same effect as well. Electronics emit blue light, which has the most impact on your circadian rhythm.(9) Some electronics, especially newer ones, now offer an option called “dark mode” that emits less blue light to help counteract its effect.(10)As far as room temperature goes, cool is best, between 60 and 67 degree Fahrenheit is ideal for most people.(7) But, if you tend to have constantly cold extremities, definitely put on socks. Having warm hands and feet can help you call asleep quicker.(7)
  • Consider taking melatonin. This hormone is produced in the body to help with sleep but has been chemically synthesized into a pill. Its job is to regulate sleep and wake cycles, so some people find it helpful for helping with sleep problems.(11) Interestingly, a study in 2013 found that melatonin also helped improve bladder symptoms and damage in rats with induced cystitis.(12) So it has the potential to be helpful for IC patients. HOWEVER, it can also be problematic, perhaps because of it being chemically synthesized. Some patients have reported flares from taking melatonin. Others have had issues with it causing nightmares. And others have found it too much of a sedative. If you decide to try it, talk with your doctor first and start with a very low dose.

Problem 4: Feeling anxious

Anxiety often goes hand-in-hand with IC and can most definitely be an issue with sleeping. It is hard to relax and doze off when not only is your body hurting but your mind is reeling from one stressful issue to another.

Solutions to try:

  • For years, aromatherapy has been popular, but there may be something to it. A study in 2005 found that the scent of lavender increased the percentage of deep sleep in the healthy young men and women in the small study.(13) Lavender also helped women fall asleep faster. It might be worth a try of spraying your sheets with lavender or dabbing lavender essential oil on your temples to perhaps soothe you into sleep and help you relax your body and mind.
  • Give yourself time to process your day before going to bed. Taking even just a few minutes before going to bed to think over the day you had and the one coming tomorrow (maybe even writing in a journal, meditating or praying) can help ease anxiety when your head hits the pillow.(7)
  • Go to your proverbial happy place. When your thoughts start spiraling out of control, try stopping yourself and instead imagine a happy, relaxing place. It sounds a bit corny, but visualization is actually a deep relaxation technique that can slow brain wave activity and get you headed to dreamland.(7)
  • Try getting out of bed when you are feeling overly anxious. Go somewhere else in your house with the lights still being off. Just moving elsewhere can help you reset your thoughts and let go of anxious thoughts that are hard to get away from otherwise in that state being sleep and wakefulness. Another bonus is that it helps prevent you from associating your bed with anxiety.(8)

References

  1. Panzera AK, et. al. Sleep disruption and interstitial cystitis symptoms in women. Urol Nurs. May-June 2011 Volume 31, No. 3.
  2. Nickel JC, et. al. The relationship among symptoms, sleep disturbances and quality of life in patients with interstitial cystitis. J Urol. June 2009 Volume 181, No. 6.
  3. Chung SD, et. al. Obstructive sleep apnea increases the risk of bladder pain syndrome/interstitial cystitis: a population-based matched-cohort study. Neurourol Urodyn. Mar 2014 Volume 33, No. 3.
  4. Consumer Report News. How long does a mattress last? Dec. 17, 2007.
  5. VU Bioengineering RET Program, School of Engineering, Vanderbilt University. Hands-on activity: pill dissolving demo. Teach Engineering.
  6. The National Association for Continence. Nocturia.
  7. Klein S. 37 science-backed tips for better sleep tonight. Huffington Post. Dec. 6, 2017.
  8. The Editors of Prevention. Your top 10 reasons why you can’t sleep. Prevention magazine. Jan. 27, 2012.
  9. Borsari K. 10 Unexpected things that can ruin your sleep. Huffington Post for Life by Daily Burn. Dec. 27, 2013, updated Dec. 6, 2017.
  10. Murphy D. How to enable YouTube’s ‘Dark Mode’ on IOS. Lifehacker. March 14, 2018.
  11. WebMD. Melatonin.
  12. Zhang QH, et. al. Melatonin improves bladder symptoms and may ameliorate bladder damage via increasing HO-1 in rats. Inflammation. June 2013 Volume 36, No. 3.
  13. Goel N, et. al. An olfactory stimulus modifies nighttime sleep in young men and women. Chronobiol Int. 2005 Volume 22, No. 5.