When we look at the wisdom of Donguibogam through the lens of modern science, it becomes even clearer. Nocturia, or visiting the bathroom frequently at night, is not a simple problem of the urinary bladder; it is a phenomenon resulting from our body's complex systems intertwining organically.
The most important factor is antidiuretic hormone. This hormone helps the kidneys produce less urine and concentrate it more while we are asleep. It is thanks to this antidiuretic hormone that we can sleep comfortably without going to the bathroom all night long. However, as we age or as lifestyle habits change, the secretion of this antidiuretic hormone decreases, causing as much urine to be produced at night as during the day, leading to repeated trips to the bathroom. The concept of kidney deficiency discussed in Donguibogam can be interpreted in modern medicine beyond simple kidney hypofunction, extending to a weakened ability to regulate antidiuretic hormone secretion, as well as an impaired capacity to regulate fluid metabolism and electrolyte balance.
There are also issues within the urinary bladder itself. Bladder muscles can weaken, or the nerves can become hypersensitive—as seen in overactive bladder—causing a strong desire to urinate even with only a small amount of urine present. Weakness of the pelvic floor muscle, in particular, can appear more commonly in women with a history of childbirth, as these muscles play an important role in supporting the urinary bladder and urethra. When these muscles weaken, the power to hold urine diminishes, which can even lead to urinary incontinence where urine leaks during a cough or a sneeze.
Chronic sleep disorder can also worsen nocturia. When sleep is not deep and you wake often, the brain more easily sends signals that you need to go to the bathroom half-asleep, even if the urinary bladder is not full. Furthermore, when breathing is unstable throughout the night, as in sleep apnea, the sympathetic nervous system is activated, stimulating the urinary bladder; in other cases, fluid that pooled in the lower body during the day is absorbed into the blood at night due to reduced heart function, increasing urine volume.
Moreover, when blood glucose levels rise, as in diabetes, osmotic diuresis can occur, where urine volume increases due to an osmotic effect. Excessive intake of caffeine or alcohol also promotes diuresis, disturbing night sleep. Because nocturia is a symptom caused by multiple overlapping factors, it is difficult to resolve simply by drinking less water; you must comprehensively examine which system in your body has lost its balance. Understanding our body's delicate harmony is the very first step toward health.
