Why Constant Nighttime Pee Breaks Cost the US Economy $44 Billion Annually

"The more I learned about this condition, I thought, this could be a problem." 

Going to the bathroom in the middle of the night already feels excruciating, in that terrible moment when you have to tear yourself from the warm covers. But according to a recent analysis, these nighttime pee breaks may exact an even bigger toll on the economy.

A report released Monday by economists at the RAND Corporation, a non-profit think tank and policy organization based in Santa Monica, California, suggests that two or more nighttime bathroom breaks — a condition also called “nocturia” — cost the US economy roughly $44.4 billion dollars per year for one important reason. Marco Hafner, the lead author and senior economist at RAND, says that even those short interruptions in the sleep cycle can take such a toll that they impact worker productivity when morning arrives.

“Our guess is that a large part of that will be driven by the fact that people have interrupted sleep,” he tells Inverse. “I know it from my own experience. I have young children, and when they wake me up twice per night, I’m just not working normally the next morning.”

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Waking up to pee can have costs the next day, Hafner's analysis showed. 

This research was conducted with partial funding from Ferring Pharmaceuticals, which produces the drug Nocdurna to treat nocturia that’s caused by nocturnal polyuria — a common cause of the condition.

For Hafner’s analysis, he constructed a model to estimate the costs of nocturia on the economies of several countries — specifically, the United States, Germany, Spain, the UK, and Australia. To make his prediction, he needed two things, an estimate of how many people get up to pee twice or more per night and data indicating how those breaks make people feel the next day. Getting these data, it turned out, was complicated.

He estimated the prevalence of nocturia in the United States from the results of several studies, including one published in July 2017 in the European Journal of Health Economics. Hafner’s team also based the estimate on the results of two surveys from insurance companies in other countries: Britain’s Healthiest Workplace Survey from Vitality UK and AIA’s Asian Healthiest Workplace survey in 2017 and 2018. Based on these data sources, his team estimated that 27.5 million adults of working age in the US wake up at least twice to pee at night. That’s about 12.5 percent of the population, which was in line with the results from the surveys as well as the previously published studies.

The real heart of Hafner’s analysis was to quantify how waking up at least twice for a bathroom break impacts how people feel the next day — especially at work. To estimate this, Hafner and his colleagues also looked into the survey data collected from Britain and Asia. There, they found correlations between waking twice or more per night and self-reported poor sleep quality, less overall sleep time, and daytime fatigue.

“I think we specifically looked at the working age population and found that nocturia was still statistically significantly associated with workplace productivity,” Hafner adds. “Getting up twice per night is where all of these negative consequences kick in.”

These metrics led them to conclude that nighttime pee breaks, and the sleep loss associated with them, account for a three percent loss of productivity during the day. When Hafner plugged those variables into his economic model, he concluded that these losses would result in losses in the billions each year in the US.

This analysis isn’t published in a peer-reviewed scientific journal, but sleep loss itself has shown significant effects on judgement and mood. The question is whether nocturia itself occurs as frequently as these authors suggest, and if it presents as big a disruption as they think it does.

Hafner, for one, adds that he was actually surprised to see any correlation — let alone a statistically significant one — between workplace productivity and a nighttime pee break but is convinced that his analysis suggests it’s worth probing the connection. “When we started this research, I thought, we probably wouldn’t find any effects on workplace productivity,” he says.

Even if the economic costs don’t pan out, on a personal level, his results seem to strike a chord with anyone who’s had to wrench themselves out of bed at night to make the long, cold trek to the bathroom.

“The more and more I got into this research, I realized that I had friends and colleagues who said ‘How interesting, I had the same problem’,” he says. “The more I learned about this condition, I thought, this could be a problem.”