Multi-center Trial to Improve Nocturia and Sleep in Older Adults

Eligibility Criteria

• * Age ≥ 60 years
• * Average of ≥ 2 episodes per night of nocturia on the International Consultation on Incontinence Questionnaire-Overactive Bladder Module (ICIQ-OAB) questionnaire
• * Insomnia Severity Index \> 7
• * Able to attend weekly study visits
• * Prior cognitive behavioral therapy for insomnia
• * Presence of bipolar disorder
• * Significant cognitive impairment as measured by a score \< 20 on the Mini-Mental State Exam
• * Sleep disturbance better explained by another sleep disorder such as restless legs syndrome, narcolepsy, insufficient sleep syndrome, or circadian rhythm sleep-wake disorders
• * Untreated sleep-disordered breathing (respiratory event index ≥ 15 plus • Epworth Sleepiness Scale \> 10 or respiratory event index \> 30. Note that participants with treated sleep-disordered breathing will not be excluded)
• * Current urinary tract infection or hematuria
• * Unstable doses or recent changes in bladder medication
• * New or recently discontinued insomnia medication within past month
• * Previous or current intensive behavioral therapy for insomnia or urinary symptoms,
• * Unstable health conditions expected to result in death or hospitalization within 3 months, as assessed by overall study PIs or Site PI.
• * Unstable medical conditions that could contribute to nocturia or insomnia such as poorly controlled heart failure as evidenced on physical examination, poorly controlled diabetes mellitus with either hemoglobin A1c of ≥ 9.0, or chronic kidney disease (stage 4 or 5) or a potential to initiate dialysis in 3 months
• * Unstable psychiatric conditions (e.g., psychosis, active alcohol/substance abuse based on history and medical records)
• * Unstable housing situation
• * Evidence of significant urinary retention as measured by a residual bladder volume of ≥ 200 mL by bladder ultrasound with 15 minutes of voiding
• * Genitourinary cancer undergoing active treatment
• * Pelvic or colon surgery within 6 months of enrollment or onabotulinum toxin therapy for urinary symptoms within 6 months of enrollment