Nighttime Potty

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Many patients I see have difficulty sleeping because they have to go to the bathroom multiple times during the night. Men are often told it has to do with their prostate being enlarged while women are often told they have a distended or prolapsed bladder.

While these problems may cause people to urinate more frequently in daytime or nighttime, the dysfunction of the Autonomic Nervous System is the most common cause of frequent nighttime urination.

This is why most of the medicines prescribed for frequent urination because of prostate or anatomical bladder problems have their effect by changing how the Autonomic Nervous System functions.

The Autonomic Nervous System is our brain’s master control mechanism for running our body. The Autonomic Nervous System controls all organ function (bladder, intestines, heart, etc.), regulates most hormones, and it controls inflammation and other aspects of our immune system.

When the Autonomic Nervous System quits functioning correctly people begin experiencing problems such as frequent urination, heartburn or constipation, and headaches.

One of the most difficult jobs your Autonomic Nervous System performs is regulating the proper pressure of blood upwards into the upper half of the body when you are in the upright position. The two main branches of the Autonomic Nervous System have to control the changes in pressure in both the lower extremities and up in the head.

If your Autonomics are not functioning correctly, gravity will prevent you from getting enough oxygen and blood pressure up into your head and this results in a lightheaded or dizzy sensation when you stand up quickly. This poor response to gravity when there is a change in position is called orthostatic intolerance.

Orthostatic intolerance may also cause unexplained anxiety or neck pain and tightness when you are sitting or standing still. Other abnormal orthostatic responses when someone stands up include erratic elevations in blood pressure (white coat syndrome), excessive increase in heart rate (tachycardia/POTS), decreases in heart rate (bradycardia), or decreases in blood pressure (hypotension).

Our brain temporarily compensates for the symptoms of low brain blood pressure involved in orthostatic dysfunction by directing us to get up and walk around, to fidget our muscles such as foot tapping or being hyperactive, by sitting with our leg crossed underneath us, or by compelling us to exercise. We also get the same temporary boost by eating carbs or sugar, drinking liquids, or by smoking nicotine. All of those things can help us get through our day when we are impaired by low brain blood pressure.

But there is a price to pay at the end of the day that interferes with our ability to sleep through the night. Low pressure in the brain triggers an increase of thirst during the day. Drinking more liquids temporarily improves blood pressure in the brain. But this low pressure also prevents your kidneys from making as much urine as normal during the day.

The consequence of drinking more than normal, plus urinating less than normal, results in an excessive amount of water collecting in the lower half of your body while you are in the upright position (sitting, standing, or walking around) throughout the day.

At night when you lay flat to sleep the excessive fluid that was abnormally collecting in the lower half of your body shifts to the upper portion of your body just as a half full bottle of water will when tipped on its side. Suddenly your kidneys are presented with an excessive amount of fluid that needs to be filtered and turned into urine.


Understanding the mechanics behind numerous nighttime bathroom trips and how they are a response to Autonomic Nervous System dysfunction may help you work towards sleeping through the night.

First, you need to know that Autonomic dysfunction is capable of improvement. The old way of thinking in the field of Autonomics was that once damaged or broken, our Autonomics could be stabilized but that they probably would never recover. My medical discovery is that our Autonomics are indeed capable of improvement or repair, and the tools I use to accomplish this in my patients may be surprisingly simple for many people.

Second, you need to understand that lowering your inflammation is the key to your cells and systems functioning again. A low inflammatory environment is created by reproducing the natural environment our cells enjoyed before omega-6 vegetable oils (soybean oil, soy oil, safflower oil, grapeseed oil, etc.) and margarines were added to our foods, and before modern medicines, surgeries, pollution, and chemicals altered our intestinal bacterial flora. I commonly prescribe dietary shifts for my patients such as eliminating omega-6 oils from foods, maintaining a healthy balance of intestinal bacterial by consuming the prebiotic fiber inulin, and discontinuing all probiotics.

Third, there are additional nutritional steps to improve Autonomic function that are found in giving the brain and nervous system the critical core nutrients they require by supplementing with both omega-3 fatty acids in fish oil, and with two tablespoons per day of omega-9 found in authentic domestic (California Olive Council certified) extra virgin olive.

Fourth, know that inflammation is not just about what we eat but also how we cook it. Cooking methods can make a substantial difference in our levels of inflammation. When foods are cooked hot and quickly they make abnormal molecules called advanced glycation end products (AGE’s) that contribute to inflammation and our premature aging. I cook slowly and at low temperatures with crock pots and by sous-vide (water bath) methods to cut down my exposure to AGE’s.

And fifth, some people over the age of 40 need more anti-inflammatory measures and I may prescribe Vagus nerve stimulation (tVNS) for my patients. Thanks to decades of work by Dr. Kevin J. Tracey, M.D. we now understand how the Vagus nerve in the Autonomic Nervous System suppresses inflammation. Stimulating the Vagus nerve helps regulate and reduce harmful inflammatory cytokines. This stimulation is a form of non-invasive bioelectrical medicine that some of my patients use every day to helps to lower their inflammation.

Vagal nerve stimulation is a doctor-prescribed medical treatment and it should not be initiated on one’s own or by a medical professional who does not understand exactly what they are doing to the patient. Failure to perform tVNS correctly, and the use of some frequencies, may result in permanent damage to the Vagal nerve. Vagal nerve stimulation should never be done while pregnant.

I have been testing and treating the Autonomic Nervous System for 12 years and I have developed a treatment program called “The Nemechek Protocol™ for Autonomic Recovery” (Patent Pending) that is specifically designed to reduce multiple sources of inflammation and restore the body’s natural brain repair mechanism.

I believe that the key to restoring our natural inflammation control mechanisms is through a reduction of inflammation throughout the brain and body by using every scientific, nutritional, and bioelectric tool available.

I am an internal medicine physician (D.O.) from UCLA and my Internal Medicine and Autonomic practice is in the Phoenix, Arizona area. For additional information, go to

This post is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, and it does not create any patient-physician relationship.

© 2018. Nemechek Consultative Medicine, Inc. All Rights Reserved.

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Patrick Nemechek, D.O.

Patrick Nemechek, D.O.

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April 23, 2019 2:09 am

Hi Dr NemeCheck, I have a son who is 3.5 years old and has been diagnosed with Fragile X Syndrome. And he has Cognitive delays and Non Verbal. Does the Protocol helps kids with Fragile X Syndrome ? Can you please suggest.

Tish Reagan
Tish Reagan
April 3, 2019 6:35 pm

Dr Nemecheck, I found your book online and we started the protocol for my developmentally delayed daughter 2 weeks ago. She has a rare genetic disorder, Wiedemann-Steiner Syndeome, and many of the individuals with WSS struggle with autonomic problems. .. Evie had severe constipation and neurogenic bladder. We have determined these are neurological issues. She is also severely delayed in size and cognitive skills, she just turned 4 but if you saw her she looks like a 4-6 month old baby with teeth! Do you have any additional suggestions you might offer for a child with this syndrome? Thanks! Mom… Read more »

Tish Reagan
Tish Reagan
April 7, 2019 5:36 pm

Okay, I will keep you posted. On week 3, this last week has had some rough points but we are pushing through. I adjusted doses and it helped. Thanks!

February 9, 2019 4:25 pm

Dear Dr. Nemechek, I put my mother on your protocol and it has helped her sleep through the night without waking up to go to the bathroom!!! She has had issues of waking up at nightly a couple times a night to go the washroom. The problem was ongoing for several years. It took the protocol 4 months to turn things around. She is on 1 tsp of inulin, 4 caps of NOW DHA 500, 2 TBS of COCC certified evoo and a handful of nuts. She also has a lot more energy and feels that her body is functioning… Read more »

Melissa Savoie
Melissa Savoie
January 21, 2019 3:05 pm

Hello Dr. Nemechek,
So I understand auto-immune issues can lead to bladder problems…in your opinion, could/should someone take medications that can help (e.g., oxybutynin) while doing the protocol? Or should one try to avoid such medicines for quicker recovery, as it could interfere with the protocol? Thank you!

December 12, 2018 3:47 pm

Hi Dr.
I have gut issues right from the childhood . From last three years i get on and off mucous in stool ,I have this feeling of in complete emptying of bowels . I do have anxiety , i feel lightheaded sometimes and brain fog. Should i start with inulin or rifagut ? i am 43 year old female .

Callista Foit
Callista Foit
October 5, 2018 8:51 pm

Hi there dr Nemechek! My 2 1/2 yo daughter was recently diagnosised with Autism. Before she was diagnosed she was gaining unexpected weight rapidly upon pediatric endocrinologist eval they said her IgF(insulin growth factor) was elevated we did a brain mri done because they were worried about a pituitary brain tumor which was negative she did however show gliosis and myelination when we went to neurologist he said basically her nerve endings never developed I have a feeling it’s mitochrondrial and she needs the spark we still don’t have answers on her weight gain and are going to see a… Read more »

September 26, 2018 5:29 am

We are currently researching your protocol for our 4 year old grandson who has ASD. We hope to start in the next couple of weeks.
My 23 year old daughter has type 1 diabetes. Would the protocol benefit her?

September 18, 2018 12:57 pm

Dr N, I have a question for my father 58 yrs. who had brain tumour previously. He started protocol after I showed him your book and he observed my daughter 5.5 yrs. He started of with NN Ultimate Omega (used with kids). so I ordered FO DHA 500 (Adults one). And also he started inulin for a month until we got prescription for Rifaximin. Now it’s almost 2 weeks he has finished his cycle of 10 days Rifaximin. We started DHA 500 (with 4 capsules) 4 days back. Evoo: 12 mls (we will slowly up it 25mls). My Question: From… Read more »

August 19, 2018 9:58 pm

What is your opinion on omega 3s being bad for people with adrenal issues? Also, I did rifaximin and the approved FO and EVOO but my depression got significantly worse so I stopped the protocol. What could be the reason for this? Is it sometimes necessary to be on an antidepressant while trying to heal the ANS or will it make it worse?

Julia Heather Clark
Julia Heather Clark
August 10, 2018 9:20 am

On protocol for 9 months and doing well. Decided to increase my son’s inulin dose from 1/2 tsp to 1 tsp and we are now seeing bed wetting. This was not an issue before. Will this resolve or should I decrease inulin dose? He’s 4.5yo. Thanks!

August 5, 2018 3:35 pm

Dr. Nemechek – thank you for all of your work and efforts to heal people. I have a 14 year old son that regressed after the MMR vaccine and became nonverbal. Language started to come at age 4. He had extreme sensitivities to light, sound, etc., and these have mostly resolved. He is high functioning ASD, but has extreme social anxiety and great difficulty tuning in (he spends a lot of time in his head). He is always hungry. Separately, my daughter is 17, and at about the age of 7/8 I believe she got some kind of bacterial infection… Read more »

August 2, 2018 10:53 am

Hi Dr Nemechek,
My 5.8 asd son has overactive bladder issues. He frequently uses toilet within 20-30 minutes after drinking a glass of water/ liquid. He never complains about any pain while urinating. He just could not hold it little longer. How could I help him? Please advise.

July 30, 2018 11:31 am

Hi Doctor Nemechek!
Can a 45 years old person with high cholesterol levels but no other significant medicle problem other than chronic constipation alternating with diarrhoea start the Nemechek protocol?

July 8, 2018 6:26 am

As an adult doing the program (mostly for headaches and brain fog), I’ve completed Rifaximin and now on EVOO/DHA according to recommendations in your book. But being in my 40s and unable to find a physician to prescribe tVNS, would you recommend any other steps to curb inflammation? I’m thinking of the low carb approach you’ve mentioned elsewhere in this blog. Or how about a little curcumin?

July 5, 2018 7:28 pm

Hi Dr Nemecheck
My nearly 4 year old is on protocol from last 4 months. We have noticed great awareness nd eyecontact .
But since last one month he is continously spitting , playing with it . Is there anything we can do ??? Pls
2.5 ml nn omega3(1560mg) ,1/4 inulin, 2 tsp olive oil

June 28, 2018 12:18 am

Dr. N., I am doing this protocol with my 3 kids. My oldest is 13 and needs Rifaximin. He has been taking the gummies for almost a year now and gets stomach aches (this was an issue prior to this protocol that comes and goes). Do I need to make an in person appt with you to potentially get this prescription? or will a skype appt do? Thank you.

June 21, 2018 4:50 pm

Hi Dr. Nemechek, Worried mom over here in Philadelphia. Trying to figure out how to help my son. My question prior to starting the protocol is genetics related. Our 5 year old sweet boy has pten autism. I wanted to know if you’re familiar with the syndrome. Kids with this form of asd have white matter in the brain which causes developmental issues. What are your thoughts on whether your protocol, would work in this case? Coupled it potentially reverse the white matter or is this unlikely? Do you feel your protocol could benefit my son? Thank you for your… Read more »

Pinky Desai
Pinky Desai
June 17, 2018 7:23 am

Hi Dr.Nemcheck, 1st of all the protocol is miracle care for kids like my son. I have 3 years old non verbal son who is diagnosed with ASD recently. While i have started him on Omega 3 and EVOO. I am hesitant to start inulin due to of son’s medical history which is as follows 1) Born premature, underweight.while in NICU developed Nectorizing Entercolities (age 20 days) and treated with antibiotics for 21 days. Also,diagnosed with Hirschprung disease. 2) Half of his colon removed as part of Hirschprung correctional surgery (age 5 months,surgery lasted 9.5 hours and 10 days on… Read more »

June 11, 2018 8:20 pm

Dr. N, Yet another blog that supports my need for the Protocol! While I have yet to begin, my 5 y/o daughter has been on the protocol since mid-April. In the past week, she’s finally started having daily bowel movements. Sometimes more than one. This is great news! Though, my daughter reports it’s hard for her to feel when it’s time to go and most of them end up in her pants. Does this mean we should reduce our dosage? Or is it something that will work itself out over time. I don’t want to halt our progress, but with… Read more »

June 2, 2018 2:11 pm

Dr. N, I have been trying to do the protocol. I am an adult with severe dysbiosis and mast cell activation syndrome, both came on with 5 rounds of heavy antibiotics in one year. I have attempted Xifaxin but it makes my gut worse and I’m fearful of getting worse MCAS, as this can occur with antibiotics. Inulin also bothers me horribly as it seems to just make things worse. I get to the point where eating becomes nearly impossible on it. Then fighting it back afterwards with herbs takes months. There are many individuals like us on the facebook… Read more »

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