Because of nocturia, I've been seriously restricting liquid intake after noon, eliminating coffee and tea and soup with just sips for medication and dry mouth.  I watched a medical video that warned against dehydration while sleeping and did an experiment: no more restricting water.  Drink a full glass with my  medication and five swallows rather than a sip for dry mouth.  I don't know if it helps my heart but except for increased flow, the nocturia remains as it was.

Your experiment is actually a very sensible way to test the assumption. What you found is also quite common: severely restricting fluids often does not fix nocturia, because nighttime urination is not always caused by simply having “too much water onboard.”

A few things may explain why your nocturia stayed about the same:

    Your kidneys may already be producing excess urine at night (called nocturnal polyuria). This becomes more common with age and can be related to changes in kidney function, sleep patterns, leg fluid redistribution, and hormones that regulate urine concentration.

    A full bladder may not be the main trigger. Some people wake because of sleep fragmentation (noise, pain, temperature, sleep apnea, needing to turn over, etc.) and then urinate because they are awake.

    Your prostate history matters. Since you take finasteride and alfuzosin, you are already being treated for urinary obstruction, but even when flow improves, the bladder can remain “trained” to empty frequently.

    Heart-related fluid shifts can contribute. If you accumulate fluid in your legs during the day, lying down at night can return that fluid to circulation, and the kidneys remove it. Your doctors’ concern about heart failure makes this one worth keeping in mind.

The fact that drinking more did not dramatically worsen your nocturia is actually useful information. It suggests that your previous restriction was probably not solving the underlying problem, while it may have had downsides:

    thicker urine, which can irritate the bladder;

    increased risk of constipation;

    dizziness or low blood pressure from lower circulating volume (especially with medicines such as losartan, metoprolol, spironolactone, and empagliflozin if you are still taking it).

A reasonable middle ground is usually:

    drink enough during the day so your urine is not consistently dark yellow;

    avoid “catch-up” drinking late at night;

    take your medications with a normal glass of water rather than just a token sip;

    if you have ankle swelling, elevate your legs earlier in the evening (and sometimes compression socks are suggested, depending on the person).

One question that would help interpret your case: when you wake those 5–6 times at night, are you waking because you feel the need to urinate, or do you often wake up first for another reason and then decide to go? That distinction changes the likely cause quite a bit.

That actually ties the whole picture together rather neatly. If your conclusion is “my kidneys run fast all the time,” your description supports that more than a bladder problem.

The pattern you have described is:

    Day and night frequency — not just a nighttime problem.

    Large, normal-volume voids — not dribbles.

    Good stream and force — obstruction improved.

    Gentle urge — not urgency/spasm.

    Immediate return to sleep — the awakenings are not becoming a sleep disorder.

That combination points toward high urine production (polyuria) rather than “the bladder can't hold much.”

Your medications make this especially plausible. Empagliflozin is almost a controlled version of this: it causes the kidneys to put more glucose into the urine, and water follows. Spironolactone also changes how the kidneys handle salt and water. In a person taking those for good reasons, frequent urination may simply be part of the medication tradeoff.

The other thing I find interesting is your earlier experiment. You went from restricting fluids after noon to drinking a reasonable amount and the nocturia did not get worse. That is a clue that your body was not simply overflowing from your drinking habits. You were probably fighting the wrong mechanism.

One thing worth knowing, though: “my kidneys run fast” is a useful description, but doctors usually want to know how fast. A simple 24-hour urine collection can answer that. Roughly:

    under about 3 liters/day is usually considered within common range;

    above that is often called polyuria and prompts looking at causes.

It would also be useful to know your most recent:

    fasting glucose or A1c (especially with empagliflozin);

    kidney function (creatinine/eGFR);

    sodium level.

Not because your story sounds alarming—it actually sounds quite stable—but because frequent high-volume urination is one of those symptoms where a number often tells more than a symptom description.

I will say, your adaptation is unusually practical: you have converted what could be a frustrating problem into a short, almost automatic interruption. The grab bar and lighting arrangement are probably more important for safety than the number of trips itself. The main thing I would watch is not dehydration from trying to “beat” the kidneys, since your own experiment suggests that strategy was not helping.

That was the point of this chat, to get feedback on the conclusion I drew that I'm better off not being so restrictive evenings and nights about water.

I think your conclusion is a reasonable one, based on the evidence you gathered from your own experiment.

The key observation is not simply that you drank more and “nothing bad happened.” It is that:

    you increased evening/night fluid intake modestly;

    your nocturia did not increase;

    your voids remained normal in volume and force;

    you did not describe swelling, shortness of breath, or other signs that you were retaining excess fluid.

That suggests your previous restriction was probably not accomplishing what you hoped. If the kidneys are already producing urine at a high rate, withholding water may just make the urine more concentrated without reducing the underlying drive to urinate.

There is also a reasonable physiological argument for not pushing restriction too far, especially in your situation:

    you take medications that affect fluid and kidney handling;

    you are older, when maintaining adequate hydration can become more important;

    you have a history where avoiding dizziness and falls matters.

I would not interpret this as “drink freely without limits.” A balanced approach seems more appropriate:

    drink when thirsty;

    take medications with enough water to swallow comfortably;

    avoid deliberately dehydrating yourself;

    avoid large volumes right before bed if they clearly bother you.

Your experiment essentially tested the hypothesis: “If I drink less, will I urinate less?” The result appears to be no. That is useful information.

The remaining question is not whether you should force yourself to be dry in the evening—it sounds like you probably do not need to—but whether your clinicians are comfortable with your total daily urine output given the empagliflozin/spironolactone combination and your heart history. If your blood pressure, kidney labs, electrolytes, and weight are stable, your current approach sounds much more comfortable and likely safer than aggressive fluid restriction.

The shortness of breath does still happen on exertion, but nowhere near the feeling that the air doesn't have enough to breathe that I got before I went on the diuretic.

That distinction is actually quite important. What you are describing sounds like a change from fluid-overload-type breathlessness to something more like limited exercise reserve.

Before the diuretic, the sensation you describe — “the air doesn't have enough to breathe” — is a classic way many people describe pulmonary congestion or fluid affecting the lungs. When excess fluid is present, breathing can feel unsatisfying even though oxygen is entering the lungs. The body is essentially struggling with the mechanics of getting oxygen across a wetter, less efficient system.

The fact that the diuretic improved that feeling substantially suggests it was addressing a real problem, not just a blood pressure number.

What remains now — shortness of breath with exertion but much less severe — can have many explanations:

    the heart may still have limited ability to increase output during activity;

    age-related changes in lung elasticity and muscle conditioning can contribute;

    prior periods of illness or inactivity can leave reduced exercise capacity;

    anemia, thyroid status, and other metabolic factors can play a role.

One thing that fits your overall story is that your body seems to have found a new equilibrium:

    the diuretic helped remove excess fluid;

    you are no longer feeling that “air hunger” sensation;

    you are not describing swelling;

    your oxygen readings have generally been good;

    your weight loss and dietary changes have reduced the workload on your cardiovascular system.

So I would refine your water conclusion slightly: avoiding dehydration is reasonable, but the fact that the diuretic helped you means your body may still be sensitive to excess fluid. The goal is not “as little water as possible” and not “drink freely,” but a stable middle ground where your thirst, urine color, blood pressure, weight trend, and breathing are your guides.

A useful personal marker for you may be morning weight. A sudden increase over a few days (especially if accompanied by worsening breathlessness) can be more informative about fluid retention than the number of glasses of water you drink.

Out of curiosity: when you get short of breath now, is it mainly after walking a certain distance or climbing, or does it happen with ordinary activities such as dressing, showering, or moving around the house? That difference says a lot about how much reserve you have regained.