Sleep Apnea and Gout

When you have gout, symptoms like pain and swelling can make it difficult for you to sleep well at night. Gout is caused by a buildup of uric acid crystals in the joints (most often the big toes, but it can also occur in knees, ankles, feet, hands, wrists, or elbows), causing intense joint pain that often comes on suddenly, especially during the night.  

“The main sleep problem that people with gout suffer from is flares, because the pain and discomfort can interfere with sleep and decrease sleep quality,” says Michael Toprover, MD, Rheumatologist & Assistant Professor of Medicine, NYU Grossman School of Medicine. 

Unfortunately, gout pain tends to act up most often in the middle of the night. One study published in Arthritis Rheumatology found that the risk of having a gout attack was 2.4 times higher during the night and early morning than during the day. Flares can come on and linger from a few days to even up to a week or two. Your joint may become swollen, red, and tender to the touch. 

When gout interrupts your sleep, it also, by nature, interrupts your day. An Internet survey found that people with physician-diagnosed gout were more likely to experience sleep disorders. Additionally, two thirds of participants said they felt sleepy at least three to four times a month or more.  

Why Gout Attacks Strike at Night

There are a few reasons gout attacks may be more common at night: 

Your body temperature drops

While it’s only a small amount, your body temperature does decrease while you’re snoozing. The drop can encourage uric acid crystals to form in the joints, causing the sudden onset of pain. 

Your breathing changes

Breathing also slows while asleep, so the lungs don’t expel as much carbon dioxide as they do when you’re awake. The extra carbon dioxide can increase the acidity in your blood and trigger the production of uric acid.

You have sleep apnea

In a study published in Arthritis Research & Therapy, people with obstructive sleep apnea were 1.86 times as likely to develop gout compared to those without. However, when looking for other potential causes that could be increasing this risk, including body mass index (BMI), smoking status, alcohol use, history of heart failure, diabetes, kidney function, and use of certain medications that increase gout, this risk disappeared.  

“There is definitely an increased risk of people with obstructive sleep apnea developing gout,” says Dr. Toprover. “However, it’s unclear whether that risk is directly from the sleep apnea, or whether underlying conditions exist that increase the risk of both diseases, e.g., older age, male gender, and obesity.” Share your symptoms with your doctor to determine if you qualify for a sleep study (polysomnography), a non-invasive exam that records what happens in your brain and body while you sleep.  

Who Is Most Likely to Experience Gout?

Gout is caused by high levels of uric acid in your body. So you’re more likely to have gout if you have a lot of uric acid. Factors that increase uric acid, and thus, your risk of gout, include: 

  • Age and gender. Gout most often occurs in males ages 30–50 years old. Women are more likely to develop gout after they go through menopause (when uric acid is higher).
  • Diet. Certain foods can raise uric acid levels, such as red meat, seafood, and high-fructose corn syrup (found in many diet sodas and processed sweets). Additionally, high alcohol consumption can also increase risk for gout. 
  • Being overweight. “Increased weight directly causes increased uric acid, and weight loss has been shown to lower uric acid,” says Dr. Toprover. Additionally, added weight makes it harder for the kidneys to filter out uric acid.
  • Medical conditions. Certain health conditions such as chronic kidney disease are linked to gout, research shows. Other conditions that may increase your risk for gout include high blood pressure, heart disease, and diabetes.
  • Family history. If others in your family have experienced gout, you may be more likely to get it too.

How to Treat Sleep Issues With Gout

Sleeping better with gout means getting your flares under control as soon as possible, so if you haven’t already, talk to your health care provider about taking a uric acid-lowering medication like allopurinol or febuxostat.  

Here are a few more strategies you and your doctor might discuss to treat your gout and get sound slumber. 

General pain relief

Gout flares can be treated with anti-inflammatory steroids and nonsteroidal anti-inflammatory drugs (NSAIDs). However, beware of corticosteroids (e.g., prednisone), which can “occasionally act as stimulants and cause trouble falling asleep,” says Dr. Toprover. Also avoid aspirin, which can increase your uric acid levels.

Cold compresses

A cold pack or compress can help reduce inflammation and soothe flare-up pain. If you don’t have one handy, try wrapping ice or a frozen water bottle in a washcloth and apply it to the pain. A clinical study showed that ice and other cold applications were significantly more helpful in relieving joint pain than heat.

Rest

If your gout is acting up, one of the best things you can do is ease the pressure on the joint until you feel better. Try elevating the affected joint on a pillow or bunched-up blanket, which can help reduce swelling.  

Lifestyle Changes to Help Prevent Gout Attacks at Night

The pain and discomfort of the flare can sometimes make sleep impossible. So how do you conquer the pain and sleep better at night?

“The most important thing is to speak with your doctor about how to decrease your gout attacks, but generally speaking, lifestyle changes that can help decrease uric acid can be beneficial,” says Dr. Toprover. Try some of these preventative strategies today.

Pay attention to your diet

A healthy diet along with medication and lifestyle changes can help you better manage gout. Eat foods that are low in purine, a chemical compound that can create more uric acid when metabolized. Low-purine foods include vegetables, whole grains, citrus fruits, beans and lentils, tofu, low-fat dairy, and others.  

A study published in Annals of the Rheumatic Diseases found that eating too many purine-rich foods — e.g., red meat, organ meats, seafood, alcohol, and sugary fare — increased the risk of gout attacks, but avoiding these foods reduce the risk. 

Avoid alcohol 

One study of over 700 participants with gout found a significant link between amount of alcohol consumed and risk of recurrent gout attacks. “Liquor and beer increase uric acid, and while wine does not directly increase uric acid, all alcohol intake, including wine, leads to dehydration, which can increase gout flares,” explains Dr. Toprover. “Additionally, all alcohol is dehydrating, which can cause gout flares, and alcohol is turned into an acid in the body.”

Stay hydrated

Carry a water bottle on you at all times to ensure you’re drinking enough water, which can help flush uric acid from your system. Plus, dehydration can lead to more uric acid buildup. The Arthritis Foundation recommends eight beverages a day (preferably water), and, if you frequently have flares, up it to 16 beverages a day, if you can. Not great about remembering to drink water? Download the Plant Nanny app, which reminds you, motivates you, and tracks your water intake.  

Create a good sleep environment 

Avoid caffeine in the later half of the day, minimize TV, phones, and other screens and devices one to two hours before bed, and practice good sleep hygiene — aka “go to sleep around the same time every night and aim for seven to eight hours of sleep every night,” suggests Dr. Toprover. 

Exercise regularly

Exercising helps control gout by lowering uric acid levels to prevent gout attacks. Additionally, staying active may help you to lose weight, another factor in reducing uric acid levels (fat in the body carries more uric acid than muscle). Try low-impact exercise, like walking, as well as stretching to keep your joints flexible. 

The bottom line: Keeping gout flares at bay and getting a good night’s sleep comes down to a variety of factors — things like eating a gout-friendly diet, staying active, and finding the right treatment. Don’t wait to talk with your health care provider about how to better control flares and make quality sleep part of your overall health and disease management. 

Download Our Patient’s Guide to Gout

Whether you are newly diagnosed, have been living with gout for many years, or are caring for someone with gout, it’s easy to feel overwhelmed by the whirlwind of information — and misinformation — available about gout.

Our guide offers comprehensive yet easy-to-understand information on gout and its treatment: what causes gout, how gout can affect your health, how gout is treated, and the steps you can take on your own to prevent flares, manage symptoms, and avoid long-term complications.

Click here to download a Patient’s Guide to Gout for free.

Choi, HK, et al. Nocturnal risk of gout attacks. Arthritis & Rheumatology. February 2015. doi: https://doi.org/10.1002/art.38917.

Durme, CV, et al. Obstructive sleep apnea and the risk of gout: a population-based case-control study. Arthritis Research & Therapy. April 25, 2020. doi:  https://doi.org/10.1186/s13075-020-02176-1.

Interview with Michael Toprover, MD, Rheumatologist & Assistant Professor of Medicine, NYU Grossman School of Medicine.

Neogi, T. Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study. The American Journal of Medicine. April 2014. doi: https://doi.org/10.1016/j.amjmed.2013.12.019

Schlesinger, N. Response to application of ice may help differentiate between gouty arthritis and other inflammatory arthritides. Journal of Clinical Rheumatology. December 12, 2006. doi: https://doi.org/10.1097/01.rhu.0000249864.95389.cf. 

Singh, JA. Self-reported sleep quality and sleep disorders in people with physician-diagnosed gout: an Internet cross-sectional survey. Arthritis Research & Therapy. January 25, 2019. doi: https://doi.org/10.1186/s13075-019-1821-2.  

Singh, JA, et al. Gout is associated with a higher risk of chronic renal disease in older adults: a retrospective cohort study of U.S. Medicare population. BMC Nephrology. March 15, 2019. doi: https://doi.org/10.1186/s12882-019-1274-5

Zhang, Y, et al. Purine-rich foods intake and recurrent gout attacks. Annals of the Rheumatic Diseases. September 7, 2012. doi: http://dx.doi.org/10.1136/annrheumdis-2011-201215. 

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