By Chris Iliades, M.D.
Medically reviewed by Lindsey Marcellin, M.D., MPH
If you have ever been jolted out of a sound sleep with throbbing pain in your big toe, you know that a gout flare can make it impossible to get the rest you need. About 50 percent of gout flares begin in the toe, a condition called "podagra." This gout pain usually starts at night and may be accompanied by fever and muscle aches. Even the weight of a sheet or blanket on your foot can be excruciating.
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"Gout occurs when monosodium urate crystals precipitate in bones, joints, or soft tissues. These crystals are more likely to crystallize in lower temperatures. As it generally is colder at night, this may be why many gout attacks begin at night," says Jennifer Sloane, M.D., a rheumatologist at Temple University Hospital in Philadelphia.
The sudden onset of pain in a single joint, with accompanying swelling, redness, and warmth around the joint, is such a classic symptom for a gout flare that most doctors can make the diagnosis over the phone. And, if you have had previous attacks of gouty arthritis, you know right away what's happening.
What To Do For A Gout Pain Flare
Virtually 100 percent of people with an acute gout flare at night will not be able to go back to sleep. The only real option is to call your doctor and start treatment. You may already have access to gout medication in your medicine cabinet or can get some over-the-counter relief at your pharmacy. Your doctor can prescribe stronger medications if needed. Often, this sudden onset of gout pain responds to treatment within 12 hours.
Because gout pain can be quite severe, it is important to know how to quell it as fast as possible, usually by taking medication as soon as possible.
- Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can work well if you take them early and at a maximum dose; check with your doctor first.
- Your doctor may advise you to take prescription-strength pain medications if needed.
- Your doctor may prescribe a drug called colchicine that helps reduce pain and swelling.
- Steroids may also be used to reduce the inflammation of gouty arthritis.
- What not to do: Don't take aspirin because aspirin can increase uric acid in your blood and make the attack worse.
- “Nonsteroidal anti-inflammatories, colchicine, and/or corticosteroids can decrease the severity and duration of gout attacks,” says Dr. Sloane. “As all of these medications have possible side effects, none should be taken without first conferring with a physician.”
Can Poor Sleep Trigger A Gout Flare?
Sleep apnea is a fairly common condition in which the airway collapses during sleep, causing short periods of decreased oxygen called hypoxia. Sleep apnea could be another reason why gout attacks happen at night: Decreased oxygen in your blood can lead to increased uric acid. But the link between gout and sleep apnea could also be obesity since both conditions are more common in people who are overweight.
"It is difficult to state whether sleep apnea causes gout," says Sloane. "There have been no large studies evaluating sleep apnea as an independent risk factor for gout. As patients with sleep apnea are often hypoxic, one could hypothesize that untreated sleep apnea could cause gout."
Gout likes to attack at night when you are sleeping, and getting back to sleep after a gout flare will be difficult unless your medicine cabinet is well stocked. Talk to your doctor about your risk factors and ask what medications you can be prepared with if a gout flare catches you in the dead of night.
"Trying To Sleep Through Gout Pain" originally appeared on Everyday Health
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