Do you wake up in the middle of the night, feeling like your joints are on fire? Does this pain prevent you from falling asleep at all some nights? Sleep and pain can create a vicious cycle of worsened pain and more sleep deprivation, especially if this pain occurs primarily at night. And if you’re one of the millions of Americans suffering from gout, then you know this all too well.
The connection between chronic pain and sleep disorders like obstructive sleep apnea (OSA) is well-documented, but is there a connection between sleep apnea and gout? The answer might surprise you.
If you’re already familiar with the condition, feel free to skip ahead and discover how a sleep disorder is impacting your experience with gout. If not, let’s explore what gout is, what causes the disorder, and how it can affect your sleep overall.
What is Gout?
Gout is a common form of inflammatory arthritis. Gout is characterized by sudden and severe pain— also known as a flare or gout attack— as well as swelling, tenderness, redness, and pain in your joints. Gout most commonly occurs in your lower body, especially around your big toe.
Gout flares are especially common at night. These attacks can, and often will wake you from sleep with sudden, burning pain.
What Causes Gout?
Gout is caused by elevated uric acid levels in your blood, known also as hyperuricemia. This creates urate crystals, which cause the inflammation and pain associated with gout. Uric acid is a waste product naturally produced by your body and is a normal part of your body functioning. In excess, however, it can be harmful to your health.
Your body produces uric acid when you break down chemical compounds known as purines, which are created by the foods you eat.
Uric acid normally dissolves in your blood and leaves your body through your urine, but excessive uric acid in the body can build up and form sharp urate crystals in your joints or tissue. Gout is the pain created by these sharp crystals in and around your joints.
Gout symptoms often occur at night, and without warning. These symptoms can include:
- Severe joint pain, normally around your big toes— it can affect the joints in your fingers, wrists, elbows, knees, and ankles too
- Prolonged joint discomfort after a gout attack ends
- Inflammation, tenderness, and redness of the affected joint or joints
Risk Factors for Gout
Your gout risk can increase if you meet any of the following criteria:
- Your diet is high in purine-rich foods— more on those later
- A family history of gout
- Being overweight or obese— anywhere above 25 on the body mass index scale
- Certain medical conditions, including high blood pressure, diabetes, heart failure, and metabolic syndrome
- Age and sex— gout occurs most often in men, developing between ages 30-50. Post-menopausal women are also at increased risk of developing gout.
Gout itself can also be a risk factor for kidney stones, and if left untreated, gout can cause joint damage or destruction. Gout can also be a symptom or a cause of kidney disease, reduced renal function, or renal impairment. However, treating gout can help prevent future attacks and potentially clear up the condition entirely.
So now that we’ve talked about gout, what is its connection to sleep apnea?
The Connection Between Sleep Apnea and Gout
If you’re reading this article or have been reading our blog for a while, then you probably have a good idea of what sleep apnea is and how it impacts your health.
Maybe you even know someone who has sleep apnea.
We won’t go into detail on the condition here, but if you need more information about obstructive sleep apnea, we recommend checking out our information about Sleep Apnea Diagnosis and Treatment once you finish reading about how sleep apnea contributes to gout.
While sleep apnea does not cause gout, multiple studies have found that sleep apnea and gout are linked. Sleep and gout also have a correlational relationship, since gout attacks may be influenced by your circadian rhythm, and your sleep quality is likely affected by nighttime gout flares.
According to one study published by BMC Rheumatology, diagnosed or suspected OSA patients are at higher risk of developing gout, and patients with gout often reported disorders including insomnia, restless legs syndrome, and obstructive sleep apnea.
Obstructive sleep apnea patients were nearly 3 times as likely to also have gout. Gout patients were also more likely to have more comorbidities, or accompanying conditions, alongside sleep apnea including diabetes and heart disease.
But why is this the case? Researchers believe that sleep apnea’s characteristic breathing cessation and low oxygen levels can lead to increased production of uric acid in your body, which can cause gout.
However, on a positive note, treating sleep apnea can also help treat any underlying conditions you may also have. One of the best ways to do this is with CPAP therapy.
CPAP Treatment and Gout
CPAP, or continuous positive airway pressure, therapy is one of the most common and effective treatments for sleep apnea. CPAP therapy keeps your airways open with a constant stream of air, allowing you to breathe easier and prevent apnea by keeping your airways unobstructed.
Breathing freely at night isn’t something you should take for granted. Getting enough oxygen while you sleep can not only prevent health problems, but it can help improve pre-existing ones.
So how does CPAP therapy help with gout? More research is needed to know for sure, but one theory is that correcting low oxygen levels from sleep apnea may also reduce elevated uric acid levels that can cause gout. This could help treat existing gout or lower your risk of developing it if you’re currently being treated for sleep apnea.
Low oxygen levels can also spike your heart rate, your blood pressure, and your blood sugar, creating further problems. This is why CPAP is also effective in treating other underlying conditions along with sleep apnea, including heart disease, high blood pressure, and diabetes.
Our 5 Tips on How to Treat Gout and Sleep Better
Even without sleep apnea, gout symptoms can make getting a good night’s sleep a challenge. Here are our 5 tips to help manage your gout and sleep better at night.
1. Change Your Diet
If you consume a lot of purine-rich foods, then your diet is one of the biggest risk factors for you to develop gout. Some examples of purine-rich foods include:
- Red meat or organ meat like liver and sweetbreads
- Seafood, including tuna, trout, anchovies, and sardines
- Shellfish, including scallops and mussels
- Alcoholic beverages, especially beer
- Beverages sweetened with fruit sugars— like fructose or high fructose corn syrup— including soda or fruit juices
You don’t have to remove these foods from your diet entirely, but reducing your intake can help prevent flare-ups. However, if any of these foods immediately trigger a gout attack, consider removing the offending food from your diet.
Eating a healthy, balanced diet full of fresh produce, whole grains, plant protein, and low-fat dairy can help keep your gout symptoms under control. Cutting back on processed foods can help too.
If you consume alcohol— especially beer— or artificially sweetened beverages, cutting back can also help reduce your gout symptoms. Make sure to drink plenty of water to keep yourself hydrated and to help flush excess uric acid from your body.
Related: Alcohol and Sleep May Not Mix as Well as You Think
Being overweight is a major risk factor for gout. But like with many conditions, regular moderate exercise can help reduce your symptoms and keep you healthy. Losing extra weight and bringing your weight into the normal body mass index range can make a huge difference.
Regular exercise can also help treat sleep disorders by removing extra pressure from your organs and airways, and increasing your lung capacity.
Performing light, low-impact exercises like walking or yoga for 30 minutes a day can be very beneficial for your symptoms. As long as you’re increasing your activity levels, it can help. Just remember to keep at it and listen to your body to prevent injury.
Related: Does Exercise Help Sleep Apnea? Which Exercises Reduce Risk and Improve Symptoms
Medication is very helpful in not only controlling your symptoms during a gout attack, but also in preventing them.
Common prescriptions that treat gout include allopurinol and febuxostat, which reduce uric acid production in your body, and colchicine and corticosteroids, which help fight inflammation.
Over-the-counter nonsteroidal anti-inflammatory drugs, or NSAIDs like ibuprofen and naproxen can also reduce the pain and swelling during gout attacks, and may even shorten them.
If you think you need a prescription to help keep your gout symptoms under control, talk to your doctor. Never deviate from your prescription course, stop taking medication, or start taking others without consulting your doctor first.
4. Keep Track of Your Triggers
For many, gout attacks can be linked to a very specific trigger. Knowing what triggers your gout flares and avoiding them can go a long way in keeping your symptoms under control. If certain foods or drinks flare up your symptoms, remember those or write them down so you can more easily avoid them in the future. Other common gout triggers include:
- Stress on your body— such as injuries, illness, or surgery— can make you much more likely to have a flare-up.
- Health conditions including high blood pressure, heart disease, kidney disease, and diabetes can also make you more likely to have gout, so keeping these under control if you have them can help with gout symptoms.
- Certain medications, including aspirin and some diuretics for high blood pressure, can also trigger gout attacks.
5. Get Tested for Sleep Apnea
The connection between sleep apnea and gout means that if you have one, then you’re at higher risk for the other. If you’re experiencing gout symptoms as well as any of the following, it’s important to get tested for sleep apnea as soon as possible:
- Loud snoring, choking, or gasping for air during sleep
- Consistently feeling tired and sluggish throughout the day
- Waking up feeling exhausted even after a full night’s sleep
If you’re not sure if you’re experiencing sleep-disordered breathing or are at risk for sleep apnea, try our sleep apnea quiz. This quiz won’t diagnose you with the disorder if you have it, but it can help you make sense of your symptoms and seek proper treatment. You can discuss your symptoms with your doctor, or you can schedule an evaluation with an accredited sleep center near you.
Don’t let gout or an undiagnosed sleep disorder ruin your sleep and your health. Contact us at the Sleep Centers of Middle Tennessee today, and get back to restful, pain-free sleep.
“Gout.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 Mar. 2021, www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897.
Dykes, Lana. “Obstructive Sleep Apnea Linked to Gout.” Rheumatology Network, Rheumatology Network, 10 Sept. 2021, www.rheumatologynetwork.com/view/obstructive-sleep-apnea-linked-to-gout.