How to sleep through gout pain

Gout can wake you from a sound sleep,and getting back to sleep without medication can be impossible.Here’s how to be well prepared.

By Chris Iliades,MD

Medically Reviewed by Lindsey Marcellin,MD,MPH

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If you have ever been jolted out of a sound sleep with throbbing pain in your big toe,you know that agoutflare 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.

“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 manygout attacksbegin at night,” says Jennifer Sloane,MD,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 classicsymptom for a gout flarethat 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.

Here are the basics fortreating a gout flare:

  • 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?

Pain management is a crucial part of living with gout. Try these simple tips, which include resting and keeping all pressure off the joint, and taking the right medicine, to manage a painful gout attack.

How to sleep through gout pain

How to sleep through gout pain

Gout is a particularly painful form of crystalline or inflammatory arthritis in which high levels of serum urate cause swollen, stiff joints. Often related to genetics, gout is not the lifestyle consequence it’s been portrayed as. Forget the stereotype of carousing, overindulgent men such as King Henry VIII ending up stricken with gout.

“That’s just victim-blaming, While it does affect men more than women, and can be exacerbated by obesity and diet, genetics are a more important factor,” says John Fitzgerald, MD, with the department of rheumatology at the UCLA Medical Center in Los Angeles, and coauthor on the American College of Rheumatology’s recent guidelines update .

Many Risk Factors May Contribute to Gout and Gout Flare-Ups

Women can develop gout too, especially later in life after menopause.

Other risk factors and conditions for developing gout include:

  • Diabetes
  • Insulin resistance
  • Congestive heart failure
  • Metabolic syndrome
  • High cholesterol
  • High blood pressure,
  • Kidney disease and the medications taken for it, because they increase uric acid levels.

Your 10-Point Plan: Easing a Gout Attack

During a gout attack, the affected joint becomes swollen, warm to the touch, and appears very red. Even the slightest pressure on the joint can be very painful. The attacks more often occur in the middle of the night; about 50 percent start in the big toe, according to the Alliance for Gout Awareness.

Want to get ahead of the intense pain? Make sure you have a plan:

1. Get a Diagnosis

If this is the first time you have had an attack, see your doctor immediately. “Gout is one of the most underdiagnosed diseases because data on how to treat high uric acid has been lacking. We have better information now. If you are experiencing a flare, you should have an action plan in place, created with your doctor,” says Payam Shakouri, MD, nephrologist with Advanced Kidney Care of Hudson Valley in New York, and medical advisor for gout to CreakyJoints. The sooner you start treatment and pain management, the more quickly you will be back on your feet.

2. Take the Right Anti-Inflammatory Medications

There are three different kinds that are effective: over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, or naproxen sodium; prescription steroids; or a prescription anti-inflammatory called colchicine, which influences the way your body reacts to uric acid crystals. “Your doctor will figure out which is the best for your unique needs. NSAIDs, for example, are not appropriate if you have renal disease, and steroids could make your blood sugars worse if you have diabetes,” points out Dr. Fitzgerald.

3. Free the Joint!

The least pressure on the affected area can be very painful. People report they can’t even bear to be under a bedsheet. Make sure there are no constraints on the joint when it is flaring up.

4. Rest and Elevate

Stay off the affected joint and keep it elevated as much as possible.

5. Apply Ice — if You Can Bear It

“Apply ice if you can do so comfortably without creating pain,” says Fitzgerald.

6. Watch Your Diet

You can lower uric acid levels by limiting foods high in purines (like red meat, organ meat, and seafood), and alcohol intake (particularly beer and hard liquor).

7. Stay Hydrated

Drinking water can help flush the uric acid crystals that cause gout out of your system. “A well-hydrated patient should drink enough to urinate every two to three hours,” says Dr. Shakouri.

8. Practice Mindfulness and Meditation

The good news: A gout attack is self-limited and will clear in time. In the meantime, according to the Arthritis Foundation, meditation, yoga breathing, mindfulness, and guided imagery can help you deal with the pain.

9. Create a Support Network

Many patients suffer in silence because of the stigma around gout. Let trusted friends and family know that you have this disease, and reach out for support when you are having a flare.

10. If You Are Having Repeated Attacks, See Your Doctor

Some patients can go a long time between attacks. In fact, for 62 percent of patients the next attack will be more than a year away, and some won’t have another attack in the next 10 years. However, if you begin to have more frequent attacks, talk to your doctor about escalating treatment. “People think it’s normal to have flares every now and then, but it’s not. The gout can be doing damage to your joints. It means you still have too much uric acid,” says Shakouri. In particular, ask about allpurinol. It won’t help with an acute attack but will help prevent future attacks by reducing uric acid production.

Gout, or gouty arthritis, is a common and complex form of arthritis that is caused by high levels of uric acid in the tissues, joints, and blood.

Uric acid is produced in the body during the breakdown of purines (Chemical compounds that are found in high amounts in certain foods such as meat, poultry, and seafood), if too much uric acid is produced, or not enough is excreted, it can build up and form needle-like crystals that trigger inflammation and pain in the joints and surrounding tissue.

An excessive amount of uric acid in the body will cause sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe.

Because the risk of gout attacks during the night was 2.4 times higher than in the daytime, it’s a good idea to know how avoid a gout flare up and how to relieve the pain once it begins.

How to sleep during a gout flare

Ice the area

How to sleep through gout pain

In general, the first 36-48 hours of a gout attack are the most painful, if your pain isn’t too bad, try cold packs or compresses on the joint to lower inflammation and soothe the ache.

To avoid skin damage, wrap ice in a thin towel and apply it to the joint for 15 to 20 minutes every hour that you are awake.

Cooling an inflamed joint can stimulate sensory receptors in the skin and decrease the transmissions of pain signals to the brain, it also causes the blood vessels of the muscles to constrict, and can therefore decrease the flow of blood and help reduce inflammation

Keep the affected joint elevated as much as possible while you ice it, this will help to avoid the blood settling in the area that is being iced.

Take over-the-counter pain relievers

How to sleep through gout pain

Regular gout attacks can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) include over-the-counter options such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as well as more-powerful prescription NSAIDs such as indomethacin (Indocin) or celecoxib (Celebrex).

Long-term NSAID use can increase the chances of a heart attack or stroke and can also increase the risks of stomach pain, bleeding and ulcers — So talk to your doctor if you are struggling.

However, avoid any aspirin or topical aspirin products during any gout flares since this drug can cause more uric acid to deposit in the joints.

You may be interested in these related articles:

Preparing to Sleep While Having a Flare Up

Avoid foods that increase uric acid before bed

How to sleep through gout pain

Our sleep is influenced by the food we eat, so try to avoid foods that increase uric acid levels such as red meat, lamb, pork, seafood, and high-fructose products like soda and some juices, cereal, ice cream, candy.

Foods such as nuts, peanut butter, grains, cheese, yogurt, and beans may help protect against gout.

Cherries even have been shown to lower the levels of uric acid in the body.

During the day, It’s a good idea to drink lots of fluids

How to sleep through gout pain

The Institute of Medicine recommends that men drink around 16 cups of liquids (water and other beverages) each day, while women should drink roughly 11 cups each day, the water helps to flush uric acid from your system.

Alcohol should be avoided

How to sleep through gout pain

Although alcohol may make it easier to fall asleep, it actually disrupts sleep because the process of breaking down the alcohol can also increase levels of uric acid, making a gout flare more likely.

Elevate the Foot

How to sleep through gout pain

Propping up the affected joint can ease pressure and reduce pain, if your big toe is affected (about half of all gout cases affect the big toe), prop your painful foot on pillows while lying down.

Also, you might want to apply ice while your foot is elevated, it makes for a good one-two punch for pain relief.

Practice good sleep hygiene

How to sleep through gout pain

Turn off all the lights before going to bed, make sure no light enters the bedroom and play calming music or “white noise” to help you relax.

If you can, take a warm shower or bath before bed, this can help you relax even more.

Try some deep breathing exercises, calming music, or mindfulness meditation techniques to try and relax as much as possible.

Get up and go to bed at the same time every day while try to exercise in the morning, and do not exercise fewer than four hours before you go to sleep.

Don’t force sleep – If you can’t fall asleep, do something else such as write diary, read books until you’re tired – Always resolve conflicts before you go to bed.

This article was co-authored by Siddharth Tambar, MD. Dr. Siddharth Tambar, MD is a board certified rheumatologist at Chicago Arthritis and Regenerative Medicine in Chicago, Illinois. With over 19 years of experience, Dr. Tambar specializes in Regenerative Medicine and Rheumatology, with a focus on Platelet rich plasma and Bone marrow derived stem cell treatments for arthritis, tendinitis, injuries, and back pain. Dr. Tambar holds a BA in Economics from State University of New York at Buffalo. He earned his MD from State University of New York at Syracuse. He completed his Internship, Residency in Internal Medicine, and his Rheumatology Fellowship at Northwestern Memorial Hospital. Dr Tambar is board certified in both rheumatology and internal medicine. He also holds Musculoskeletal Ultrasound Diagnostic and Interventional certifications from the American College of Rheumatology and the American Institute of Ultrasound in Medicine.

There are 12 references cited in this article, which can be found at the bottom of the page.

wikiHow marks an article as reader-approved once it receives enough positive feedback. In this case, 100% of readers who voted found the article helpful, earning it our reader-approved status.

This article has been viewed 463,605 times.

Gout attacks are so painful that they may wake you up at night. It occurs when urate crystals build up on your joints. Most often it happens in the big toe, but other joints in the feet and hands may be affected. The joints will be painful and inflamed, and the attack can last 3-7 days. [1] X Expert Source

Siddharth Tambar, MD
Board Certified Rheumatologist Expert Interview. 25 August 2020. [2] X Trustworthy Source Mayo Clinic Educational website from one of the world’s leading hospitals Go to source The most effective way to treat gout is using medications recommended by your doctor, but you can complement that with home treatments to manage the pain and lifestyle changes to lessen the chances of future attacks. [3] X Trustworthy Source Mayo Clinic Educational website from one of the world’s leading hospitals Go to source

Arthritis pain can ruin your sleep and sleep problems can make your pain worse. Learn how arthritis pain affects your sleep and what you can do about it.

As many as 80% of people with arthritis have trouble sleeping. With achy, stiff and sometimes swollen joints, getting comfy, dozing off and staying asleep while in pain due to arthritis can be a tall order.

Many people blame their restless nights on arthritis pain. But research finds that the relationship actually works both ways – poor sleep can make your joint pain worse, and even increase the likelihood that you may become disabled or depressed.

“Patients often attribute sleep problems to pain. While pain can certainly contribute to sleep problems, the more we learn about sleep, pain and inflammation, the more we find the relationships are likely to be multidirectional,” says Yvonne Lee, MD, Assistant Professor of Medicine at Brigham and Women’s Hospital in Boston. Which problem starts first is different for different people – but once one of these issues occurs, they lead to the others and can come full circle.

Poor Sleep, Pain, Disability and Depression

Research shows that individuals with osteoarthritis pain who have sleep problems are more likely to experience depression and even become disabled over time. One study found that nearly 70% of more than 300 participants reported having sleep disturbances including having difficulty falling asleep, waking up in the middle of the night, or rising too early in the morning. Results showed that sleep problems predicted increases in depression and disability.

Studies also show that not sleeping at night exacerbates pain the next day. But there is something about sleep disruption that predisposes people with arthritis to become more disabled over time, explains Patricia Parmelee, PhD, Director of the Alabama Research Institute on Aging, University of Alabama at Tuscaloosa. “This is a scary finding that suggests we really need to treat the sleep problems so they do not contribute to the progression of the disease.”

What Causes Sleep to Affect Pain

The big question is why does disrupted sleep affect pain?

The culprit, Dr. Lee says, may be found in the central nervous system (CNS). Dr. Lee explains that studies show CNS pathways (the spinal cord and brain) that regulate pain may be abnormal in people who are not sleeping well.

Another theory is that sleep problems may lead to increased inflammation throughout the body.

“Studies in healthy individuals have found that sleep deprivation is associated with an increase in inflammatory markers measured in the blood,” Dr. Lee explains. “It is possible that an acute inflammatory response to sleep deprivation could lead to more long-term problems.”

How You Can Sleep Better

Since pain, sleep and inflammation are inextricably linked, Dr. Parmelee says treating insomnia is an important step in managing arthritis. A restful night’s sleep often starts with developing good sleep hygiene, such as avoiding electronic devices and caffeine, and adhering to a strict bedtime schedule.

“We are a sleep-deprived nation. When arthritis is in your face with pain, we tend to focus on treating the symptoms and less on our overall health picture,” says Dr. Parmelee. “A good night’s sleep is central to taking care of yourself so you can better cope with the disease.”

Managing a Gout Flare

Gout flares are unexpected and painful; here’s how to get a handle on them.

Few things in life are more painful than a gout flare, so if you’re awakened in the wee hours by a joint that is tender, swollen, red and radiating heat, you’ll want to act fast. Here’s what you can do when a gout flare starts to ease the pain of and reduce the risk of others.

Take medicine you have on hand

Ice down

Applying an ice pack to the painful joint may help ease pain and inflammation. Wrap a pack (a bag of crushed ice or frozen peas will also do) in a dish cloth and apply to the area for 20- to 30-minutes at a stretch several times a day.

Call your doctor. Let your doctor know what is going on right away. She may prescribe a new medication, or have you come to the office for a joint fluid test (to confirm the gout diagnosis) or an injection of a corticosteroid to start relieving inflammation quickly. Getting treatment within the first 24 hours of the start of a flare can lessen its length and severity.

Drink plenty of fluids

Avoid alcohol.

Get a cane

Elevate your foot, if affected

Create gout-friendly socks

Chill out

Revamp the menu

Stop eating troublesome high-purine foods, such as shellfish, red meat, sweetbreads and gravies.

Quick Links
Gout Related Articles

How to sleep through gout pain

What is a Flare?

How to sleep through gout pain

Tips for Managing an Arthritis Flare

How to sleep through gout pain

How Long Does a Flare Last?
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How to fight gout pain

Gout is an excruciatingly painful form of arthritis that often affects the feet.

Dietary factors, such as red meat and alcohol, can trigger gout pain. However, medications and medical conditions can be a problem too, says Kenneth G. Saag, MD, a rheumatologist at the University of Alabama at Birmingham.

“Non-food items are the major risk factors for developing gout,” he says. Here are nine such triggers, which could be causing your gout pain.

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Aspirin

Aspirin drives up the amount of uric acid in your blood. At high enough levels, uric acid deposits in joints (especially in the big toe and fingers) and forms the razor-sharp crystals responsible for gout.

If you take low-dose aspirin to reduce your risk of heart disease, don’t skip your daily pill for fear of gout. Instead try to avoid other gout risk factors (such as

food triggers). If your uric acid levels are still high, medications can help reduce them, Dr. Saag says.

For occasional pain, acetaminophen (Tylenol) or ibuprofen (Advil) might be better for the gout-prone.

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Diuretics

Diuretics help reduce blood pressure by flushing water and salt from the body. At the same time, they block the excretion of uric acid from the kidneys, which can allow uric acid to accumulate to gout-causing levels.

Although switching to a different blood-pressure drug may help, some people get the best results with a diuretic, Dr. Saag says.

In those cases, combining diuretics with medications that slow the body’s production of uric acid, such as allopurinol (Lopurin) or febuxostat (Uloric), can help. “Quite a few people take both,” Dr. Saag says.

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Dehydration

Dehydration can have many ill health effects, and gout is one of them.

“Dehydration can increase the blood uric acid concentration, and in susceptible individuals such an increase can contribute to a gout attack,” says Theodore Vanitallie, MD, professor emeritus of medicine at Columbia University College of Physicians and Surgeons in New York.

Aim to drink around eight cups of water a day, Dr. Vanitallie says, especially if you have already had a gout attack or have other risk factors.

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Extra weight

It’s not enough just to limit those food items that are particularly bad for gout, such as meat, alcohol, and sugary drinks.

Research suggests that obesity itself ups gout risk by both stimulating the body to make more uric acid and blocking uric acid excretion.

Maintaining a healthy weight is an important step toward keeping uric acid levels under control.

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Fasting

If you want to get both your weight and uric acid levels down to within a healthy range, forget about crash dieting.

“Trying to lose weight by fasting can put you at risk of gout attack,” Dr. Vanitallie says.

The main reason is because when you fast the level of ketones in your body increases, and ketones compete with uric acid for excretion, Dr. Vanitallie explains.

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Menopause

An increased risk of gout can be an unwelcome consequence of menopause. This is because estrogen, a hormone that helps the kidneys excrete uric acid, dips during and after menopause. (This protective effect of estrogen is probably also the reason premenopausal women are less likely to get gout than men.)

After menopause you should be careful to avoid other gout risk factors. Some studies suggest that you can help keep gout at bay by consuming coffee, cherries, and vitamin C.

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Injury

A minor injury like bumping your big toe can do more than just smart for a few minutes.

Injured joints seem to make better spots for uric acid to collect, and can lead to a gout attack that can last for weeks. “A traumatic event can start a small inflammatory response, which may then precipitate a gout attack in that joint,” Dr. Vanittalie says.

Osteoarthritis, which is the wearing down of joint-cushioning cartilage as we age, is also associated with gout. Take this as another reason to try to avoid jamming a toe or finger, twisting an ankle, or putting repetitive stress on a joint.

Sleep Tips for Arthritis

Arthritis symptoms – both physical and emotional, like worrying about the coronavirus – can make it difficult to sleep, which can worsen pain. These strategies can help you get the rest you need.

1. Lack of Sleep Makes Pain Worse
2. Talk to Your Doctor
3. Keep a Regular Schedule
4. Write in a Sleep Diary
5. Get Moving
6. Power Down
7. Avoid Caffeine and Alcohol
8. Reserve the Bed for Sleep and Intimacy
9. Treat Stress
10. Go for a Sleep Study
11. Consider Medication
Managing Pain

How to sleep through gout pain

Expert Q&A: Strategies for Interrupted Sleep

How to sleep through gout pain

Arthritis Pain at Night: Tips to Position Yourself for Pain-Free Sleep
Quiz to Help Manage Pain
Give & Get Your Best
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Make a Donation

Help millions of people live with less pain and fund groundbreaking research to discover a cure for this devastating disease. Please, make your urgently-needed donation to the Arthritis Foundation now!

Become a Member

Become an Arthritis Foundation member today for just $20 and you’ll receive access to helpful tools. and more.

Make a Honor or Memorial Gift

Honor a loved one with a meaningful donation to the Arthritis Foundation. We’ll send a handwritten card to the honoree or their family notifying them of your thoughtful gift.

Gift Planning

I want information on ways to remember the AF in my will, trust or other financial planning vehicles.

Other Ways to Give

  • Match Gift
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Volunteer

Volunteer Opportunities

The Arthritis Foundation is focused on finding a cure and championing the fight against arthritis with life-changing information, advocacy, science and community. We can only achieve these goals with your help. Strong, outspoken and engaged volunteers will help us conquer arthritis. By getting involved, you become a leader in our organization and help make a difference in the lives of millions. Join us and become a Champion of Yes.

More About Volunteering

Live Yes! INSIGHTS

Give Just 10 Minutes.

Tell us what matters most to you. Change the future of arthritis.

By taking part in the Live Yes! INSIGHTS assessment, you’ll be among those changing lives today and changing the future of arthritis, for yourself and for 54 million others. And all it takes is just 10 minutes.

Your shared experiences will help:

– Lead to more effective treatments and outcomes
– Develop programs to meet the needs of you and your community
– Shape a powerful agenda that fights for you

Now is the time to make your voice count, for yourself and the entire arthritis community.

Currently this program is for the adult arthritis community. Since the needs of the juvenile arthritis (JA) community are unique, we are currently working with experts to develop a customized experience for JA families.

How are you changing the future?

By sharing your experience, you’re showing decision-makers the realities of living with arthritis, paving the way for change. You’re helping break down barriers to care, inform research and create resources that make a difference in people’s lives, including your own.

Partner

Meet Our Partners

As a partner, you will help the Arthritis Foundation provide life-changing resources, science, advocacy and community connections for people with arthritis, the nations leading cause of disability. Join us today and help lead the way as a Champion of Yes.

Trailblazer

Our Trailblazers are committed partners ready to lead the way, take action and fight for everyday victories. They contribute $2,000,000 to $2,749,000

Visionary

Our Visionary partners help us plan for a future that includes a cure for arthritis. These inspired and inventive champions have contributed $1,500,00 to $1,999,999.

Pioneer

Our Pioneers are always ready to explore and find new weapons in the fight against arthritis. They contribute $1,000,000 to $1,499,999.

Pacesetter

Our Pacesetters ensure that we can chart the course for a cure for those who live with arthritis. They contribute $500,000 to $999,000.

Signature

Our Signature partners make their mark by helping us identify new and meaningful resources for people with arthritis. They contribute $250,000 to $499,999.

Supporting

Our Supporting partners are active champions who provide encouragement and assistance to the arthritis community. They contribute $100,000 to $249,999.