Why Does My Gout Flare Up At Night?

Gout, Attacks at Night, and how to treat it

While all forms of arthritis seem unbearable at times, a particularly painful, rather common and, most of the time, unexpected strain is gout. Perhaps you’ve heard the term, but don’t know how to characterize the form of arthritis – but now, suddenly, the joint of your big toe has become affected and you’re looking for any kind of relief available. What is gout? Why does it attack at night? And what can I do to help it?

If you’re experiencing sudden, severe gout flare ups, don’t hesitate to get a specialist’s opinion. While you wait for your appointment, here’s a short guide to gout and night-time flare-ups.

What Is Gout?

Gout is a specific form of arthritis that usually manifests in the joint of the big toe. While it can affect any joint, over 50% of gout cases occur in the big toe, with the ankle, lesser toe joints, and knees also common sites of inflammation.

It’s characterized by common arthritis symptoms, but in sudden and severe attacks, usually at night. A study published in Arthritis Rheumatology found gout attacks were 2.4 times more likely to happen during the night and early morning than the day. Associated symptoms include:

  • Acute pain
  • Swelling
  • Redness
  • Heat

This affliction is caused by Hyperuricemia, which means that there is too much uric acid in the body. Uric acid is your body’s naturally-produced method of breaking down purines found in foods and the body. But when there is an overproduction of uric acid, it crystalizes and builds up in joints, fluids, and tissues within the body.

There are certain factors that can contribute to this overproduction, including:

  • Gender – Males are more prone to Hyperuricemia
  • Weight – Increased weight causes an increased production of uric acid, which can lead to Hyperuricemia and gout
  • Diet – Alcohol (particularly beer), high-fructose foods and drink, red meat, organ meat, anchovies, sardines, mussels, scallops, trout and tuna are all high-purine foods
  • Health Conditions – Hyperuricemia has been linked to increase with the presence of congestive heart failure, high blood pressure (hypertension), insulin resistance, diabetes, sleep apnea, metabolic syndrome, and kidney problems
  • Certain Medications – Diuretics have been linked to a higher risk of Hyperuricemia

Gout flare-ups can last from days to weeks, and are often followed by long periods of remission that can last up to years without symptoms before another flare-up occurs.

One of the worst features of gout is its propensity to manifest at night, when you’re at your most vulnerable and pain seems so much more intense. Along with a disturbed sleep schedule that can bleed into other parts of your life, it’s not fun to deal with.

So why does gout flare-up at night, when you least expect it to?

Potential Reasons for Gout Flare-Ups at Night

Dropping Body Temperature

The natural drop in body temperature when you’re resting can contribute to uric acid crystallization in the joints. And, since the body’s extremities usually drop to an even lower temperature than the rest of the body due to blood flow and the body’s protective measures for its organs, toes and fingers are prime locations for uric acid crystals to accumulate.

Change in Breathing

What the change in your breathing actually does is acidifies your blood. With less expulsion of carbon dioxide, the excess escapes to your blood, increasing the amount there in a condition called respiratory acidosis, which encourages the formation of uric acid crystals.

Dropping Cortisol Levels

As you sleep, your body slows its natural production of cortisol, which plays a critical role in the fight against inflammation, which is why corticosteroid shots are used to help treat arthritic conditions, including gout.


As you sleep and stop the consumption of fluids that you supply the body with during the day, your system draws on the water it retains, as well as both sweats it out and expels it out by breathing, which depletes its stores that are maintained throughout the day. As water content decreases by absorption and expulsion, uric acid concentration in the blood and joints increase, which leads to Hyperuricemia, and consequently, gout flare-ups.

Sleep Apnea

Sleep apnea, which is a disorder characterized by a decreased intake of oxygen when asleep, contributes even further to the change in breathing, but in a different way. Instead of carbon dioxide as the main culprit, with sleep apnea, decreased oxygen results in higher levels of the naturally-produced purines that cause Hyperuricemia and gout. It’s been reported that there is a 50% risk increase of gout with the presence of sleep apnea.

How to Help Gout Flare-Ups

Luckily, all is not hopeless when it comes to treatment and prevention of gout. Since attacks are sudden and relatively short-lived, there are plenty of ways to prevent or mitigate the effects. If you suffer from frequent or in-frequent gout flare-ups, make sure to consult a doctor for professional guidance and treatment options, but in the meantime, there are a couple of things you can do to help gout stay out of your joints.

Keep a Healthy Lifestyle

While some of the primary risks and factors that contribute to the formation and development of gout relating to personal health, keeping a healthy lifestyle is critical in all factors of life, not only in managing gout. Big factors that you can actively monitor, however, can be:

  • Maintenance of proper hydration to combat dehydration and to flush uric acid out of your body
  • Paying attention to your diet to avoid high-purine foods (alcohol (particularly beer), high-fructose foods and drink, red meat, organ meat, anchovies, sardines, mussels, scallops, trout and tuna)
  • Weight control
  • Regular exercise to improve sleep

These are all lifestyle factors that will benefit other facets of your health, and should be considered even if you haven’t experienced a gout attack recently.

Seek Treatment

Professional treatment should always be an option, especially if the pain is frequent, lasting, or debilitating when it occurs. Common medical treatments for gout include:

  • Prescription pain medications
  • Corticosteroid shots
  • Colchicine

Since gout is a form of arthritis, it isn’t curable – but it is treatable, and the symptoms can be highly managed to reduce pain, duration, and other side effects.

Non-Steroidal Anti-Inflammatory Drugs

IMPORTANT: DO NOT take Aspirin, however, as Aspirin has ben known to increase uric acid in your blood and make gout attacks worse.

Over the counter medications are still an option for those who don’t want or don’t have the option of prescription treatments. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox DS, Naprosyn), and Celecoxib (Celebrex). Pairing NSAIDs with a cold compress or ice pack can also alleviate symptoms.

If you or someone you love suffers from gout or arthritis in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.