Gout Triggers :Sleep Apnea

Can Gout be Triggered By Sleep Apnea? 

 Someone sent me this stunning article about a little known trigger of gout namely sleep Apnea.If you, like many others still battle painful gout attacks this (to me )revelation ,might just be the break through that you have been looking for.

 

  Curing Gout — My Personal Discovery

Guess what! I stumbled on a way to cure my gout! It happened when I cured my sleep apnea!

   (Note from Joe: I stumbled across this article while searching Google for sleep apnea information for a friend. I found it very interesting that this person cured his gout by curing his sleep apnea - using a very unique "home remedy" involving Wiffle balls, of all things!

 I thought I'd pass this along to you... I don't know who this person is that wrote it - he gave no name or reference or copyright information... but it certainly wouldn't hurt to try this remedy in hopes to cure your gout - because, like he says, you don't have to worry about what you eat, but only how you sleep). What’s The Connection? A gout attack is caused when uric acid reaches such high concentration in the blood that it precipitates as monosodium urate crystals which then become deposited in a joint, often causing severe and widespread pain and inflammation in that joint and the area surrounding it. Sleep apnea (literally, absence of breathing) in adults occurs when the tissues around the soft palate and the pharynx have become flabby usually due to age and/or obesity, so that they relax during sleep sufficiently to close off the air passage to the lungs. Usually, after many seconds of apnea the reduction of oxygen to the brain causes an unconscious response that jolts the sleeper to open the airway so that breathing is restored, at least until the next apnea episode occurs a short while later. Almost everyone who has sleep apnea is also a snorer, but not all snorers have sleep apnea. Sleep apnea in particular and sleep disorders in general have been recognized as problems by the medical profession only in the last few decades. Much more remains to be learned. So what could be the connection between sleep apnea and gout? I asked every physician I came in contact with that question, including my rheumatologist (joint disease specialist). All were clueless. But I trusted my own observation that my gout disappeared immediately and completely as a direct result of my sleep apnea cure. As of this writing I have been gout free for over sixteen months, except for one event, which I will describe later. Before my sleep apnea cure I would have gout attacks every few weeks, with varying degrees of severity, over a period of at least fifteen years. After realizing the connection between my gout and sleep apnea, and that no doctors recognized the connection, I began researching as much information as I could about these conditions. I was able to piece together information from articles in medical journals that confirm the connection. This information was first published around 1990, but nobody pieced it together until now. I sure wish that I had known about it years ago, so that my gout would have alerted me to resolve my sleep apnea before it led to any serious problems. For everyone else's benefit, I have included a list of references to those medical journal items at the end of this article, as well as one that I wrote recently to synopsize this information for doctors. In layman’s language, they describe how reduction of oxygen in the blood, which results from sleep apnea, has been shown to cause the cells in the body to begin to disintegrate and generate an excess of uric acid in the blood. Drinking alcohol has a similar effect on the cells, but it may be even more pronounced in causing gout by the fact that alcohol helps to induce sleep apnea. In some people, including me, the excess uric acid precipitates to cause a gout attack (and maybe uric acid kidney stones as well.) Other evidence that further corroborates their connection is that the typical (with some exceptions) profile of the person who first experiences either gout or sleep apnea is the same—MOM (middle-aged, overweight, male). Second, sleep apnea and gout are both far more common in women after menopause than before menopause. In addition, a large neck circumference is associated with both gout and sleep apnea. The most important piece of evidence, though, is that the onset of a gout attack commonly occurs when the gout sufferer is asleep. That was always my own experience as well. I don’t know how commonplace this connection is in other people. One other person has posted a web message at www.sleepnet.com/apnea81/messages/648.html about his gout disappearing when he resolved his obstructive sleep apnea (OSA). Former U.S. President Taft is known to have had gout and is now reputed to have had sleep apnea, because his own journals record him frequently falling asleep at meetings. But sleep apnea was not known in Taft’s time. Of the four acquaintances of mine who have been diagnosed with sleep apnea, none has ever had gout. (None of us is obese either, even though sleep apnea is much more common in obese people.) In fact, the percentage of people that have gout is much smaller than the percentage that have sleep apnea. Thus, it is clear to me that there is not a one-to-one correspondence between gout and sleep apnea or obesity. Yet to be determined is how high a percentage of gout sufferers also have sleep apnea, and vice versa. Some gout sufferers test high for uric acid in their blood. My tests were always normal, and maybe that is a factor that distinguishes those with the sleep apnea connection from those with a different underlying cause for their gout. Medical science needs to conduct some epidemiological studies to answer these questions. How I Discovered My Sleep Apnea My discovery of sleep apnea occurred because of an astute physician who was treating me in the hospital for another ailment, and he knew that sleep apnea was implicated in that ailment. In the presence of my wife, he asked if I snore. Before I could respond, she jumped in quickly with a passionate and animated description of my snoring. Then the doctor turned his questioning to her, and he paid as much attention to me as he did to the furniture. He next asked her if it ever seems like I stop breathing in my sleep, and she replied affirmatively. I am extremely grateful that my wife was there to answer that question. I knew that I had been accused of snoring, and I begrudgingly accepted that as fact. I thought I knew what sleep apnea was, but if anyone were to ask me if I had it, I would have said no. My limited knowledge of sleep apnea was that people who had it would nod off during the day, and even fall asleep while driving. Since I didn’t have those symptoms, I thought that I didn’t have sleep apnea. I now know that a person can have sleep apnea without those symptoms. This physician arranged a consultation for me with a pulmonologist (lungs)/sleep specialist who had me tested overnight with a monitoring device called a pulse oximeter. This machine had a cable attached to a sensor that slips over a finger, and illuminates it like ET’s finger. It is not uncomfortable to be connected to it. It measures both the pulse rate and the blood’s oxygen saturation percentage. The machine that was attached to me was able to print out a reading every few minutes on a thermal paper tape so that my overnight readings were recorded for examination in the morning. The first sign of a possible sleep apnea problem is to see if overnight the oxygen saturation level ever dips below 90%. Mine dipped down to 80%. I was recommended to have further, more extensive testing as an outpatient in the hospital’s sleep lab. But to me the problem was clear, and worrisome. How I Cured My Sleep Apnea At the sleep lab I was attached to many types of sensors all over my head and body to monitor many things overnight, including sleep apnea. I found out in that test that my blood oxygen saturation level had dipped as low as 88%. It was still below the 90% target, but I wondered why it was so much higher than the 80% measured in the hospital. In my investigation of sleep apnea, I learned that an effective remedy for some people is to avoid sleeping on one’s back, since in that position the airway is more likely to become closed. It just so happened that when I went to the sleep lab I was engaged in a bout with sciatica that was more painful when I slept on my back, so I tried not to sleep that way. Previously in the hospital, however, I didn’t have the sciatica pain, and I purposely slept on my back to avoid disturbing my IV drip. While I was in the hospital I had a gout attack. I subsequently learned that gout sufferers are more likely to have an attack in the hospital than at home. I now know why. There are established methods to allow sleep apneacs to avoid sleeping on their backs. One method is to insert a tennis ball in a sock and pin the sock to the back of one’s pajama tops. The idea of this method is to arouse the sleeper by the ball’s discomfort if he ever turns over onto his back. Since I don’t like to wear pajama tops, I cut two slits in a tennis ball through which I slipped an elastic belt. When I went to bed I buckled the belt around my torso with the ball in the back. In order to test the effectiveness of my method, I rented a tape-printout pulse oximeter from a medical supply company for $50 (not covered by my health insurance) to use for several nights in my own bed. With the ball, my lowest reading was 94%. I tested without the ball one night and found several times when my percentage dropped to 87%, even though I tried to sleep lying always on my side. During subsequent use of my belt and tennis ball method, I found that I would occasionally awaken lying on my back with the ball pushed aside. I upgraded my method to straddle my spine using the belt with two tennis balls, one of which I jokingly labeled "Venus" and the second of which I labeled "Serena". Since then I introduced a second upgrade by replacing the tennis balls by Wiffle® perforated plastic softballs*. Compared to the slitted tennis balls, the Wiffle® balls are larger, less compressible, lighter weight, come with the slits built into them, and dry faster after washing. The one time that I suffered a gout attack with the balls in place, I awakened to find my neck turned so that my body was lying on its side and my head on its back, my wife was complaining about my excessively loud snoring, and my foot was screaming with the searing pain of gout. I know that avoiding sleeping on one’s back is not sufficient to prevent apnea for many sleep apneacs. There are other methods that are much less user friendly, such as a pressurized CPAP mask or even surgery. The ball method is the simplest and most user-friendly one that I know, and I could demonstrate its effectiveness for me by my own testing. And I continue to demonstrate its effectiveness by remaining cured of gout. In order to mitigate my gout, my physicians had advised me to avoid eating foods with high purine content. Following that advice produced at best minimal benefit for me. The foods that I used to avoid, I now eat with relish, and I have had no gout attacks. What matters is not how I eat, but how I sleep. Epilogue It is now more than 18 months after I first cured my sleep apnea by using the ball method to keep me from sleeping on my back. For the past four weeks I have tried sleeping without a net, so to speak, to see if I had trained myself well enough to stay off my back without the balls. It worked - no gout. I just rented a pulse oximeter again for four nights to see if the numbers were good. They're great! Recommendation If you suffer from gout, check with your doctor about getting tested for sleep apnea. If your doctor needs convincing, provide him or her with the list of references below. Based on my own doctor's new results from screening his gout patients for sleep apnea, it appears that almost everyone with gout also has sleep apnea. While overcoming your gout is important to achieve, overcoming your sleep apnea is even more important because sleep apnea can have life-threatening consequences over the long term, such as high blood pressure, heart arrhythmia, heart attack, stroke, diabetes, and even sudden death, as happened with former football great Reggie White. Overcoming your sleep apnea not only will stop your gout, but it also will greatly reduce your risk of future development of these life-threatening diseases. Heed the alarm that your gout is screaming at you! *WIFFLE is a registered trademark owned by The Wiffle Ball, Inc., Shelton, CT, and is used with the written permission of that company. 

 

 References [1] Abrams B. Gout Is an Indicator of Sleep Apnea, Journal SLEEP Feb 2005;28(2):275. [2] Grum CM. Cells in Crisis: Cellular Bioenergenics and Inadequate Oxygenation in the Intensive Care Unit, Chest 1992;102(2):329-30. [3] Hasday JD, Grum CM. Nocturnal Increase of Urinary Uric Acid:Creatine Ratio: a Biological Correlate of Sleep-Associated Hypoxemia, American Review of Respiratory Diseases 1987;135:534-38. [4] McKeon, JL.,et al “Urinary Uric Acid with Obstructive Sleep Apnea,” American Review of Respiratory Diseases 142 (1), 1990, pp. 8-13. [5] Sahebjani, H., “Changes in Urinary Uric Acid Excretion in Obstructive Sleep Apnea Before and After Therapy with Nasal Continuous Positive Airway Pressure,” Chest 113(6), 1998, pp. 1604-1608. [6] Saito, H., et al, “Tissue Hypoxia in Sleep Apnea Syndrome as Assessed by Uric Acid and Adenosine,” Chest 121 (55), November 1, 2002, pp. 1686-1694. [7] Schafer, H., et al, “Body Fat Distribution, Serum Leptin, and Cardiovascular Risk Factors in Men with Obstructive Sleep Apnea (Clinical Investigations),” Chest, Sept. 2002, pp. 829-839. [8] Silverberg, DS., et al, “Treating Obstructive Sleep Apnea Improves Essential Hypertension and Quality of Life,” American Family Physician, Jan. 15, 2002, pp. 229-240. [9] Brown, LK., “A Waist Is a Terrible Thing to Mind: Central Obesity, the Metabolic Syndrome, and Sleep Apnea Hypopnea Syndrome (editorial),” Chest, Sept. 2002, pp. 774-778. [10] Khokhar, N., “Hyperuricemia and Gout in Secondary Polycythemia Due to Chronic Obstructive Pulmonary Disease,” Journal of Rheumatology 7(1), Jan.-Feb. 1980, pp.114-116. [11] Khokhar, N., “Gouty Arthritis in Chronic Obstructive Pulmonary Disease,” Archives of Internal Medicine 142(4), Apr. 1982,