Many people who suffer from gout have experienced waking up at night with pain that has no aura and strikes in the middle of the night while they are asleep, often not relieved for a long time. There are 4 reasons why gout tends to strike at night. 1, the body is relatively dehydrated at night, and uric acid is more likely to be deposited. Gout attacks are caused by high concentrations of uric acid in the body, which in turn form tiny deposits of uric acid in the joint cavity and other places, activating the body’s own immune system and triggering acute joint pain. When you sleep, you lose water through breathing, sweating, urination and so on, and you can’t drink water at any time like during the day, so your body is in a relatively dehydrated state, and your blood is concentrated, which makes the concentration of uric acid also rise, and it tends to gather in the joints and other parts, and the crystals accelerate precipitation, triggering gout attacks. 2, low hormone levels at night, the ability of anti-inflammatory, pain relief and uric acid drainage is reduced. Glucocorticoids have the effect of inhibiting inflammation, which can effectively prevent gout attacks and at the same time relieve the pain symptoms during attacks. However, glucocorticoid secretion has an obvious circadian rhythm: it is lowest at 0~2 a.m., starts to rise at 3~5 a.m., reaches a peak at 6~8 a.m., and then gradually decreases. It is because the glucocorticoid secretion decreases at midnight that gives the gout attack a chance to take advantage of it. 3. The body temperature drops at night. Especially after falling asleep, the metabolic rate of the body enters a trough, and the body temperature is relatively low. The temperature drop makes the saturation of uric acid salts decrease, and precipitation is more likely to occur. 4.Lack of oxygen. In clinical practice, it is found that many gout patients snore when they sleep, which is more common in overweight and obese people. Snoring is medically known as “sleep apnea syndrome”, accompanied by snoring that starts and stops, in fact, it is a recurring apnea, which can seriously cause the body’s blood oxygen concentration to decrease. In response to tissue hypoxia, the body’s nucleoside metabolism increases, so that despite not eating or drinking, the patient’s body produces large amounts of endogenous purines, the end product of purine metabolism, which is uric acid. To prevent nocturnal attacks of gout, in addition to the most basic measures such as a low purine diet, moderate exercise, and reasonable use of uric acid-lowering drugs, we must also target interventions for the four causes mentioned above. First of all, drink a glass of water (about 300-500 ml) before bedtime, and moderately increase the amount of water you drink in summer when you sweat easily or in winter when you have heating. However, drinking too much water before bedtime can lead to too many wake-ups and interfere with sleep quality, so gout patients should find a balance with their own situation and also increase their water intake during the day to ensure that their urine output is above 2000 ml throughout the day. In addition to avoid too dry bedroom, especially in winter to purchase a humidifier, bedside water cups, so that feel thirsty at any time to drink. Secondly, pay attention to keep warm when sleeping, especially the extremities, do not be cool in summer, should not set the air conditioning temperature too low. Once again, obese and gout patients with severe snoring symptoms should take measures to correct sleep apnea as soon as possible. Choose side or semi-prone position when sleeping, elevate the head of the bed or pillow, and keep the nasal passage open. Patients who meet the indications can choose to wear orthoses, undergo surgery and treatment such as continuous positive pressure ventilation via the nose. Overweight and obese patients should lose weight as soon as possible. Finally, it is reminded that although glucocorticoids can effectively relieve gout symptoms, these drugs have certain side effects and potential risks and are not recommended for long-term use on their own. They should be evaluated by a specialist and only used if they meet the indications for hormone therapy.