Leg cramps are the painful result of the spontaneous tightening of muscle tissue, below the knee, usually in the calf area and sometimes in the foot. These contractions often happen at night and more often affect older rather than younger people.
Although leg cramps at night are a very common condition, extensive research has not been able to determine a singular definitive cause. However, there are some specific activities and risk factors that can contribute to the development of leg cramps.
The stimulus for muscle contraction typically starts with the brain sending a signal to the muscles via nerves. While it is not likely that leg cramps are related to a brain issue, it is possible that there is some defect or cause within the nervous system that signals muscles to contract involuntarily, without the brain telling the muscle to contract. Some scientists believe that the mechanism which prevents the response of muscles to dream-generated brain activity may be involved. A compromise in that mechanism could allow certain signals through to the muscles.
Some research points to a problem with the transition from wakefulness to sleep. Many individuals who have nocturnal leg cramps have them at the time of dreaming. That’s why some researchers think that these cramps result from a subtle malfunction in the control system that normally separates our brain from triggering body movements based upon what our bodies are doing in the dream. However, most scientists believe that the problem is not a disorder within the brain.
The following disorders occur in this transition from wakefulness to sleep or from sleep to wakefulness. All of these disorders can occur often or to a severe degree in otherwise healthy persons. These parasomnias include:
- Rhythmic movement disorder
- Sleep starts
- Sleep talking
- Nocturnal leg cramps
Here are some of the more identifiable and treatable contributing factors for nighttime leg cramps:
- Insufficient fluid intake
- Extended periods when legs and/or feet are in unusual positions
- Prolonged standing and standing on very hard surfaces
- Atypical bone formations
- Unusual exercise patterns
- Weight gain during pregnancy
In addition, an imbalance or low level of magnesium can cause cramping. Low levels of others like potassium, calcium and even sodium are known to result in leg cramps. Excessive levels of sweating as with extreme exercise may deplete certain nutrients and lead to cramping. Although certain exercises can be a cause, those with limited leg exercise, and those confined to an electric wheelchair have also experienced leg cramps. Both the use of diuretics, and kidney dialysis have been linked to leg cramps. Other causes include thyroid problems, diabetes and Parkinson’s disease.
If the necessary mineral levels of magnesium, sodium, potassium and calcium are insufficient, supplementation is recommended. Many have found that stretching before going to bed helps to prevent cramps. Application of heat after stretching may also be useful. Sudden motions or undue extension of the feet while in bed may trigger a cramping response. Unusual positions of the feet while sleeping may also cause the onset of leg cramps at night.
When cramps occur, it is a good idea to attempt to exercise and stretch the affected leg. One method is to lean forward against the wall, keeping the affected foot flat on the floor and bring the knee to a straightened position. This puts pressure across the back of the calf. Stretching is also useful to return the muscle to its resting position until the contraction subsides. While in bed or sitting down, grab the ball of the foot and pull upward in opposition to the cramp. Others attempt to massage the cramping muscle, take a warm bath, or apply ice massages to the muscles.
Placing a bar of soap between the sheets by your feet overnight has been reported by a number of people to work for them. And this after trying many other things and not believing it would work. The mechanism of action is unknown, and YMMV.
What can you do when natural therapies aren’t helping? Medications such as diphenhydramine hydrochloride (Benadryl) may be required. Certain muscle relaxants like meprobamate (Equanil, MB-TAB, Miltown, Trancot) and verapamil hydrochloride (Calan, Covera, Isoptin, Verelan) may be prescribed, though this is an off-label use.
For safety reasons, quinine is no longer recommended as a treatment, but some find benefit from drinking tonic water before bed. Caution is advised – check with your doctor – even though quinine has been demonstrated to decrease the frequency of cramps, but not their intensity or duration.
Hopefully, by reading this, you have found some effective suggestions to help ease the discomfort or even eliminate nocturnal / nighttime leg cramps.
Risk factors for Leg Cramps At Night
Dehydration
Dehydration may play a role in muscle cramping.
History of nighttime leg cramps
Leg Cramps At Night suggests the following may be present
Recommendations for Leg Cramps At Night
Dairy Products Avoidance
There is some information suggesting that milk may make leg cramps worse due to an underlying calcium deficiency. Milk does not make a good calcium replacement source because of the amount of phosphorus it contains.
Pregnant women and others who get legs cramps due to low calcium levels should reduce milk intake, because drinking milk does not correct the underlying imbalances in calcium and phosphorus. The most common cause of nocturnal leg cramps is calcium deficiency. Non-phosphate containing calcium supplements should be used if low calcium is suspected. However, some people are helped by taking milk before bed.
One person writes that “Both my son and I have severe nocturnal leg cramps if we eat cheese, milk,,etc. Even the ‘hidden’ lactose added to sweetened sausages has this effect…”
GHB (Gamma-Hydroxybutyrate)
An IND (Investigational New Drug Application) has been filed with the FDA for GHB’s proposed action on reducing nocturnal myoclonus (painful leg cramps at night).
Aerobic Exercise
Exercise, such as riding a stationary bicycle for a few minutes before bedtime, can help prevent cramps from developing during the night, especially if you do not get a lot of exercise during the day.
Calcium
Both calcium and magnesium are involved in relaxing nerve impulses and regulating muscle activity. Calcium is needed to contract the muscle, and magnesium is needed to relax it. An imbalance in this dynamic duo can irritate and confuse the muscle.
Oxygen
There are some reports that muscle cramps at night may be associated with shallow breathing, or the oxygen depravation from sleep apnea. Try taking several deep breaths at the first sign of cramping to see if more oxygen helps.
Vitamin E
Nocturnal leg cramping often responds to 400-800iu of vitamin E per day. In one of the largest studies, 103 of 125 people who had been experiencing leg and foot cramps at night reported relief after taking vitamin E. A daily dose of 300iu was effective for half of the participants, while the others required 400iu or more for relief.
Vitamin D
Here is the story of one man’s journey to find an answer for his night time leg cramps:
‘I need to tell you about my quest for nocturnal leg cramp relief and how I achieved it. I am a healthy 60 year old male who five years ago, was being treated for hypertension. The doctors were giving me medicines to treat this and then a heart specialist put me on some kind of diuretic. I don’t remember the name of it but it was a small white pill.
I think this caused some type of electrolytic imbalance because not more than two weeks into this treatment I started being awakened in the early mornings (4AM) by painful calf cramping. I was also having cramps in the arch of my feet. It was so bad that I had to jump out of bed and walk around the bedroom for relief. Even quiting the treatment didn’t cure the cramping.
These are not the kind of fatigue cramps that I’ve had in my large muscles, such as thigh or hamstring which can be cured with quinine sulfate tablets, these come right out of the blue and are very strong. The GP doctors that I complained to kind of poo poo’ed my problem and told me I should get plenty of potassium and calcium etc. I loaded up on these minerals (calcium, magnesium, and potassium) and it reduced the problem by about 20%.
This went on for YEARS before I told a co-worker about this problem and he said “Oh, You need vitamin D”. I started taking a 400IU vitamin D pill daily along with a Calcium tablet and IMMEDIATELY stopped having these nightly cramps. I think this cure is remarkable and have never seen this reported in any article about leg cramps and hoping that I am telling the right people. Someone should launch a study on this.” Barry M.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| May do some good |
| Likely to help |
Glossary
Nervous System
A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.
Magnesium
An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.
Potassium
A mineral that serves as an electrolyte and is involved in the balance of fluid within the body. Our bodies contain more than twice as much potassium as sodium (typically 9oz versus 4oz). About 98% of total body potassium is inside our cells. Potassium is the principal cation (positive ion) of the fluid within cells and is important in controlling the activity of the heart, muscles, nervous system and just about every cell in the body. Potassium regulates the water balance and acid-base balance in the blood and tissues. Evidence is showing that potassium is also involved in bone calcification. Potassium is a cofactor in many reactions, especially those involving energy production and muscle building.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. Calcium is also important to heart health, nerves, muscles and skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Sodium
An essential mineral that our bodies regulate and conserve. Excess sodium retention increases the fluid volume (edema) and low sodium leads to less fluid and relative dehydration. The adult body averages a total content of over 100 grams of sodium, of which a surprising one-third is in bone. A small amount of sodium does get into cell interiors, but this represents only about ten percent of the body content. The remaining 57 percent or so of the body sodium content is in the fluid immediately surrounding the cells, where it is the major cation (positive ion). The role of sodium in the extracellular fluid is maintaining osmotic equilibrium (the proper difference in ions dissolved in the fluids inside and outside the cell) and extracellular fluid volume. Sodium is also involved in nerve impulse transmission, muscle tone and nutrient transport. All of these functions are interrelated with potassium.
Diuretic
An agent increasing urine flow, causing the kidneys to excrete more than the usual amount of sodium, potassium and water.
Dialysis
The artificial process of cleaning wastes from the blood when kidneys fail.
Thyroid
Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
Diabetes Mellitus
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Mineral
Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.