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August 19, 2012 at 9:50 PMComments: 2 Faves: 0

About Nocturnal Leg Cramps

By Jeffrey VanWingen M.D. More Blogs by This Author

It happened again this week! I woke up from a dead sleep writhing to an unbearable wrenching in my lower leg.  Try as I may I could not even flex my ankle to stretch out the gridlock in my calf muscle.  Agony - it lasted a few minutes but seemed much longer. 

Though nocturnal leg cramps are common and up to 60 percent of people report experiencing them at one time or another, as a parent with young children, I covet my sleep. These leg cramps have got to go! 

Let's discuss nighttime (nocturnal) leg cramps, their cause and options for prevention.

Nocturnal Leg Cramp Risk Factors

It’s not known for sure what causes them exactly but some theories exist. They are associated more frequently with some conditions.

  • Being a Woman. Women get them more, especially those who are pregnant or on hormone therapy. 
  • Having Kidney Disease.People on dialysis for kidney disease also get them more frequently, likely from the large swings in electrolytes like calcium, magnesium and potassium. Still, leg cramps are not associated with dehydration of specific electrolyte deficiencies. 
  • Taking Certain Medications.Some drugs are reported to increase the risk of nighttime cramping such as naproxen (an anti-inflammatory) and albuterol treatment for asthma. 
  • Having Poor Circulation. Problems with blood flow or the nerves in the leg can promote cramping.  Examples include claudication (plugging of the arteries) or lumbar stenosis (pinching of the nerves in the lower spinal canal). 
  • Exercising Frequently. Finally, a high degree of exercise is associated with leg cramping.

What Causes Nocturnal Leg Cramps?

Though science has not offered the exact mechanism of the cramping phenomenon, there is speculation. 

Anthropologists suggest that it has to do with the fact that man today is no longer the hunter-gather. The relative lack of squatting in our current lifestyle does not provide the duration of squatting which stretches the calves nicely.

Some believe that the muscles are sufficiently fatigued during sleep and the cramping is a logical reaction.

Others suggest that the way we sleep with our ankles extended shortens the leg muscles to make cramping more likely. 

Can Nocturnal Leg Cramps Be Treated?

Despite the fact that nocturnal leg cramps are extremely common and extremely annoying, there is no safe and effective treatment.

  • Quinine for Nocturnal Leg Cramps: In fact, one old “tried and true,” quinine, has been shown to do more harm than good.  This drug, also a component of some brands of tonic water, has a number of interactions and possible complications. 
  • Magnesium for Nocturnal Leg Cramps: As far as electrolytes, magnesium is the only one that has shown mixed results in some studies.
  • Vitamin B12 for Nocturnal Leg Cramps: With vitamins, B12 has shown mixed results. 
  • Muscle Relaxers for Nocturnal Leg Cramps: Muscle Muscle relaxer drugs have also been studied with mixed results.
  • Stretching for Nocturnal Leg Cramps: Stretching before bed has absolutely no side-effects and can only yield benefit. Appropriate stretching would involve stretching the calf muscles and underside of the feet by plantar flexing at the ankle (toes up toward the nose). Stretch your hamstrings between your knees and hips by reaching to touch your toes. Hold this for at least 30 seconds.

Should I See A Doctor?

Cramps may leave the muscles painful and weak, but this should not last more than a matter of minutes. However, if you notice any of the following, call your doctor:

  • Persistent leg pain in the muscles
  • Weakness in the leg
  • Wasting, or shrinking, of the calf muscles

Nighttime leg cramps are annoying, but common. Some associations are seen, though no cause has been pinpointed. Also discouraging is that no sure-fire remedy exists. It doesn’t hurt to try supplementing with magnesium and vitamin B12 and start a stretching regimen before bed.  If persistent muscle pain or weakness is seen, contact your doctor for further evaluation.


American Family Physician, August 2012.

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  • so are these cramps you talk about the same as a Charlie Horse! That's what I remember them being called, I definitely had them when I was pregnant.
    Since then I seldom get them but when I do, the best relief I find is to quickly stand up! Yup you heard me I immediately jump out of bed and stand on my legs and the pain stops almost instantly.
    Just allow yourself enough time to stand because if you lay down to quick they will come back.

  • yes, correct!

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