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Nocturnal leg cramps are sudden, involuntary contractions of the calf muscles that occur during the night or while at rest. The cramps can affect persons in any age group, but they tend to occur in middle-aged and older populations. Sometimes muscles in the soles of the feet also cramp.
Causes & Development
Research has not identified precisely what causes nighttime muscle cramps. The problem is most likely with the nerves controlling the muscles rather than with the muscles themselves. 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 the body movements we make in our dreams. However, most scientists believe that the problem is not a disorder within the brain.
Sometimes the cramps are caused by overexertion of the muscles, structural disorders (flat feet), standing on concrete, prolonged sitting, inappropriate leg positions while sedentary, or dehydration. Doctors do know that those who are more muscular seem to have more leg cramps. Less common causes include diabetes, Parkinson's disease, hypoglycemia, anemia, thyroid and endocrine disorders and use of some medications.
Low levels of certain minerals known as electrolytes - magnesium, potassium, calcium and sodium - have long been linked to leg cramps. (Marathon runners sweating out the miles are particularly prone to this variety.) Certain drugs, such as diuretics have also been cited as a cause of leg cramps. Dialysis patients often complain of leg cramps, and pregnancy is also a factor.
Treatment & Prevention
When cramping occurs, try walking on the affected leg and then elevate it. Stretch your calf by grabbing your toes and pulling them upward toward your knee, especially with you leg extended straight. Take a hot shower or warm bath, or apply an ice massage to the cramped muscle.
Persistent or severe leg cramps often are treated with medication. Such medications include diphenhydramine hydrochloride (Benadryl), simple muscle relaxants such as meprobamate (Equanil, Miltown) and verapamil hydrochloride (Calan, Isoptin, Verelan). Quinine, while effective, has too many side-effects and has been banned in the US for this use.
To prevent cramping consider the regular use of supplements, especially calcium, magnesium, potassium and sodium (only if your sodium intake is low or if you sweat a lot). Stretching your calves regularly during the day and at night will help. You can often prevent night cramps by exhausting the stretch reflex before you go to bed by stretching your calf muscles with wall pushups and applying a heating pad for 10 minutes before going to bed. Keeping blankets loose at the foot of the bed will help prevent unnatural positioning of your feet and toes which can cause night time cramping.
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Signs, symptoms & indicators of Leg Cramps At Night:
Risk factors for Leg Cramps At Night:
Recommendations and treatments for Leg Cramps At Night: | | | | | Drug |  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). |
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Habits |
Aerobic Exercise| | Exercise, such as riding an exercise bicycle for a few minutes before bedtime, can help prevent cramps from developing during the night, especially if a person does not get a lot of exercise during the day. |
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Mineral |
Magnesium| | Because of its nerve and muscle support, magnesium may also be helpful for muscle cramps. Some people taking magnesium may get relief from leg cramps right away, but a long-standing deficiency can take weeks to overcome with supplements. |
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Vitamins |
 Vitamin E| | Nocturnal leg cramping often responds to 400-800 IU 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 300 IU was effective for half of the participants, while the others required 400 IU or more for relief [Ayres, Mihan. South Med J. 67(11): pp.1308-12,1974] |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link | | | May do some good | | | Likely to help |
GLOSSARY
Anemia (Anaemia, Anemias)
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. The body also needs calcium to carry nerve signals, keep the heart functioning, contract muscles, clot blood and maintain healthy 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.
Cramp (Cramping, Cramps)
A sudden, involuntary, painful muscular contraction.
Diabetes Mellitus (Diabetes, Diabetic, Diabetics)
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.
Dialysis
The artificial process of cleaning wastes from the blood when kidneys fail.
Diuretic (Diuretics)
An agent increasing urine flow, causing the kidneys to excrete more than the usual amount of sodium, potassium and water.
Electrolyte (Electrolytes)
An element or compound that, when melted or dissolved in water or other solvent, breaks up into ions and is able to carry an electric current.
FDA
The (American) Food and Drug Administration. It is the official government agency that is responsible for ensuring that what we put into our bodies - particularly food and drugs - is safe and effective.
Hypoglycemia
A condition characterized by an abnormally low blood glucose level. Severe hypoglycemia is rare and dangerous. It can be caused by medications such as insulin (diabetics are prone to hypoglycemia), severe physical exhaustion, and some illnesses.
IU (mIU, uIU)
International Unit: An arbitrarily defined but agreed upon unit that depends on what is being measured.
mIU: 0.001 or one thousandth of an IU.
uIU: 0.000001 or one millionth of an IU.
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.
Mineral (Minerals)
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.
Parkinson's Disease (Parkinson's)
A chronic, slowly-progressing disease of the nervous system characterized clinically by the combination of tremor, rigidity, extreme slowness of movement, and stooped posture. It is characterized pathologically by loss of dopamine in the substantia nigra.
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.
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.
Thyroid (Thyroid Gland)
The thyroid gland is an organ with many veins, anchored around the front of the throat near the voice box. It is essential to normal body growth in infancy and childhood. It absorbs iodine from the diet and releases thyroid hormones - iodine-containing compounds that help govern the rate of the body's metabolism (its total life processes), affecting body temperature, and regulating 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. To a high degree, metabolism is regulated by the hormone thyroxine, which can be made by the thyroid if enough organic iodine is available. An enlarged thyroid gland that is not cancer is sometimes called goitre.
Vitamin E
An essential fat-soluble vitamin. As an antioxidant, helps protect cell membranes, lipoproteins, fats and vitamin A from destructive oxidation. It helps protect red blood cells and is important for the proper function of nerves and muscles. For Vitamin E only, 1mg translates to 1 IU.
Last updated: Jun 08, 2008
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