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Nocturnal Leg Cramp - The causes, management and treatment of the cramp that appears while you sleep

Nocturnal Leg Cramp - The causes, management and treatment of the cramp that appears while you sleep

A nocturnal leg cramp is a painful, involuntary contraction or muscle spasm which happens during the night, usually when you’re asleep; the pain can be so excruciating that you are awakened by it. The ache usually occurs in your calf although it can happen in your foot and thigh too. It’s hard to estimate how many people suffer from leg cramps as many go unreported as they only happen now and again, however according to the NHS UK, research has found that three out of four people suffer only at night with leg cramps, although anyone can suffer from a leg cramp it’s more common in pregnant women and the elderly. As we get older our tendons shorten which cause the connected muscles to cramp; tendons are very tough bands of tissue that connect muscle to bone; this explains why the elderly suffer more from leg cramps. There are two types of leg cramps, these are:

  • Idiopathic leg cramp – this is when the leg cramps happens for no apparent reason and usually when the muscles are shortened in a relaxed position.

  • Secondary leg cramp – this is when the cramp is a symptom or a complication of a health condition such as pregnancy, medications, exercise or an underlying health condition.

Nocturnal leg cramps shouldn’t be confused with restless leg syndrome (RLS); RLS is when a person has a sudden urge to move their legs to relieve uncomfortable tingling sensations. Where nocturnal leg cramps can last from a few seconds to ten minutes with pain and tenderness sometimes remaining for several hours after, RLS can last for a number of hours with many episodes occurring during this duration. However RLS can sometimes be the cause of nocturnal leg cramps. 

What are the causes?

It’s still unknown by doctors to what causes nocturnal leg cramps but certain factors have been known to play a part when a leg cramp occurs; the main ones are:

  • Low sodium, calcium, potassium and magnesium levels – not having the sufficient amount of these minerals in your body can cause leg cramps as low levels can disrupt the balances in both the nerves and muscles; this can stop the muscles and nerves from responding and recovering normally causing the cramp to occur.

  • Changes in circulation and nerves (muscle fatigue) – this is usually through exercise; ignoring the signs when fatigue starts to show after prolonged exercise can cause the muscle to cramp as the energy levels in that muscle have decreased greatly. For example, long distance runners can experience leg cramps during or after running because the lack of blood flow suppresses the oxygen and nutrients reaching the muscle and slows down the removal of fatigue.

  • Some medications – leg cramps can be a side effect of certain medications such as: diuretics – increases urine excretion also known as ‘water tablets’ to help treat high blood pressure, heart and kidney problems; statins – used to treat people with high cholesterol and raloxifene – helps to prevent osteoporosis in women who are experiencing the menopause.

  • Alcohol – alcohol is a diuretic, meaning it can leave you feel dehydrated; dehydration is another factor which can lead to muscle cramps – see below.

  • Dehydration – it’s not fully understood by doctors how dehydration and leg cramps are related but one theory is that when a person is dehydrated, blood flow around the muscles is limited which increases the chance of a leg cramp. Dehydration can come from perspiration through sports and intense activities, diuretics and low sodium levels.

  • Pregnancy – the later stages of pregnancy can cause leg cramps as you are carrying more weight around with you. Also a decrease in minerals such as magnesium and calcium can cause cramps.

  • Health condition – it’s very rare that leg cramps are caused by other health conditions but when they do happen it’s usually down to conditions such as diabetes, blood flow problems, kidney and thyroid disease.

  • Exercise – overusing and injury from exercise can cause leg cramps as can under stretching and resting after a sport.

How to deal with a leg cramp at night

When a leg cramp occurs during the night it can greatly disrupt your sleep which can leave you feeling tired and groggy the following morning; sometimes you feel like you have to deal with the cramp until it passes but there are certain things you can do to help diminish and manage the pain, these are:

  • Massage the muscle – use circular motions with your fingers, this should help loosen and allow blood to flow around the affected muscle.

  • Stretch your calf muscle – avoid pointing your toes away from you, this may increase the pain and tenderness you feel at the time. Instead, bring your toes and foot towards your head.

How to prevent nocturnal leg cramps recurring in the future

There are ways to help prevent leg cramps from recurring in the future; some of the more common ways are:

  • Exercise/stretch daily – you should always stretch pre and post-workout to prevent any injuries and cramps; on the days where you aren’t exercising you should still stretch – in the morning and in the evening. A well-known exercise for the calf is the calf stretch; while standing put one leg out in front of the other with the front knee slightly bent but not so it’s past your foot. If it’s past your foot, shuffle your foot further forward; try and keep the back leg as straight as possible to engage in the calf muscle stretch.

  • Stay hydrated – make sure you’re drinking plenty of fluids to help prevent dehydration; according to Mayoclinic, around 3 litres of fluid for men and 2.2 litres of fluid for women is seen as an adequate daily amount.  

  • Eat a balanced diet – make sure you’re eating a balanced diet full of fruit, vegetables, carbohydrates and protein; you should make sure you are eating foods rich in potassium (bananas, cabbage, pork etc…), magnesium (spinach, mackerel, brown rice etc…) and calcium (milk, cheese, tuna, beans etc…).

When to see a doctor

However for some, nocturnal leg cramps can occur on a nightly or weekly basis; if your cramps are often and are severe we would recommend visiting your doctor. You should also contact your doctor if you feel like your affected muscles (from cramp) are feeling weaker and aren’t fully functioning and if your daytime concentration levels are low due to disruption to your sleep pattern from leg cramps. 


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