Nighttime Leg Cramps: What you can do about them

[David Baxter PhD]

Nighttime Leg Cramps Are Jerks. Here's How To Make Them Go Away
by Eileen O'Sullivan, HuffPost Canada
August 10, 2017

When bedtime beckons we look forward to restful repose. But for those of us who suffer from nocturnal leg or calf cramps, also known as a charlie horse, uninterrupted sleep can be elusive. Leg cramps are characterized by an uncomfortable contraction in the muscle that doesn't let up for a few minutes or more.

According to American Family Physician, up to 60 per cent of adults have experienced nighttime leg cramps. It's also reported that women suffer from leg cramps more often than men, and that the prevalence of leg cramps tend to increase with age.

Leg cramp causes
In a study of people aged 60 years and older, almost a third experienced leg cramps in the previous two months, including half of those 80 and older. Forty per cent suffered leg cramps more than three times a week, with 21 per cent describing their symptoms as "very distressing." In fact, up to 20 per cent of people who have leg cramps find their daily symptoms severe enough to seek medical attention.

Leg cramps are an idiopathic condition that have no specific and identifiable cause. There's much conjecture as to what causes leg cramps during sleep, but a few common causes include:

• Mineral deficiencies in calcium, magnesium and potassium
• Deficiencies in vitamins A, B and E
• Medical conditions like liver failure, cirrhosis, kidney disease, diabetes, hypothyroidism
• A fluid/electrolyte imbalance
• Dehydration, especially after exercise
• Prescription medications such as diuretics, statins and bronchodialators for asthma

Dr. Shaun O'Keefe is a clinical lecturer at Galway University and co-author of the definitive Galway study on nocturnal leg cramps in older adults. Dr. O'Keefe says, "Low potassium and magnesium can cause and worsen leg cramps. However, apart from getting these corrected and improving your cramps, you would want to find out why your blood chemistry is abnormal ? low potassium and magnesium at a level that would influence cramps is not a normal finding."

Leg cramp relief and remedies
As it turns out, an effective cure can be equally as elusive as the root cause of a leg cramp. The only medication that has been found effective for reducing the frequency and intensity of leg cramps is quinine.

However, it's only prescribed in severe cases and should be used with extreme caution. According to the Galway study, "the degree of benefit from quinine is modest and the risks include rare but serious immune-mediated reactions, and specifically in older adults, dose-related side effects." The U.S. Food & Drug Administration advises against the use of quinine to treat nighttime leg cramps due to the drug's serious side effects.

What can be done to get relief from leg cramps? Here are five lifestyle and home remedies to consider:

1. Stretch and massage your legs
After a sudden onset of nighttime leg cramps, stretching and massaging the affected areas can bring instant relief. Gently rub the cramped area to help your muscles relax. Stretch your legs by putting the weight on your cramped leg and bending your knee slightly. If you find it difficult to stand, try sitting on a chair with your affected leg extended.

2. Apply a hot or cold compress
Use a heating pad or warm towel to ease cramped muscles. A hot shower can also help relax the calf muscles. Alternatively, applying an ice pack to the affected area can help numb the pain.

3. Ensure your diet is rich in calcium, magnesium and potassium
Getting your calcium from dietary sources (as opposed to supplements) has several advantages. Your body absorbs calcium better when it gets it in smaller doses throughout the day, rather than all at once. In addition, calcium-rich foods, such as kale, bok choi, chia seeds, asparagus and artichokes, provide other nutrients that help your body absorb and utilize this essential mineral. Green leafy vegetables, whole grains, nuts, seeds and legumes are good sources of magnesium, while pistachios, fennel, persimmons and avocados are dietary sources of potassium.

4. Stay hydrated
Since muscle cramps are an effect of mild-to-moderate dehydration, it's important to drink plenty of water. Dehydration can be an issue, especially for older adults. Researchers estimate that 20 to 30 per cent of older people have water-loss dehydration. Sip water throughout the day (drinking a large amount all at once can fill you up, affecting your appetite) or suck on ice cubes, particularly if it's a hot day and snack on fruit, such as watermelon, cantaloupe and cucumber and other foods that have high fluid content.

5. Strengthen your calf muscles
As part of your weekly fitness routine, incorporate exercises like reverse lunges and dead lifts, which strengthen your calf muscles. Before climbing into bed, stretch your calf muscles or do some light exercise like riding a stationery bike. This may help prevent instances of nighttime leg cramps.

 

[Retired]

I recently experienced severe night time leg cramps, that were so severe that I had to jump out of bed and try to walk off the pain...made difficult because my calf muscles were in spasm.

After discussion with my doctor and working through an elimination list like that cited in the article, the recommendation was to stop taking Lipitor (a statin medication) to see if it made a difference. After two nights, the cramps ceased.

I tried restarting Lipitor, and after two doses the cramps restarted!

Stopped Lipitor immediately with the Doctor's approval.

I began doing calf strengthening exercises as the article states, and have restarted taking a low dose of another statin, to see how my system will react.

After a week on the other statin, no cramping, so far.

There are a number of warnings associated with statins, that a doctor would take into consideration, to assess if a patient can be at risk for muscle related adverse effects, such as the person's age and/or previous history of muscle side effects.

The take home message with respect to statins, is that while they are important and beneficial to help control cholesterol, muscle cramping should be reported to the doctor immediately if a statin is being taken, because this particular adverse effect with a statin can be potentially serious.

There are a number of options available among statins, so if one is not tolerated, there can be other choices, and although they are all indicated for the same purpose, they all do not act in the body metabolism the same way.

BTW, if you are taking a statin drug, it should not be taken with grapefruit juice or cranberry juice which can cause a drug interaction and affect how the drug behaves in the body.

A Medscape article on this topic: How to Manage Muscle Pain in Patients on Statins

 

[David Baxter PhD]

I have had the same issue with anti-cholesterol medications. I was unable to find a medication that worked and now try to control it with diet and weight management.

I had similar issues with cramps and spasms in my back and kidney area with several medications for hypertension (high blood pressure). After several attempts, I was able to find one that worked for me, but a side effect of that is potassium depletion, so I take a daily potassium supplement.

However, I also have issues with peripheral vascular disease, especially in my right leg, so I still get periodic muscle cramps in that leg while sleeping and have to jump out of bed to stretch it and walk it off.

I do find that trying to drink lots of water helps considerably. The trick is to remember to keep drinking water during the day.

Sadly, it turns out that drinking coffee, tea, wine, or beer doesn't work.

 

[GaryQ]

@David Baxter and @Steve,

Been there on all points. Statins while some are worse are probably the worst medication ever invented not only can they cause muscle problems including severe cramping (the want to cry like a baby type) but they can cause permanent muscle damage. Now, when you have PAD (peripheral arterial disease, aka: peripheral vascular disease) this can be a nightmare as the leg muscles already get less oxygen hence more susceptible to muscle pain and cramping.

If you have had or are susceptible to a heart attack Beta blockers, commonly added to blood thinners and high blood pressure medication (usually ACE inhibitors) are know to increase the risk of claudication in people that also have PAD making things worse.

Since I got off statins that took care of the leg muscles cramps especially the night time ones and when I got my GP and cardiologist to give in and get me off beta blockers and replaced it with clonidine (primary use was as a blood pressure med) to also help with my TS+ symptoms my legs are a lot better off. Before, after 5 minutes walking I was in pain after 7 to 10 mins even with a short break I wanted to cry my legs hurt so bad.

I've had 3 heart attacks, first at age 38, a triple bypass at 39, 7 stents (1 in each femoral artery) a totally blocked bypass graft and I lost count of how many angioplasties I've had. My acquired knowledge on the subject through the school of hard knocks is quite detailed.

The funniest thing is the medication that has the most chance of causing me severe damage over time is ASA good old aspirin.

To close this post on a funny note, 2 quotes from my GP and my cardiologist:

My GP: "Gary, sometimes I wonder if you're alive because of us or in spite of us"

My cardiologist just this summer: "This is the first time where I'm optimistic when I say I'll see you in six months" I give him the confused look; to which he responds: "Honestly we never thought you'd make it this far"

Can't wait to see my vascular specialist next month to tell him.