Leg Cramps at Night: Why You Get Them and When to See a Doctor
Here's the scoop on the surprisingly common condition.
No one likes to jolt awake from a deep sleep to a shooting pain radiating through their leg. Most people refer to this type of leg cramp as a Charley horse and it’s incredibly common for them to occur at night. “It can be totally debilitating because it affects your sleep,” says Cory Fisher, DO, family medicine physician at the Cleveland Clinic. “When people don’t sleep well, they wake up unrefreshed and it does negatively affect their lives.” Below is everything you need to know about leg cramps at night and how to prevent them. (These are the best sleeping positions for a good night’s sleep.)
What do night leg cramps feel like?
Nocturnal leg cramps don’t feel anything like sore muscles — they’re actually extremely painful. It often feels like an intense tightening or knotting up of the muscle that can last anywhere from a few seconds to several minutes. “It wakes people right out of sleep,” says Daniel Barone, MD, sleep expert and neurologist at Weill Cornell Medicine and New York-Presbyterian and author of Let’s Talk About Sleep. “The pain is so severe that you don’t know what to do.” These involuntary contractions in the legs, typically occur in your calves, but can also cause muscle spasms in your feet and thighs as well. Older adults over the age of 50 tend to experience leg cramps at night more frequently than younger adults and children. And yet, doctors still can’t explain why leg cramps at night appear more often in older age groups, but they suspect it may have to do with becoming more sedentary in our later years. “As we get older, we’re not as active,” says Dr. Fisher. “When you’re not stretching or using your muscles as much, you might tend to have more cramps at night.”
What causes these leg cramps at night?
Since the condition is not very well understood in the medical world, perplexed doctors still can’t pinpoint why these nocturnal leg cramps occur at all. “There’s no underlying disorder that causes it which makes it frustrating because they’re super common and really hard to treat,” says Dr. Fisher. “But the underlying ideology is thought to be a neuromuscular problem where the nerves are firing off and the muscles are cramping because of it.” Even though there’s likely no apparent cause for these nocturnal leg cramps, the Mayo Clinic and Cleveland Clinic cite dehydration, muscle fatigue, sitting for long periods of time, and standing on concrete floors, as just a few of the potential causes. “If your muscles are not getting enough hydration, you’re not carrying the right amount of oxygen to your muscles and you’re not carrying away the toxins,” says Dr. Fisher. “It’s like if an elite athlete would get a cramp, they try to hydrate, which helps to relieve them and the same goes for muscles, which tend to cramp less if you’re in a well-hydrated state.” (Here are the health benefits of staying hydrated.)
Are leg cramps ever a sign of a serious medical condition?
Nocturnal leg cramps rarely ever represent any sort of underlying medical problem. But some cases have been associated with Parkinson’s disease, diabetes, chronic kidney disease, and hypothyroidism. Just keep in mind that leg cramps at night are rarely the initial symptoms for these health conditions. For example, “Parkinson’s disease is a neurologic disorder that can sometimes cause nerve irritation, but you would generally know if you have this problem. Patients typically have tremors or a shuffling gait,” says Dr. Fisher. “While Parkinson’s disease can in its later stages cause leg cramps its very rarely the presenting complaint.” In fact, blood tests, neurologic testing, and muscular testing are generally not conducted for a single complaint of nocturnal leg cramps. But you may need a blood test if your doctor suspects that you have an electrolyte imbalance. Your muscles tend to get irritable and cramp up when the levels of salts and minerals in the blood are too high. For electrolyte imbalances, Dr. Barone says that “the muscles are reacting to the fact that the blood environment is not normal.”
Are nocturnal leg cramps the same thing as restless leg syndrome?
Even though restless leg syndrome also occurs at night, it is very different from nocturnal leg cramps. Restless leg syndrome does not cause pain or cramping unlike leg cramps at night. Plus, restless leg syndrome is more of a discomfort or crawling sensation that makes you want to move your legs. And the discomfort and restlessness always return once you stop moving your legs.
What can you do to prevent leg cramps at night?
Unfortunately, the treatment options are limited since no one knows what causes leg cramps in the first place. Over the years, doctors have recommended magnesium supplements, muscle relaxants, and calcium channel blockers, cardiovascular medicine, but none of them seem to have great success in reducing nocturnal leg cramps. “We used to recommend tonic water because tonic water has quinine but it turns out that quinine has all kinds of issues,” says Dr. Fisher. Quinine, an organic compound from the bark of a South American tree, is no longer used to treat leg cramps at night because of its potential for serious and adverse effects such as cardiac arrhythmias and a condition that causes low blood platelet count.
Since you can’t pop a miracle pill in your mouth yet, your best option is to perform a deep pressure massage or stretch out the tightened muscle. “When you massage your legs or stretch your legs, you use those muscles and that reactivity tends to calm down,” says Dr. Fisher. In the midst of a leg cramp, a deep pressure massage can ease the pain. Slowly stroke the cramped muscle and apply firm pressure to reach the deeper layers of the muscle. Continue massaging your leg until you muscle relaxes. After the acute pain subsides, gently stretch the calf muscle by using a blanket: sit up in bed, loop the blanket around your foot, and gently pull your toes toward you while you keep your knee straight. Or you can press the ball of your foot against the bottom of the wall with your heel on the floor and flex the calf at a 45-degree angle. “You may even want to do it before bed to preemptively prevent it,” says Dr. Barone. Drinking lots of water a few hours before bed to stay hydrated while you’re asleep and riding a stationary bicycle for a few minutes before bedtime could help too. “Staying physically active and well-hydrated will prevent them,” says Dr. Fisher. “And then stretching your legs and doing that deep pressure massage is really the best management.”
When should you visit your doctor for leg cramps at night?
Dr. Barone suggests seeking a physician if you experience persistent and severe cramping more than twice a week. Especially if you develop muscle weakness and atrophy with leg cramps or have trouble functioning during the day because your leg cramps keep interrupting your sleep, according to the Mayo Clinic. “It’s almost always benign but people who complain of leg cramps that happen throughout the day or are associated with swelling, redness, or warmth of their legs, those symptoms could mean that there’s something more significant underlying,” says Dr. Fisher.
Next, check out the 10 stomach pains you should never ignore.