That Nighttime Wake-up a Pain in the Leg

"Not at all [surprised at the prevalence of nighttime leg cramp complaints]. Because I see patients, I see how common they are [such complaints]."
"As a sleep doctor, I tell patients, 'We don't understand the causes and we don't have good, reliable treatments'." 
It's at night [that these episodes occur], during sleep -- out of sight of a doctor. You can't do a test for it."
John Winkelman, sleep medicine specialist, Harvard University

"The best evidence is for quinine. But it's not recommended because of its side effects."
"Now when patients tell me they have cramps, I think, hmmm . . . sleep apnea?"
Andrew Westwood, sleep medicine specialist, Columbia University

"I have found in my clinical practice that trial and error works for most people."
"I'll recommend one thing, and if it doesn't work, I'll recommend another. Eventually, everyone seems to find something that helps them."
Richard Allen, family medicine doctor, Utah Health Care Institute

A small Israeli study assessed the potential for magnesium supplements to help adults suffering from the surprisingly common syndrome of painful cramping in the calf, during sleeping hours. In the study there were 94 adults participating, half of whom received a placebo, the other half the supplement. The end result was that each of the groups similarly experienced a decrease in the frequency of cramping. The placebo effect in action.

A Taiwanese study found in a study undertaken there that vitamin B-complex supplements in elderly people with hypertension experiencing nighttime cramping had an appreciable effect. In the United States a cross-country survey prompted people to report experiencing nighttime leg cramps, concluding that close to 30 percent of adults experience such disturbing events at least five times monthly, with six percent affected some 15 times each month, according to an analysis resulting from the survey published in June in the journal PLOS One.

A group of European researchers questioned 516 French patients finding among them, aged 60 or older, similar numbers with 46 percent reporting cramps having been experienced, while 31 percent claimed they had been awakened by cramps, among whom 15 percent claimed they experienced such inconveniences during their sleeping hours over three times monthly. So, when such untoward occurrences happen that disturb one's sleep, and ultimately the state of your health, what to do? Easy, consult your doctor.

And if you do, it appears doctors haven't much to impart in the way of solid, dependable advice, since it seems that it isn't known what it is that causes nighttime leg cramps. A search on Google, however, comes with ample advice, from stretching regimens, hydrating, to vitamins. Evidence for their workability?

None whatever. Some benefit might be had by stretching calves and hamstrings before bedtime. Eighty people older than 55 in the Netherlands with an average of three cramps nightly at the start of the study, appeared to benefit. Among them one group practised stretching exercises for a six-week period. Their cramp frequency decreased on average to one per night.

Whereas the group that failed to stretch still reported an average of two episodes of cramping per night at the end of th4e study. Again, perhaps the results of placebo effect, while under observation by researchers.

There exists a paucity of studies, and that results in a lack of understanding of cause and of potential avoidance. Perhaps the result of a lack of imagination other than to propose what is already in the public domain as worth a try. Studies take investment, and money is scarce, particularly for treatments that see no profit.

Science supports one treatment in particular: the antimalarial drug, quinine. But quinine has consequences, it can cause nausea, diarrhea and vomiting. Oh, and fever, chills and dizziness. Are all those to be considered a fair exchange for relief from leg cramping? Not likely. Considering the possibility of more serious, albeit rare side effects like severe loss of blood platelets.

And that the Food and Drug Administration has warned against quinine's use for nighttime leg cramps more or less depresses the very thought.

Dr. Westwood experienced an epiphany when he realized that patients using continuous positive airway pressure machines for sleep apnea would often inform him their nighttime cramps had vanished. He and his colleagues maintained a record of these reports, and published that record, even while he admits it isn't clear why sleep apnea and nighttime leg cramps could be related.

Older people more commonly experience nighttime leg cramps, and it is hazarded there may be some relation to medical conditions like diabetes and peripheral artery disease.

Diuretics and some statins may also trigger the phenomena as side effects. Most often, however, those irritating and miserable leg cramps just happen with no obvious reason that comes to mind. In which case doctors do the best they can, recommending their patients make an effort to try any type of treatment available, through their own searches, to determine whether any have an ameliorating effect for them.

How to prevent leg cramps

If you’re you’re prone to leg cramps at night, these 6 tips may help:

• Stay flexible with a regular stretching program.
• A lot of uphill walking/running or stair-climbing shortens the back muscles and the muscles and tendons at the back of the legs, making them more likely to cramp later. Focus attention on stretching these muscle groups after a hilly workout.
• Go for a deep-tissue therapeutic massage with an experienced practitioner. Ask her/him to teach you the techniques for the muscle groups in the legs and feet, so you can work the knots out before they become disabling cramps.
• Loosen the bedcovers so they don’t press your feet down and shorten the muscles of your arches, encouraging them to cramp.
• Drink when you feel thirsty, especially after exercise. Don’t overdo it. Tea, coffee, smoothies, fruits, and vegetables all contribute to your daily fluid needs.
• Eat a variety of potassium- and magnesium-rich foods every day. Good choices: Black beans, kidney beans, nuts and seeds, potatoes, sweet potatoes, leafy greens (especially beet greens), bananas, and other fruits.

The Old Farmer's Almanac