Nocturnal Muscle Cramps: Causes and Treatment
They won’t kill you but the pain sure is breathtaking – just ask anyone who suffers from leg cramps in the middle of the night.
Medically referred to as “nocturnal leg cramps”, these severe muscle contractions can last several minutes and are a common complaint that affects people of all ages but are more common in pregnant women and older adults.
Pain results when a muscle contracts and shortens beyond physiological tolerance. The reasons for this are unclear but they may involve spontaneous firing of nerve cells or abnormal motor nerve excitability. Because it affects older people more commonly, there is some speculation that tendon shortening which occurs with age and lack of stretching are predisposing factors.
Primarily, leg cramps are idiopathic – which simply means there is no underlying pathology such as neurological disorders or metabolic/electrolyte disturbances to account for it (even though many patients would like to believe this).
A detailed history will look for the presence of dehydration, enlarged thyroid, muscle wasting or any signs that might point to a secondary cause. Blood work will check for electrolyte imbalances as well as thyroid function, iron, magnesium and calcium levels.
Some studies using non-pharmacological treatment have shown that calf stretching 2-3x/day helps prevent or decrease the frequency of the attacks, but not the severity. Anecdotal treatments also include a warm bath before bed followed by gentle stretching of the leg muscles.
Pharmacological treatments have traditionally used quinine to treat nocturnal cramps. Quinine is thought to increase the refractory period (resting phase) of skeletal muscle contraction but side effects include a high occurrence of tinnitus (ringing in the ears), and decreases in white blood cells and platelets. One double-blind placebo-controlled study of 98 individuals found that 400mg dose of quinine decreased by 50% the frequency of cramps in 78 of the subjects.
Because of the side effects however, the FDA in 1995 ordered that quinine not be marketed as a treatment of muscle cramps. Magnesium citrate (900 mg twice daily), certain types of calcium channel blockers (diltiazem and verapamil), vitamin E (400 IU, mainly in dialysis patients), vitamin B complex and gabapentin (for patients whose leg cramps are due to an underlying neurological disorder) have all been studied for their usefulness in treating leg cramps. The National Institutes for Health (NIH) is currently funding research that the University of Wisconsin is conducting on the effects of Vitamin D using very high doses for a 2 week period.
Given the number of small studies to date and the mixed results, larger clinical studies are needed. For more information click on these links to Tufts or the Cleveland Clinic. In the meantime, you may find that stretching works just for fine for you in decreasing the frequency of this most uncomfortable sleep disrupter.
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