Nocturnal leg cramps are involuntary, extremely painful muscle contractions that occur during sleep. There are times when cramps will wake one from a sleep state, further disrupting the quality of one’s sleep. Many adults, particularly the older adults, complain of nocturnal leg cramps frequently. Indeed, Rabbit et al. ( 2016) and Grandner & Winkelman (2017) estimated that at least 60% of the older adults have nocturnal leg cramps at least once a week. Clearly, it is essential to find out the possible causes of nocturnal leg cramps, their possible prevention and their impact on health.
There are a variety of factors that can contribute to nocturnal leg cramps. Dehydration is one such factor. Without adequate fluid intake, muscles can become more prone to cramping. Long periods of time spent sitting or standing can also contribute to the development of leg cramps due to stiffness. The human body requires motion to help promote healthy muscle function. Prolonged periods of sitting can disrupt normal muscle function and contribute to leg cramps. Mineral deficiencies can also cause leg cramps. Potassium, calcium, and magnesium deficiencies are particularly common and contribute to a host of different symptoms, including nocturnal leg cramps. The body needs adequate levels of these minerals to help regulate normal muscle function and prevent involuntary contractions and spasms.
One of the most common complaints from elderly patients is complaints of muscle cramps. These are very common in this population and a multitude of causes have been described. The physiological changes of aging such as poor circulation, muscle atrophy and the fact that the elderly population is exposed to more drugs can be contributing factors to muscle cramps. According to Tipton & Wszołek (2017) , drug side effects such as hypokalemia and hypocalcemia caused by the use of diuretics are among the most common causes that lead to severe nocturnal leg cramps. Other possible underlying causes of nocturnal leg cramps such as diabetes, nerve damage etc. have also been suggested. Bhor et al. ( 2016) observed that patients with diabetes and nerve damage suffered from cramps more frequently.
When we consider that leg cramps wake us and cause considerable pain, we might initially consider their impact to be minor and not worth worrying about. But we know that sleep disruption has the potential to affect our health in myriad ways. Sleep disturbance is linked to fatigue, depression, and cognitive impairment. We can easily fall into a vicious cycle where the disrupted sleep that is caused by nocturnal leg cramps leads to additional functional limitations that further impact the quality of our sleep. So it is very important to consider nocturnal leg cramps in their broader context. Through our ongoing research on the aetiology and prevention of these troublesome symptoms, we aim to better understand the effects of nocturnal leg cramps on our sleep and overall health. So, what are nocturnal leg cramps? These are episodes of severe muscle pain in the legs occurring during sleep. A severe muscle cramp can be sudden and severe enough to waken us. As with a charley horse, the limb affected by a cramp feels rigid, stiff and tight, which is very uncomfortable and painful. We are most commonly located in the calf but can also occur in the thighs and feet. These episodes of nocturnal leg cramps occur frequently, often throughout the night and sometimes at frequent intervals. So a person can wake multiple times a night from leg cramps (Young, 2015; Brown, 2015).
They can occur suddenly, which can make a real nuisance. The nocturnal leg cramp sufferer can be plagued with a night-time dread of when the next cramp will occur. Their sleep patterns are continuously being disrupted. As they struggle with excessive daytime fatigue they start to experience difficulties with their everyday activities. As their sleep is continuously being invaded by these debilitating episodes, they begin to feel excessively tired and lacking in energy. They can find themselves being unable to focus for even the simplest of tasks. Persistent sleep disruptions can have serious future health consequences. Research suggests that the impact of sleep on our health can be quite profound, with disruptions to sleep potentially contributing to cardiovascular disease (Monderer et al., 2010; Hallegraeff et al., 2017).
Nocturnal leg cramps are associated with night time symptoms such as pain, muscle stiffness and wakefulness. These nighttime disturbances can disrupt sleep and ultimately lead to chronic sleep deprivation with daytime fatigue and its’ associated health problems. To prevent nocturnal leg cramps one must make lifestyle modifications and also possibly visit a doctor. Drinking enough water during the day can help in reducing the frequency of nocturnal leg cramps. In general, dehydration is one of the main reasons for muscle cramps. It is thus very important to make sure that the body gets enough water.
Stretching Before Bedtime Is Another Way To Help Prevent Leg Cramps Stretching can also help prevent cramps from arising at night. Doing some stretches before bedtime will loosen up your muscles so they will be ready for resting. Some stretches that can be done include calf stretches, toe touches and lying on your back and lifting one leg at a time until you feel tension at the back of your leg. Doing these stretches in a short amount of time will benefit your rest during the night and give you less chance of waking to the feeling of a cramp in your legs.
Besides other factors, nutritional factors also play an important role in the occurrence of leg cramps. Thus, in case of a vitamin and/or mineral deficiency of for example magnesium, potassium and calcium, disturbances in muscle function such as muscle cramps may occur. It is therefore very important to consume a healthy diet consisting of fruits, vegetables, wholegrain products and proteins. The food sources which are high in nutrients mentioned above are helpful for promoting general muscle health.
If your cramps don’t go away despite your best efforts to change your habits, see your doctor. Your doctor can identify whether you have a medical condition that is contributing to your cramps and advise you about whether physical therapy, particular exercises, or medication might help. Frequent and severe cramps can interfere with sleep and affect your ability to lead a normal life.
Some medications can reduce the occurrence and severity of nocturnal leg cramps. The doctor or other health care provider may suggest additional drugs to alleviate distressing cramps, especially if they continue to interfere with sleep. Good communication with the health care provider is important in arriving at an effective management program for the patient.
Preventing nocturnal leg cramps means having to undergo a change in life style which involves amongst others drinking enough water, stretching during the night, a proper diet and consulting the doctor if the occurrence is persistent. In any case improving the quality of sleep is an important factor for better health and hence preventing the negative effects of nocturnal leg cramps.
Citations:
Allen, R.E. and Kirby, K.A., 2012. Nocturnal leg cramps. American family physician, 86(4), pp.350-355. https://www.aafp.org/pubs/afp/issues/2012/0815/p350.html
Monderer, R.S., Wu, W.P. and Thorpy, M.J., 2010. Nocturnal leg cramps. Current neurology and neuroscience reports, 10(1), pp.53-59. https://link.springer.com/article/10.1007/s11910-009-0079-5
Tipton, P.W. and Wszołek, Z.K., 2017. Restless legs syndrome and nocturnal leg cramps: a review and guide to diagnosis and treatment. Pol Arch Intern Med, 127(12), pp.865-72. https://scholar.archive.org/work/sfpugvouavcgpo5ek4jlcgtbpq/access/wayback/http://pamw.pl/sites/default/files/inv_rev_Wszolek_0.pdf
Rabbitt, L., Mulkerrin, E.C. and O’Keeffe, S.T., 2016. A review of nocturnal leg cramps in older people. Age and ageing, 45(6), pp.776-782. https://academic.oup.com/ageing/article-abstract/45/6/776/2499229
Hallegraeff, J., de Greef, M., Krijnen, W. and van der Schans, C., 2017. Criteria in diagnosing nocturnal leg cramps: a systematic review. BMC family practice, 18(1), p.29. https://link.springer.com/article/10.1186/s12875-017-0600-x
Young, G., 2015. Leg cramps. BMJ clinical evidence, 2015, p.1113. https://pmc.ncbi.nlm.nih.gov/articles/PMC4429847/
Brown, T.M., 2015. Sleep-related leg cramps: a review and suggestions for future research. Sleep medicine clinics, 10(3), pp.385-392. https://www.sleep.theclinics.com/article/S1556-407X(15)00037-5/abstract
Winkelman, J.W., 2014. Nocturnal leg cramps. Up To Date. updated: Dec, 4. http://publishingimages.s3.amazonaws.com/eZineImages/PracticePerfect/737/Nocturnal-leg%20cramps-UpToDate.pdf
Grandner, M.A. and Winkelman, J.W., 2017. Nocturnal leg cramps: Prevalence and associations with demographics, sleep disturbance symptoms, medical conditions, and cardiometabolic risk factors. PLoS One, 12(6), p.e0178465. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0178465
Bhor, R.J., Damdhar, H., Kokate, G., Salve, M. and Andhale, S., 2016. An Overview on Cause of Muscles Cramps or Leg spasms; Types of Muscle Cramps and its Pharmacological Treatment by New Drugs. Research Journal of Pharmacology and Pharmacodynamics, 8(3), pp.134-140. https://rjppd.org/HTML_Papers/Research%20Journal%20of%20Pharmacology%20and%20Pharmacodynamics__PID__2016-8-3-9.html
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