Preventing nighttime leg cramps

Q: I wake up several times during the night with very painful
leg cramps. It’s getting to the point where I wake up exhausted
each morning with aching legs. What can I do to manage this
problem?
Q: I wake up several times during the night with very painful leg cramps. It’s getting to the point where I wake up exhausted each morning with aching legs. What can I do to manage this problem?

A: While it lasts, the pain from a leg cramp can be excruciating. Usually it goes away within a few minutes, though bad ones can cause lingering soreness. Typically, leg cramps affect the muscles in the calf or along the sole of the foot.

Nighttime leg cramps can be particularly bothersome because they disrupt sleep.

In addition to making you drowsy during the day, not getting enough sleep night after night can contribute to high blood pressure, heart disease and sudden death.

Research also links it with diabetes and difficulty controlling weight. So, getting your nighttime leg cramps under control will not only help you get a good night’s rest, it may benefit your overall health.

The best immediate response to leg cramps is gently stretching the taut muscles. With the calf muscles, you can do that by grasping your toes and then slowly pulling your foot toward you.

Leaning forward against a wall while keeping your heels on the ground does the same thing. Just standing up and putting weight on the affected leg may help, though you should be careful about falling: Get help, if possible.

Heat (from a heating pad or warm – not hot – water) or massaging of the leg and foot can also help muscles relax, although it’s best to try stretching first.

Here are five suggestions for preventing leg cramps before they happen:

n Wear good shoes: Flat feet and other structural problems make some people particularly susceptible to leg cramps. Proper footwear is one way to compensate. If you find that you suffer discomfort in all of your shoes, you may benefit from custom orthotic shoes – talk to a foot care specialist.

n Loosen up the covers: Many people like to sleep under snug covers. But, especially if you’re lying on your back, the covers can press your feet down, a position that tightens up the calf and the muscles along the bottom of the foot. Tight muscles are vulnerable to cramping. Just loosening the covers can help (see accompanying side bar).

n Stretch: Stretching your calf and foot muscles before you go to bed can help prevent cramps in the first place. Use the same techniques that stretch the calf and foot muscles during a leg cramp. You may also try placing the front part of your feet on the bottom step of a stairway and slowly lowering your heels so they’re below the level of the step.

n Take quinine tablets: Many doctors prescribe quinine for leg cramps. Better known as an antimalarial drug (and the ingredient that gives tonic water its bitter taste), quinine seems to help leg cramps by decreasing the excitability of nerves. Many doctors and patients swear by it, but mixed results in formal medical studies have cast doubt on its effectiveness.

On rare occasions, quinine can cause thrombocytopenia, a significant reduction in the number of platelets in the blood that may result in easy bleeding.

Because of this problem – and doubts about the drug’s effectiveness – the FDA stopped the over-the-counter sale of quinine in the mid-1990s, although you can still buy quinine tablets because of the loophole for dietary supplements. The very small amount of quinine in tonic water (about 15 milligrams per 8 ounces) is low enough not to pose a danger, but probably too low to offer any benefit.

n Drink plenty of water: If you’re active (that includes walking, gardening, doing housework, etc.), you need fluids to avoid dehydration. But don’t overdo it. High amounts of fluids can dilute the concentration of sodium in your blood.

This causes a variety of problems – including muscle cramps. How much you should drink depends on how active you are and the foods you eat.

As we get older, we tend to forget to drink enough water because the thirst impulse becomes weaker with age. Some people also worry about adding more trips to the bathroom, especially at night.

Submit questions to the Harvard Medical School Adviser at www.health.harvard. edu/adviser. Unfortunately, personal responses are not possible.

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