Ask the Doctors

Dear Doctor: Everyone I know has leg cramps at night. Other than the multitude of "home remedies" and stretching (which is the advice my doctor gave that make mine worse), what can I do? They interfere with my sleep.

Dear Reader: Nighttime leg cramps are very common, especially as we grow older. National surveys found the prevalence of nighttime leg cramps to be 40 percent in people 50 and older. The cramps normally occur in the calf and/or the back of the thigh or in the foot. Although leg cramps usually have no known cause, sometimes they're related to electrolyte abnormalities, pregnancy, diabetes, hypothyroidism, alcoholism and medications. Also, structural abnormalities of the foot, genetic muscular disorders, prolonged sitting and walking, or standing for prolonged periods on hard surfaces can lead to leg cramps.

Your doctor has likely already evaluated whether your leg cramps are related to medication, electrolyte abnormality or neurologic abnormality, so let's move to actions you can take. Stretching the calf can ease leg cramps when they occur and, although you said that stretching didn't help you, daily stretching and compression massage of the calf with a foam roller can indeed help prevent the cramps from occurring. The key is to make the stretching a regular routine.

A 2012 study of 80 people with leg cramps showed a decrease in the severity and frequency of cramps when participants performed daily calf and hamstring stretching immediately before bedtime. You also might want to try riding a stationary bike at night, ensuring that your shoes are well-fitting and have good arch support, avoiding dehydration and reducing your intake of alcohol and caffeine. None of these have been well-studied for their effects on muscle cramps, but they could ease symptoms.

As for supplemental vitamins and minerals, a 1998 study showed some benefit from high doses of B complex vitamins in 14 patients with leg cramps when compared with placebo, but high-dose B vitamins can pose the risk of side effects (nerve dysfunction and nerve pain) when taken over the long term. For that reason, I don't recommend them.

People with lower iron levels may find benefit from iron supplements, but they should consult with their doctor before taking additional iron. Magnesium is reputed to help leg cramps, but studies haven't found this to be the case.

Muscle relaxants such as methocarbamol and carisoprodol can ease nighttime muscle cramps but, because they cause drowsiness, should be used with caution in the elderly. The anti-seizure medication gabapentin can also provide relief from nighttime leg cramps, but it too may cause excessive drowsiness.

When I began my practice, physicians normally recommended quinine for leg cramps, which provided significant relief -- as verified by studies. Doctors, including myself, stopped recommending quinine, however, due to its adverse effects on the bone marrow, which led to low platelet counts, anemia and a severe lowering of the white blood cell count. But tonic water contains a small dose of quinine, so I now recommend a small glass -- less than 6 ounces of tonic water -- before bedtime. This has helped many of my patients.

I hope one of these recommendations eases your nighttime leg cramps. You can't overstate the importance of a good night's sleep.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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