Both clinicians and patients alike have experienced nagging leg cramps at night. What if these cramps were so bad that they interfered with your sleep? About one-third of patients aged older than 60 years experience leg cramps. Some of these patients will be visiting your office looking for solutions.
Healthcare providers don’t really know what causes leg cramps. Ask a runner and they will tell you dehydration, which is known to cause cramping, but research shows the causes are more likely fatigue and nerve dysfunction versus an electrolyte imbalance.
Most leg cramps occur at night and affect the gastrocnemius and the soleus. Sometimes simple dorsiflexion of the foot relieves the cramp, but some patients experience cramps regularly and report significant pain. Simple stretching does not always provide relief, but it can be helpful.
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A patient’s medications may be at the root of nocturnal leg cramps. I usually look at the patient’s medication list to see if it includes conjugated estrogens, raloxifene, naproxen or teriparatde, as these that are known to cause muscle cramps. Diuretics can also cause cramping.
Nocturnal leg cramps are also associated with various illnesses, including vascular disease, spinal stenosis, cirrhosis, hemodialysis and pregnancy. Remember if a patient does come to see you regarding their leg cramps, it is important to rule out other causes such as peripheral neuropathy, restless leg syndrome, periodic limb movements of sleep, claudication and myositis.
One popular treatment, using quinine tablets or soda with quinine, is no longer recommended. There is some evidence that quinine is better than placebo in reducing the number of cramps, but serious side effects have been reported, including tinnitus. The FDA has prohibited over-the-counter sale of quinine because of these safety concerns, so dissuade patients from using these products, if they have found a way of obtaining them.
There is some evidence that using magnesium, calcium channel blockers, carisoprolol or Vitamin B 12 may provide relief. Many of my patients suggest that eating a banana helps.
Encouraging patients to do some light-stretching exercises before bed may be useful. Most importantly, reassure patients that leg cramps typically come and go and are not indicative of any severe disease.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.
