Muscle Cramps at Night – Vascular Medicine – Angiologist (2023)

Do you suffer from muscle cramps at night? Did a “Charley Horse” wake you up? It is very common, and very painful. Thankfully, there are several easy treatments you can implement on your own at home to try to take those cramps away.

Causes for Muscle Cramps at Night

Here are several common and uncommon reasons for muscle cramping at night:

Simple Reasons for Nighttime Muscle Cramps

  • Dehydration is very common, especially in the elderly. This is because most people do not want to get up and pee during the night. So they avoid drinking before going to bed. Dehydration can trigger cramping.
  • Leg pain from tight muscles is common. But tight muscles can also cramp up. For example, if you walked more than usual during the day, your muscles may cramp up at night.
  • Electrolyte disturbances are hard to measure. This is because we have electrolytes in our blood stream but also in our muscles. If the balance between these electrolytes is off, the muscles may seize and cramp.
  • Some medications can cause cramping. Everyone likes to blame statins. These are medications that are used to treat elevated cholesterol. But other medications are actually worse offenders. For instance beta blockers that are used to treat elevated blood pressure and certain heart conditions and diuretics (“water pills”) cause muscle cramps at night most frequently.

Muscle Cramps that Require a Medical Professional

Some cramping is related to potentially serious medical conditions. Spinal stenosis can result in calf cramps. While there is much debate regarding restless leg syndrome, it can cause discomfort that is worse during the night. Obviously, muscle cramps need to be differentiated from rest pain from lack of blood flow.

Obviously, some of the more “simple” causes I wrote about above might also require professional advice. For example, You should not make any medication changes without consulting your doctor. Also, sometimes electrolyte imbalance is a sign of kidney disease. If cramps do not resolve quickly, a blood test may be in order. Those are only a few examples.

Preventing Muscle Cramps at Night

While sometimes cramps at night can be a sign of significant disease, often they are not. Addressing simple measures can help most people get through the night without pain. Here are a few examples:

Hydration

Many adults do not practice adequate hydration. Also, others take diuretics. However, in many people going to bed dehydrated is a conscious decision. They just don’t want to wake up to go to the bathroom during the night. Striking a better balance in favor of hydration may help for some to prevent muscle cramps at night.

Muscle Stretches

Many people neglect routine stretching. Believe it or not, tight muscles can imitate artery blockages. In fact, tight muscles may actually be a cause for calf pain when walking. It is also anecdotally described that prolonged sitting in an uncomfortable position may lead to muscle cramps at night. While you will not be able to find much scientific evidence to support stretching, many have the clinical experience that they work to prevent muscle cramps at night (and also to improve walking).

Quinine to Prevent Muscle Cramps at Night

Quinine is an anti-malaria medication. It actually has an interesting history. Quinine also has the ability to stabilize muscle cell walls. This means it makes it harder for muscles to “fire” off and to contract. Much of the scientific studies about medication to prevent muscle cramps at night focuses on quinine. In fact, in the 1930’s, Alexander Wolf observed that quinine worked to help treat spasms in Malaria. Together with Foster Kennedy, they decided in 1937 to experiment with the medication in other muscular disorders. Then, in 1940 Moss and Herrmann showed that it was useful in 15 patients with night cramps. Finally, to really kick-start the use of quinine in this setting, Abraham Gootnick worked to find a mechanism for night cramps in 1943. Proof of efficacy has been accumulating since.

Nowadays you can get quinine in your local supermarket. Look for tonic water. Most tonic water contains a low quantity of quinine. But sometimes that low quantity is enough. This is why some people drink a bit of tonic water before going to bed to prevent night cramps.

Finally, one important word of caution regarding quinine. This is not a benign molecule. It has significant side effects. Perhaps most important are cardiac side-effects. In the past it was very common to prescribe quinine for nocturnal leg cramps. This is now less common. Do not take quinine without medical supervision.

Magnesium Probably Won’t Help Your Night Cramps

Magnesium plays a central role in many metabolic processes and specifically in muscle function. Also, Magnesium depletion is common for many reasons. For instance, because of poor nutrition. On the other hand, Magnesium supplements can be bought over the counter. So, why not use it to cure muscle cramps at night? Well… because most of the data point to lack of efficacy. It may be useful in pregnant women who suffer leg cramps.

Talk to your Doctor about Changing Medications

Some of your medications cannot be substituted with others. But many medications have alternatives. If you have noticed that your cramps started when a particular medication was added, perhaps there is room to change it. Another idea is to ask your doctor for a “medication window”. This basically means to stop taking the medication for a certain period of time to see if that helps. It is important to do this only with proper medical supervision.

How to Stop Muscle Cramps at Night

There are several ways to stop a cramp as it is happening. The first, is to passively stretch the cramping muscle. In plain English that means “Step on that leg. Hard!”. There’s a whole mechanism behind why that works, but it does. The second mechanism is to actively work the opposing muscles. Again, in plain English, that means “Raise your foot (opposite of “press on the break”)”.

Pickle juice for muscle cramps?

A third solution may surprise you. It is pickle juice. Athlete have been using pickle juice to fend off cramps for decades. In fact, there is scientific research that focuses specifically on pickle juice and muscle cramps. There is objective data out there that states that pickle juice will stop a cramp quicker than placebo.

No one really knows why pickle juice works. Testing for changes in the blood stream have not uncovered the answer. One theory is that the acetic acid in the pickle juice triggers a reflex in the back of our throats that relaxes muscles. There is no evidence to support this theory. Other possibilities focus on the similarities between acetic acid in the pickle juice and acetylcholine which is an important chemical in muscle function.

What if Treating Myself does not Work?

Remember that sometimes muscle cramps at night are a sign of significant disease. For example, kidney disease can result in electrolyte imbalance and the first sign may be muscles cramping up. Nerve damage, such as in spinal stenosis, artery blockages, such as in critical limb ischemia and severe chronic venous insufficiency are just several other examples of conditions that can lead to cramping at night. So, it probably makes sense to talk to your doctor if you are having cramps. It also makes sense to seek advice if the simple measure above did not help you quickly.

What do Leg Cramps at Night Happen?!

Night cramps are different than cramps that happen after strenuous physical activity. There is no one specific reason for muscle cramps at night. In fact, it is not unusual not to find a reason. In some people deep sleep just triggers cramping. Other people have neurological conditions that cause the cramping. Clearly, there are several options for leg pain at night causes in general. But, if you experience leg pain at night and you cannot resolve it on your own, seek medical attention.

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