Night leg cramps

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 10, 2015
StartSymptomsNight leg cramps

Nighttime leg cramps are sudden, intense muscle spasms or contractions, typically affecting the calf, thigh, and feet. They occur most often just before falling asleep or during the evening while resting. The spasms can last anywhere from a few seconds up to several minutes or hours.


Definition & Facts

A nighttime leg cramp, also known as a charley horse, can leave muscles feeling sore, tight, and knotted. In some cases, the cramps are so severe that they can make it difficult to fall asleep and even cause nighttime awakenings.

Nocturnal muscle cramps affect people of all ages; however, they are more common in adults over age 50. It is important to note that leg cramps are not the same thing as restless leg syndrome, even though both conditions tend to occur during the evening or while at rest. Leg cramps involve painful muscle contractions that do not go way until the muscle is actively stretched.

Restless leg syndrome involves a crawling sensation and an uncontrollable urge to move the legs. The restlessness improves while moving but returns when inactive. Another type of leg pain, called claudication, is often mistaken for leg cramps. Claudication is pain in the lower extremities that occurs during exercise and improves with rest. Claudication is the result of impaired blood flow to the legs and is a symptom of peripheral artery disease.


The exact cause of nocturnal muscle spasms is unclear; however, a number of conditions and activities may contribute to the condition, including:

  • Sitting for long periods or sitting improperly.
  • Standing for long periods on hard, concrete floors.
  • Exposure to frigid temperatures and water can cause muscles to tighten and cramp.
  • Insufficient levels of certain minerals, such as potassium and calcium, can affect muscle function and lead to spasms.
  • Wearing high heels or poorly fitted shoes can put a strain on the muscles of the calf and feet.

When to see a Doctor

In many cases, nighttime leg cramps either resolve on their own or are only a minor annoyance that do not significantly interfere with sleep or quality of life. A medical professional should be consulted if the leg cramps are frequent, severe, or persist for a long time.

It is also important to seek medical advice if the leg cramps occur after being exposed to toxins like lead, if it becomes difficult to engage in daily activities due to a lack of sleep, or if the cramps are accompanied by muscle weakness or atrophy.

After reviewing the symptoms and the patient’s history, the doctor will order a variety of tests to rule out underlying medical conditions, such as metabolic, neurologic, and skeletal disorders that may be causing the discomfort.

Treatment & Therapy

The treatment of nocturnal muscle spasms depends on the underlying cause. Vitamin E and B complex vitamins have been shown to benefit some patients. In cases of mineral or electrolyte imbalance, the doctor may prescribe magnesium or potassium supplements or calcium channel blockers.

Leg cramps caused by metabolic or neurologic conditions may resolve or lessen in severity once the condition itself is treated. Cramps caused by spinal conditions or arthritis may improve with physical therapy or even surgery to correct the condition. Medications, such as muscle relaxants, may reduce the frequency and severity of leg cramps in some patients.

If a particular medication causes the muscle spasms, the doctor may be able to switch to an alternative drug with fewer side effects; however, it is important to always check with a medical professional before discontinuing any medication. Quinine was once widely used as a treatment for leg cramps; however, this is no longer the case due to the possibility of severe side effects, including cardiac arrhythmias.

Prevention & Prophylaxis

Some simple home remedies may help prevent or lessen the severity of nighttime leg cramps. It may take several attempts or even a combination of therapies to find the method that provides the most relief. Common home remedies for leg cramps include:

  • Using a heating pad on the affected area or taking a warm bath or shower to help relax tight muscles.
  • Drinking plenty of fluids can prevent cramps related to dehydration. Sports drinks, such as Gatorade®, often work better than water for this purpose since they contain sugar and electrolytes.
  • Ice packs may provide temporary relief from the pain. Be sure to wrap the ice pack in a towel or cloth instead of placing it directly on the skin.
  • Make sure that sheets and covers are loose enough that the toes aren’t bent in an unnatural position.
  • Massage or gently stretch calf muscles before going to bed by flexing the toes back and forth.
  • Go for a short walk or ride an exercise bike a few minutes before bedtime to loosen tight muscles.
  • Wear properly fitting shoes with good arch support. This will prevent undue strain on the calf muscles that can result in leg cramps.
  • A couple of teaspoons a day of apple cider vinegar diluted with water and honey is a common home remedy for leg cramps. It is believed that the vinegar helps dissolve acid crystals in the blood and provides calcium, potassium, and other minerals that can help ease nighttime leg cramps.

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