Elderly leg cramps at nightElderly leg cramps at night

Q. I am 74 years old. A few years ago, I started to occasionally experience very painful leg cramps while sleeping at night. Lately, the night cramps have come more often. When they occur I wake up tired and with sore leg muscles the next morning. What causes these cramps? Is there anything I can do to stop or prevent them?

A. You are suffering from nocturnal leg cramps, a condition that is characterized by painful and involuntary spasms of the calf, thigh and small muscles of the foot at rest, usually at night, while asleep, when the normal muscle reflex is often exaggerated. The muscle cramps usually last for a few seconds to several minutes and subside either spontaneously or when the involved muscles are stretched.

Nocturnal leg cramps is, evidently, a benign condition that does not lead to any serious complication but aside from being painful, the muscle spasms disrupt sleep and leave the person sore and tired upon waking up in the morning.

Nocturnal leg cramps are particularly common among the elderly. In fact, about a third of people over 60 years of age and half of people over 80 suffer from this condition. Of these, forty percent experience more than three attacks per week.

Many forms of muscle cramps can be traced to certain factors such as muscle fatigue, dehydration, electrolyte imbalance (sodium, potassium, calcium and magnesium, in particular) and the use of certain drugs (diuretics, for example), but the exact cause of nocturnal leg cramps is unknown that is why the condition is otherwise called idiopathic leg cramps. At any rate, just to be sure there is no underlying cause for your cramps, consult your doctor so your blood electrolytes are checked and your medications reviewed (i.e., if you are taking medications for a chronic condition like diabetes or hypertension).

During an acute attack, passive stretching of the calf muscles, which can be done by grasping the toes and pulling them toward the body, and massage of the involved muscles are usually enough to relieve the spasm and pain.

Preventive measures against leg cramps at night include mechanical and pharmacological measures.

Many experts recommend muscle stretching exercises 3x a day plus calf-muscle stretching with wall push-ups (i.e., leaning against the wall and stepping forward, leaving the back foot flat on the floor) at bedtime. Likewise, warm compress could be applied over the commonly-affected muscles for 10-20 minutes before going to bed.

If the attacks of leg cramps are frequent, pharmacological treatment may be instituted, but this has to be under the supervision of a physician. The only drug that is effective in the prevention of nocturnal leg cramps is quinine sulfate, a drug which, strangely enough, is an anti-malarial. The efficacy of quinine sulfate in preventing leg cramps at night has been supported by many well-designed studies, but its use is controversial. The US Food and Drug Administration (FDA) does not allow over the counter sale of quinine-based products for leg cramps because of potentially fatal hypersensitivity reaction and thrombocytopenia (a blood disorder). Other adverse effects of quinine include headache, nausea, disturbed vision, chest pain, asthma and ringing of ears. In pregnant women, it can cause miscarriages and birth defects.

Incidentally, quinine is found in low concentrations in tonic water (one-tenth of prescription dose). As a home remedy, you can try drinking a can of tonic water at night for a few days and see if it helps.