Nighttime Leg Cramping

Leg spasms at night, or nocturnal leg cramping, is usually a condition that we call idiopathic, meaning we are uncertain of its cause.  If the cramps also occur during the day, it is more likely that the cause may be discoverable.  Common causes day and night leg cramping include dehydration, circulation problems, nerve impingement (“pinching”) from the lower spine, or a disturbance in electrolytes (like potassium, magnesium and calcium).  If the cramps specifically occur at night and evaluation and testing do not reveal an obvious cause, then you likely suffer from the idiopathic type.  The good news is that worrisome causes have likely been ruled out and the focus becomes on improving the symptoms.

Many providers will try muscle relaxant medications at bedtime, many find that they are not overly helpful and can cause excessive grogginess in the morning.  Many individuals will try home remedies like swigging pickle juice or a teaspoon of yellow mustard, often with good results.  However, any home remedy should be discussed with your provider to make sure that it is not harming your health in any manner.  One remedy that I will often recommend is a cup of tonic water before bedtime.  Tonic water, which contains small amounts of the chemical quinine to give it a bitter taste, can help reduce muscle spasming.  Quinine pills, which had much higher concentrations of this substance, used to be prescribed by physicians for leg cramps.  However, the high concentrations of quinine in the pill form does increase the risk of things like heart rhythm problems, vision loss, hearing loss, ringing in the ears, anemia, nausea and diarrhea.  Therefore, it was felt that the risk of using these high concentrations of quinine were not worth the benefits of possibly helping with leg spasms.  While the risk is not zero, it is much less likely that you will suffer side effects with the use of tonic water.  I typically don’t recommend more than drinking a cup each evening.  Again, if you are interested in trying this remedy, it should be discussed with your medical provider before implementing this change.  I also recommend that patients drink plenty of water during the day to limit any dehydration by bedtime that can make the symptoms worse.  Taking a warm shower before bed will also relax the muscles and improve symptoms.  Doing hamstring and calf stretches around bedtime can also be helpful.