Leg Cramps at Night: Getting to the Bottom of Sharp, Aching Pain
Taking deep breaths and easing into a stretch may provide quick relief
Medically reviewed by Theresa Marko, PT, DPT, MS
Nocturnal (nighttime) leg cramps are painful muscle contractions of the calf, thigh, or foot muscles at night that can last several seconds or minutes. They often occur without warning and while resting in bed.
They usually do not have a medical cause, and you can prevent them by routinely stretching your calf and thigh muscles before bed. This type of leg cramp is sometimes referred to as a charley horse.
Leg cramps seem to increase with age, and some studies say they affect people assigned female at birth more frequently. Pregnant people are also more likely to experience them.
Some health conditions that might cause nighttime leg cramps include nutritional deficiencies, dehydration, musculoskeletal disorders, kidney failure, nerve damage, and blood circulation problems. Leg cramps may be a side effect of some medicines, including those that increase urine output.
This article covers the causes of nighttime leg cramps, when to be concerned, managing leg cramps, treating underlying causes, and more.
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What Causes Leg Cramps at Night?
Nighttime leg cramps are common in the general population, especially as people age. A 2023 Annals of Family Medicine study found that 51% of primary care patients reported leg cramps.
Experts do not know what exactly causes leg cramps, but they know certain conditions and risk factors might contribute.
Pregnancy
Leg cramps are common in pregnancy. They often occur in the second and third trimesters and at night.
Researchers are not sure exactly why they affect pregnant people, but they have some possible theories. These include:
Blood circulation changes common in pregnancy
Muscle strain due to weight gain
Dehydration
Nutritional Deficiencies
A vitamin or mineral deficiency might lead to leg cramps. This includes deficiencies of vitamins B1, B12, and D, and potassium and magnesium deficiencies. Adding these minerals and vitamins to your diet can help reduce your nightly leg cramps.
The recommended daily allowances (RDA) for adults for these vitamins and minerals are:
Vitamin B1 (thiamine): 1.2 milligrams (mg)
Vitamin B12 (cobalamin): 2.4 mg
Vitamin D: 600 international units (IU) or 15 micrograms
Potassium: Adult males and people assigned male at birth 3,400 mg; adult females and people assigned female at birth 2,600 mg
Magnesium: Adults assigned male at birth 400 to 420 mg; adults assigned female at birth 310 to 320 mg
Potassium has an adequate intake (AI) recommendation rather than an RDA. Your RDA or AI can change based on age, sex, pregnancy, or breastfeeding status.
Related: What Is Magnesium Deficiency?
A Note on Gender and Sex Terminology
Verywell Health acknowledges that sex and gender are related concepts, but they are not the same. To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
Dehydration
Dehydration is a common cause of leg cramps. Ensure you drink at least six to eight glasses of water daily and limit your alcohol and caffeine consumption.
Varicose Veins
Varicose veins are bulging, enlarged veins. They are considered superficial veins because they are present at the skin’s surface. While they do not always lead to serious health problems, they can cause pain with standing and walking. They can also cause nighttime leg cramps.
Additional symptoms include swelling, skin changes, leg fatigue, heaviness, and restlessness.
Nighttime Leg Cramps vs. Deep Vein Thrombosis
Deep vein thrombosis (DVT) is a clot that forms deep inside the veins, usually the leg veins. DVT might cause cramping that occurs both night and day and includes swelling in the affected area. The area affected by the clot will also be red and tender. Symptoms of DVT will get worse over time.
While rare, DVT is a very serious and potentially fatal condition. If your leg cramping is frequent and is accompanied by swelling, tenderness, and redness, you should seek immediate medical care.
Musculoskeletal Disorders
Musculoskeletal disorders affect connective tissues, including bones, muscles, tendons, and ligaments. This includes arthritic conditions, including rheumatoid arthritis (an autoimmune disease) and osteoarthritis (wear-and-tear arthritis), and musculoskeletal pain conditions like fibromyalgia (a condition of body-wide pain). Many of these conditions can cause leg cramps.
Leg cramps related to musculoskeletal disorders might occur because of physical inactivity or limited stretching. Some conditions might cause leg cramps due to reduced muscle or tendon length.
Medication Side Effects
Leg cramps might occur as a side effect of medications, especially those that increase urine output. Some classes of medications associated with nocturnal leg cramps are:
Beta2-agonists used to treat chronic obstructive pulmonary disease and severe asthma
Statins used to lower cholesterol
Diuretics ("water pills") used to treat swelling (edema), high blood pressure, and congestive heart failure
If you suspect your medication is causing your nighttime leg cramps, let your healthcare provider know. They may be able to prescribe a different medicine that does not cause this side effect.
Risk Factors
Some risk factors are linked to nighttime leg cramps.
Risk factors include:
Overworked muscles: Too much exercise or stress on leg muscles might lead to leg cramps.
A sedentary lifestyle: Sitting for long periods and not stretching leg muscles might increase the risk of cramping.
Standing for extended periods: If you stand for long periods during the day, you are more likely to experience leg cramps at night due to overworked and tired muscles.
Age and sex: You are more likely to experience leg cramps at night if you are an older adults assigned female at birth, according to a 2023 Annals of Family Medicine study.
When Could Leg Cramps at Night be Serious?
The causes of leg cramps are often harmless, but sometimes, they are a sign of a severe health condition. If you already have one of these conditions, your leg cramps might be a symptom of that condition.
If you have not been diagnosed with one of these conditions, your nighttime leg cramps might indicate one of them. Consult with your healthcare provider if nighttime leg cramps are a frequent occurrence.
Kidney Problems
Cramps in the legs or elsewhere in the body might indicate a kidney problem. Leg cramps occur because of imbalances in sodium, calcium, potassium, and other electrolyte levels, which may affect how muscles and nerves work. In addition to cramping, muscles might be weak and twitch.
Nerve Damage
A type of nerve damage that may cause leg cramps is diabetic neuropathy. Leg cramps might be a sign of diabetic neuropathy resulting from ongoing high blood sugar levels. You might experience muscle cramping because of damage to small blood vessels that supply oxygen and nutrients to the nerves.
Related: How Long It Takes Gabapentin to Treat Nerve Pain
Anemia
Severe anemia (a low number of healthy red blood cells) may cause painful lower leg cramps, especially in people with impaired blood circulation in the legs. Red blood cells deliver oxygen to the muscles and other tissues.
The large leg muscles need a lot of blood and oxygen to function properly, and the reduced amounts force them to work overtime, which leads to severe cramping.
Neurological Disorders
Neurological disorders, like Parkinson’s disease and amyotrophic lateral sclerosis (ALS), may cause leg cramps and muscle spasms, twitching, and weakness throughout the body.
Parkinson’s is a progressive degenerative disease of the central nervous system. ALS is a nervous system disease affecting spinal cord and brain nerve cells.
Congestive Heart Failure
Congestive heart failure happens when the heart cannot pump blood well enough to provide the body with an adequate supply. The condition may cause leg cramps if it affects blood circulation in the legs.
Steps to Take When Leg Cramps Keep You Awake
Stretching is one of the first things you can do to relieve or stop a leg cramp as soon as it strikes.
For a calf or foot cramp, stretch the muscle by straightening your leg and pulling your foot toward your shin (the front part of your leg between your knee and foot). For a thigh cramp, pull the foot of the affected leg toward the buttock.
Additional ways to manage a leg cramp are:
Deep breathing: Take a deep breath through the nose while your belly expands. Hold for a few seconds and slowly exhale. Repeat until the cramp subsides.
Elevate: Sitting up and elevating your affected leg might help stop a leg cramp.
Heat or cold therapy: A heating pad, warm bath, or warm shower may help manage muscle cramping. An ice pack might also offer relief for a spasming muscle.
Massage: Use your hands or a massage roller to massage the muscle area that has cramped up.
Pain medication: Take Advil/Motrin (ibuprofen) or Tylenol (acetaminophen) if you experience pain following a leg cramp.
Stand up and walk around: Getting up and pressing your feet to the floor might help relieve the leg cramp. Walking around while wiggling the affected leg can also offer relief.
Prevention
It might be possible to prevent nighttime leg cramps. This starts by managing some of its common causes, such as:
Stay hydrated: Drink at least six to eight glasses of water daily. Consider drinking more if you are exercising or spending extended periods outdoors. You can also avoid dehydration by limiting your alcohol and caffeine intake.
Stretch: Consider stretching or yoga before bedtime. This might help to reduce the frequency and intensity of nighttime leg cramps.
Massage: Massaging calves, feet, or thighs before bed may help reduce leg cramps by relaxing muscles.
Take a warm bath: A warm bath might help relieve or reduce nighttime leg cramps. Consider adding Epsom salts to your bath to reduce muscle pain.
Diet: Some foods, including bananas and sweet potatoes, are great sources of potassium, magnesium, and calcium. Routinely eating founds containing these nutrients might reduce the frequency and intensity of leg cramps.
Compression stockings: Wearing compression socks might also help venous blood return from the feet and lower legs and improve leg cramps.
Physical therapy: Seeing a physical therapist to create a customized exercise plan that you can do at home will also help with overall strength and flexibility to improve leg cramps.
Quinine/Tonic Water
Quinine is a medication used to treat malaria. As a prescription drug, it has a boxed warning against using it to treat leg cramps or muscle pain due to an elevated risk for bleeding and heart rhythm disturbances. Tonic water containing quinine is sometimes promoted for easing leg cramps.
Research shows quinine is moderately helpful for decreasing the frequency and intensity of muscle cramps, but it is associated with a risk of severe side effects. If you want to try quinine for managing leg cramps, let your healthcare provider know. They can review your medical history and determine whether this option is safe.
Treating Underlying Cause of Nightly Leg Cramps
You should inform a healthcare provider if you are experiencing leg cramps due to an underlying condition, such as a neurological disorder, a heart problem, or kidney disease. Leg cramps might indicate that your current treatment plan might not be helping.
If muscle cramps do not improve with self-care and changes to your treatment plan, a healthcare provider can prescribe a muscle relaxer. These medicines are given for short periods to help with severe cramping that keeps you up at night. But muscle relaxers have side effects, including drowsiness and dizziness, which can interfere with your daily routine.
Describing How Leg Cramps at Night Feel
Nighttime leg cramps can disrupt sleep, leaving you tired in the morning. They can be painful and sometimes leave you with calf, thigh, or foot pain.
Most leg cramps start as sudden, sharp pain. They cause stiffness and twitching in and around the affected muscles. The cramp may last a few seconds or several minutes.
You may feel sore after the cramp has subsided. Some leg cramps wake you from a deep sleep or make it harder to fall asleep.
Related: Causes of Muscle Spasms and Cramps
Nighttime Leg Cramps vs. Restless Legs Syndrome
Restless legs syndrome (RLS) might be confused with nighttime leg cramps, but the conditions are easily distinguishable.
The most common symptom of RLS is the urge to move the legs while trying to fall asleep. That urge will last much longer than a leg cramp, and while RLS can cause discomfort, it is not painful.
When to See a Healthcare Provider
Leg cramps are usually a harmless problem that can be managed. But sometimes, they might be related to an underlying health problem.
Let your healthcare provider know if you are experiencing severe or frequent leg cramps or leg cramps that affect your sleep on most nights. They can review your medical history and request testing to determine the cause of leg cramps.
Summary
A leg cramp is a sudden, painful, and involuntary muscle contraction in the foot, calf, or thigh. Leg cramps can last from several seconds to several minutes. While painful, most leg cramps are harmless and associated with overexertion, dehydration, and inactivity. People older than 60 assigned female at birth are more likely to experience leg cramps.
Leg cramps are common in pregnant people and people with musculoskeletal conditions. Leg cramps might also indicate a more severe condition, such as neuromuscular or kidney disease or a heart or circulation problem. They might also be a side effect of some medications.
You can reduce the number and intensity of leg cramps by stretching before bed, using heat and cold therapy, and massaging affected muscles. Aim to drink six to eight glasses of water daily and limit your caffeine and alcohol intake to prevent dehydration.
Let your healthcare provider know if you are experiencing severe or frequent leg cramps or if leg cramps are disrupting your sleep. They can adjust your treatment plan for any underlying condition or request testing to determine the source of leg cramps.
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