Causes and Treatment of Muscle Cramps

The cause of nighttime muscle cramps is most often not identifiable. They may become more frequent with advancing age.

In general, muscle fatigue, nutrition, oxygen supply and nerve problems may be involved. Such conditions can occur even in healthy people, but usually cause only transient and infrequent cramps. Recurrent nightly cramps should raise suspicion of an underlying disease that leads to cramping. If you do not know of any disease but you frequently have leg cramps, you should undergo a comprehensive examination.

Let’s review the conditions that are often associated with nighttime leg cramps.

Structural and mechanical causes

Peripheral arterial disease (PAD)

A common circulatory problem. Plaque builds up on the inner walls of the arteries, progressively narrowing their capacity (it is like a kitchen drain gradually clogging and the water flowing more and more slowly).
Because of the narrowing, insufficient blood reaches the limbs and they suffer from oxygen and nutrient deficiency.

It usually occurs in the legs but can also develop in the arms. Symptoms are especially pronounced during activity, when the muscles have an increased need for blood (and oxygen). Pain occurs while walking (claudication), typically after walking a certain distance. After stopping and resting you can walk again. Disturbed blood flow and oxygenation can also cause nighttime muscle cramps, particularly in the calf muscles.

Peripheral arterial disease may be treatable in its early stages, but this requires drastic lifestyle changes. Regular daily physical activity (walking, hiking, jogging, cycling) and a healthy diet (minimizing trans fats) form the foundation of management. Smoking is an aggravating factor and should be stopped in all its forms.

Spinal stenosis

Narrowing of the spinal canal may be caused by bony overgrowths. The spinal canal narrows and can put pressure on the nerves that run through it. It most commonly affects the lower back (lumbar) and the neck (cervical) regions.

Some patients have no symptoms. Others may experience pain, tingling, numbness and muscle weakness. Symptoms can worsen over time.

Spinal stenosis is most often caused by degenerative changes related to spinal osteoarthritis. In severe cases, doctors may recommend surgery to create space for the spinal cord or the exiting nerves.

Metabolic problems

Acute kidney injury

The kidneys suddenly become unable to filter wastes from the blood. If your kidneys lose their filtering ability, dangerous levels of waste products can build up in your blood and the chemical balance of your body can be disrupted. Acute kidney damage develops quickly, usually in less than a few days. It most commonly occurs in already hospitalized, critically ill patients who require intensive care. It can be life-threatening and requires intensive treatment, but it is often reversible. Kidney function can recover to normal or near-normal levels.

Addison's disease (adrenal insufficiency)

Also called adrenal cortical insufficiency. It is an uncommon condition that occurs when the body produces too little cortisol and aldosterone. These hormones are important, among many other roles, for regulating the transport of Na, Cl and potassium across cell membranes. Disturbance of the ion balance across cell membranes alters neuromuscular excitability and can lead to frequent cramps.

It can occur at any age and in both sexes and may be life-threatening. Treatment involves replacing the missing hormones.

Anemia

There are not enough healthy red blood cells to carry adequate oxygen to the body's tissues. You may feel tired and weak as a result. There are many forms of anemia with different causes. It can be temporary or long-term, and range from mild to severe. See your doctor if you suspect anemia, as it may be a warning sign of a more serious condition.

Treatment ranges from nutritional supplements to medical interventions. Some types can be prevented with a healthy, varied diet.

Chronic kidney disease

Also called chronic renal failure. It means a gradual loss of kidney function. The kidneys filter wastes and excess fluid from the blood, which are then excreted in the urine. In advanced stages, dangerous levels of fluid, electrolytes and wastes may accumulate in the body. Early stages may have few signs or symptoms. It may not become apparent until kidney function is significantly impaired.

Treatment of chronic kidney disease focuses on slowing the progression of kidney damage, usually by controlling the underlying cause. It can progress to end-stage renal disease, which without dialysis or kidney transplantation can be fatal.

Cirrhosis (scarring of the liver)

Cirrhosis is the late stage of liver scarring (fibrosis) caused by many liver diseases and conditions, such as hepatitis and chronic alcohol abuse. Toxins, pathogens and alcohol damage liver cells, and the liver attempts to repair itself. In the process scar tissue replaces destroyed liver cells. As liver cell loss progresses, there are fewer functioning liver cells and more scar tissue, which does not perform detoxification. Consequently, the liver’s ability to clear toxins gradually declines. In advanced stages it can be life-threatening because protection against toxins is lost (decompensated cirrhosis).

Liver damage caused by cirrhosis cannot be reversed. If detected early and the cause is treated, further damage can be prevented and slight improvement may be possible.

Hyperthyroidism

The thyroid produces too much thyroxine. This can speed up the body's metabolism, causing unintentional weight loss and a fast or irregular heartbeat.

There are various treatments. Doctors use antithyroid medications and radioactive iodine to slow hormone production. Sometimes treatment involves surgical removal of all or part of the thyroid. Most patients respond well when treatment is started in time.

Hypothyroidism

In this condition the thyroid does not produce enough of certain vital hormones. Early on it may not cause noticeable symptoms. Left untreated over time it can cause many health problems, such as weight gain, joint pain, infertility and heart disease. Treatment with synthetic thyroid hormone preparations is generally simple, safe and effective — but the appropriate dose needs to be determined for each individual.

Type 1 diabetes

Previously known as juvenile diabetes or insulin-dependent diabetes. A chronic condition in which the pancreas produces little or no insulin. Insulin is a hormone needed to allow sugar (glucose) to enter cells and be used for energy.

Various factors, including genetics and certain viral infections, may play a role in the development of diabetes. Although it usually appears in childhood or adolescence, it can develop in adults. Despite active research, type 1 diabetes is not curable. Treatment focuses on blood sugar control with insulin, diet and lifestyle measures to prevent complications.

Type 2 diabetes

A disorder of how the body uses and regulates sugar (glucose) for fuel. This chronic condition results in too much sugar circulating in the bloodstream. High blood sugar eventually leads to circulatory, nerve and immune system problems.

Two interrelated problems are mainly at work: the pancreas does not produce enough insulin — the hormone that controls sugar movement into cells — and the cells respond poorly to insulin (insulin resistance) and take up less sugar.

Type 2 diabetes used to be called adult-onset diabetes, but both type 1 and type 2 can start in childhood or adulthood. Type 2 is more common in older adults, but rising childhood obesity means it is increasingly seen in younger people.

There is no cure, but weight loss, proper diet and exercise can help manage the disease. If diet and exercise are insufficient to control blood glucose, antidiabetic medications or insulin therapy may be required.

Medications and certain treatments

• Diuretics (water tablets): diuretics are a common treatment for high blood pressure. They help rid the body of salt (sodium) and water. Most help the kidneys excrete more sodium into the urine. Sodium pulls water from the blood, reducing the amount of fluid flowing through veins and arteries. This lowers blood pressure.
• Some antihypertensive medications
• Cholesterol-lowering drugs (statins)
• Oral contraceptives
• Dialysis

Other conditions

Dehydration

Dehydration occurs when you use or lose more fluids than you take in and your body does not have enough water and other fluids to carry out normal functions. If you do not replace the lost fluid, you become dehydrated.

This condition is particularly dangerous for young children and older adults. In young children the most common cause is severe diarrhea and vomiting. Older adults naturally have less water in their bodies and may have conditions or take medications that increase their risk. This means that even minor illnesses, such as infections of the lungs or bladder, can cause dehydration in the elderly.

It can also occur if you do not drink enough water in hot weather — especially if you exercise vigorously.

Mild to moderate dehydration can usually be reversed by drinking more fluids (and it is also important to replace minerals). Severe dehydration requires immediate medical (hospital) treatment.

Diarrhea

Loose, watery, or more frequent bowel movements are common. Diarrhea usually lasts a short time, at most a few days. If it does not resolve within 1–2 days, there may be another underlying problem.

Muscle fatigue

Nerve damage

Nerve damage can be caused, for example, by surgery or cancer treatment, including radiation.

Osteoarthritis

The most common form of arthritis, affecting millions of people worldwide. Due to degeneration, the cartilage that covers and protects the ends of the bones gradually wears away. It can affect any joint but most commonly affects the hand, knee, hip and spine.

Symptoms are generally manageable, although existing joint damage cannot be reversed. An active lifestyle, maintaining a healthy weight and certain treatments can slow progression and help reduce pain and improve joint function.

Parkinson's disease

A progressive neurological disorder that affects movement. Symptoms sometimes begin with a barely noticeable tremor in one hand. Tremor is a characteristic symptom. In addition, muscle stiffness and slowed movement are noticeable. In early stages there may be little or no facial expression. The arms may not swing during walking. Speech may be soft or slurred. Symptoms worsen over time.

Although not curable, medications can significantly improve symptoms.

Pregnancy

The causes described above are often associated with nighttime leg cramps as a symptom. However, for an accurate diagnosis always seek the advice and opinion of your treating physician or another healthcare professional.

When should you see a doctor?

For most people, nighttime leg cramps are just an annoyance — something that occasionally wakes them from sleep. In some cases, however, you may need to see a doctor.

Seek immediate medical attention if

• Your cramps are severe and persistent
• You may have been exposed to a toxin, such as lead.

Schedule a clinic visit if

• You feel tired during the day because leg cramps disturb your sleep and you cannot get enough rest
• You develop muscle weakness and muscle wasting as a result of leg cramps.

Home remedies for leg cramps

To help prevent nighttime calf cramps, the following measures may be useful:

• Avoid dehydration. Pay attention to your fluid intake.
• Take regular dietary supplements that contain minerals and trace elements (A–Z products typically provide the recommended amounts of necessary nutrients in a single daily tablet).
• Stretch and relax your leg muscles before going to bed.
• Walk or use a stationary bike for a few minutes before bedtime.
• This speeds up circulation, supplying oxygen and nutrients to the muscles.
• Use muscle stimulation on the cramping muscle before bed! Programs that improve circulation, aid regeneration or promote capillarization quickly relieve symptoms. Muscle stimulation increases blood flow, relaxes the muscles and reduces neuromuscular activity (that is, the tendency to cramp).

Calf relaxation

In the evening, before going to bed, relax and stretch the calf muscles. If your muscles are stiff and tense, stretching and relaxing them alone may solve your problems. If you are on your feet all day, walk a lot or stand and by evening your lower legs feel tight, stretching will almost certainly help and relieve your symptoms.

Some practical measures for the immediate relief of a nighttime muscle cramp:

• Contract the muscle in the opposite direction of the cramp. For a calf cramp, gently but firmly pull your toes toward the front of your lower leg.
• Massage the cramped muscle with your hands or a massage stick.
• Walk or move your legs.
• Take a hot shower or a warm bath.
• Use a muscle stimulator on the cramping muscle! Programs for muscle relaxation, regeneration and stiffness relief are appropriate. These increase muscle blood flow, have a relaxing effect and reduce neuromuscular activity (thus lowering the tendency to cramp).