How to Prevent Muscle Cramps at Night?

Night-time cramps are common and usually harmless. They commonly occur in the thighs, calves and feet. Although they are harmless, we at Meds For Less understand that they can be troublesome.

The cause of these nocturnal cramps can be due to a combination of several factors that occur when you sleep. Some common reasons why night-time cramps occur include:

• Muscles (of the legs) shorten when you sleep, especially with the toes pointing downwards
• Mild dehydration overnight – increasing nerve excitability and spontaneous muscle cramping.
• Electrolyte imbalances (such as magnesium, potassium and calcium) disrupt muscle relaxation
• Excessive muscle fatigue from standing, walking or excessive exertion throughout the day.
• Poor sleep position and tight beddings can help cause muscles to keep tense throughout the night

Some ways of naturally preventing muscle cramps at night caused by the above-listed benign reasons are:

• Hydrating well throughout the day
• Eating a diet rich in minerals (magnesium, potassium and calcium)
• Stretching calves and feet before bed
• Staying active throughout the day but avoiding overuse
• Improving sleep ergonomics
• Managing stress

Sometimes supplements such as magnesium, potassium and calcium can help treat muscle cramps caused by electrolyte imbalances but it is important to confer with medical advisors before making a decision to start taking these supplements as a remedy for nocturnal cramps.

Sometimes nocturnal cramps can signal an underlying issue, if cramps are worsening, becoming more frequent or not improving despite lifestyle adjustments, please speak to your healthcare providers.

At Meds For Less, we offer general lifestyle medicine options (such as supplements) that you can easily use for purposes such as nighttime leg cramp solutions.

Why Nighttime Muscle Cramps Occur

“ Why muscle cramps happen at night?” is a common question asked by many people who suffer from this condition. This article aims to answer such questions.

Night-time cramps are sudden, painful muscle contractions that affect the thighs, calves and feet when you are asleep or resting. They are usually harmless but tend to be very disruptive. This article paragraph is to give you an overview of how and why they occur.

During long-periods of inactivity such as sleep, there is reduced muscle activity. In these cases, motor neurons fire unpredictably and muscles fibres shorten slightly. The combined effects of these make muscle fibres prone to involulntary contractions once they;re stretched or moved during sleep.

At night (not drinking for the long-hours of sleeping) can cause mild dehydration. This can cause low levels of magnesium, potassium, calcium and sodium which can increase nerve excitability and muscle firing.

The lying down position with toes pointed downwards shortens calf muscles during sleeping. This inadequate positioning combined with poor-circulation can reduce blood flow at night and provoke cramps, especially in the calves.

Muscle fatigue from the day can further exacerbate cramps in the night. Overuse of muscles during the day can deplete energy stores and cause micro-fatigue in muscle fibres. The resultant effect is fatigued muscles being more likely to cramp at night.

People who are elder in age may notice more cramps as muscles loose elasticity with age and motor neurons also fire less smoothly. The resultant effect is cramps are more frequent in older adults.

Common Causes of Muscle Cramps During Sleep

The most common causes of muscle cramps during sleep are as follows:

• Muscle inactivity and shortening at night:
  • During sleep – muscles are often relaxed and inactive for long periods of time. Calf muscles often shorten with toes pointed downwards. These shortened muscles are more likely to causes spasms or twitches when involuntarily stretched or moved.
• Mild dehydration overnight:
  • Lack of continued hydration at night (due to sleep) can cause mild dehydration and electrolyte imbalances. This can cause nerve signalling issues and improper muscle excitability.
• Electrolyte imbalances
  • People with low circulating levels of potassium, sodium, calcium and magnesium can have improper and excessive muscle firings, hence triggering cramps.
• Muscle fatigue during day
  • Activities such as prolonged standing, exercise (calf-heavy) or heavy-walking can leave muscle fibres metabolically fatigued and increase the risk of night-time cramps.
• Poor nocturnal circulation
  • Reduced blood flow or nerve compression during sleep can limit oxygen and nutrient delivery to the legs as well as trigger muscle cramps when the feet attempt to relax.

Risk Factors: Who Is More Likely to Experience Night Cramps?

The following is an overview of some individuals who are more likely to experience night cramps:

• Those of elder age (above 50):
  • Those older in age have more fiery neurons and less stable muscle fibres, this makes cramps much more likely.
• Those with dehydration or low fluid intake
  • Living in countries with hot weather and excess sweating
  • Having excess caffeine or alcohol
  • Not drinking enough during the day
• Those with electrolyte imbalances
  • Having blood reports/ suffering form low electrolytes such as low magnesium, potassium, calcium and sodium
• Those who have muscle overuse during the day
  • Having long hours standing on your feet (during the day)
  • Doing intense and unfamiliar levels of exercise.

Other risk factors making you more prone to leg cramps are pregnancy, varicose veins, obesity and smoking. If you are experiencing leg cramps at night frequently and wish to understand what is contributing to it specifically, please consult your healthcare provider.

Early Signs and Symptoms of Nighttime Muscle Cramps

The following are early signs and symptoms of nighttime muscle activity ,which can later develop into full nocturnal muscle cramps (Figure 1):

• Subtle muscle tightness
  • Mild pulling or tightening sensations in the calf, thigh or foot when people change positions in the bed can often and frequently be one of the first warning signs of cramps developing.
• Muscle twitching or fluttering
  • Small and visible muscle twitches (fasciculations) can indicate increased nerve excitability
  • These often precede stronger and more sustained contractions
• Muscle aches or soreness before sleeps
  • Dull discomfort in the calves or feet before falling asleep, especially after a long day of walking or standing can be a sign that cramps may occur later in the night.
• Tightness when stretching legs
  • Feeling pain or resistance when stretching the legs/ toes outwards can be a sign that a cramp is incoming
  • This can often give a sign that a muscle is “about to seize”.

If you are experiencing these often signs and symptoms before you go to bed, please seek your healthcare provider’s advice on how to take care of your sleep prior to cramps developing.

Figure 1: Remedies for muscle cramps at night can start with recognising Early signs and symptoms they may develop.

How Hydration Affects Night Muscle Cramps

The following is an overview of how hydration affects night muscle cramps:

Muscle cramping and twitching can occur due to improper fluid and electrolyte flows during the body. This happens through 4 main mechanisms:

• Nerve excitability increases when fluids are low:
  • Decrease in blood volume increases the electrolyte concentrations. This causes motor nerve fibres to fire more easily and unpredictably and at night (when brain inhibition is lower), this excitable state of nerves can cause excessive firing and muscle twitching.
• Existing electrolytes move poorly without adequate fluid
  • Water and good hydration is required to properly move electrolytes such as (sodium, potassium and magnesium).
  • Without good electrolyte distribution, muscles struggle to relax properly after full contraction and this makes muscle cramps more likely.
• Dehydration (during sleep) reduces blood flow to muscles overnight
  • During sleep there is a natural reduction in muscle perfusion.
  • This is further exacerbated if you are dehydrated.
  • A combination of day dehydration and poor-night time circulation can cause painful night cramps
• Muscle tissues becoming less elastic
  • Water is a key component of muscle fibres and connective tissues. When dehydrated, muscles are stiffer and stretch reflexes are triggered more easily/
  • This can make it more easier to trigger cramps when stretching in bed or pointing toes during sleep.

The Role of Electrolytes (Magnesium, Potassium, Calcium) in Preventing Cramps

The following is a guide to understanding how to prevent leg cramps at night with the potential use of electrolyte supplementation, safely and under medical supervision.

Electrolytes (like magnesium, potassium and calcium) help muscles tighten and relax appropriately when the brain wills motor neurons to fire. If even one of these electrolytes is out of balance, the muscle can get stuck in tight positions and cause cramps.

Magnesium helps muscle relax after they contract. Deficiencies in magnesium can result in muscles contracting too easily, struggling to relax and night-time cramps becoming more common. For magnesium supplementation in preventing cramps, you can eat foods rich in magnesium such as leafy greens, nuts, seeds, whole grains and dark chocolates.

Potassium is a signal carrier and is responsible for carrying smooth signals between the nerves and muscles. When potassium is low, muscle signals misfire and muscles may contract repeatedly and suddenly. Causes of low potassium include the use of diuretic, dehydration  or heavy sweating. Foods that you can eat to supplement the potassium in your diet include Bananas, oranges, potatoes, beans and yoghurt.

Calcium tells the muscles when to tighten. When calcium levels are out of balance, the muscles may tighten too strongly and unpredictably and muscle relaxation becomes harder. If you need calcium supplementation, you can use eat foods rich in calcium like milk, yoghurt, cheese and leafy greens.

 Lifestyle and Daily Habits That Help Prevent Night Cramps

The following are clear and practical daily tips to help prevent night cramps.

Staying well hydrated during the day. Hydration is one of the most important cramp prevention habits. It keeps muscles elastic and helps electrolytes (like magnesium and potassium) work properly. This reduces nerve over-excitability nocturnally and helps prevent muscle cramps at night.

Eat a mineral-rich based diet such as foods rich in magnesium (nuts, seeds and leafy green), potassium (potatoes or bananas), and calcium (milk and fortified alternatives). Muscles rely on these minerals to contract and relax smoothly.  Often natural food sources for these minerals and vitamins work better than supplements for most people.

Staying active during the day with healthy habits such as walking, gentle daily activity and light strength training. Regular movement keeps muscles conditioned and improves circulation. Avoid sudden increases in intense exercise as this can cause improper muscle contraction without a chance at recovery.

Avoid staying standing or sleeping in one position or place for too long as this can slow circulation and impair nocturnal muscle contraction.

Optimising feet position during sleep can also lower cramps.

Keeping feet in a neutral position (not with toes pointing downwards),

Avoiding tight beddings that pull the toes upwards

Using pillows that support legs if necessary.

For more specific tips to help prevent night cramps for you, please speak to your healthcare provider.

Best Stretching and Mobility Exercises to Reduce Nighttime Cramps

The following is an overview of the best stretching and mobility exercises to reduce night-time cramps. For more specific guidance/ a detailed night-time routine, please speak to your healthcare provider.

One of the most important exercises is the standing-calf stretch: This is important because it helps alleviate calf tension as the calf is the most common source of nocturnal cramps. The following is an overview of how to do it:

• Stand facing a wall
• Place hands on the wall
• Step one foot back, keeping the heel down
• Bend the front knee until you feel a stretch in the back calf

Hold this strech for 20-30 seconds and repeat it for 2-3 times.

Another good stretching exercise to do to prevent nightly cramps is the seated towel calf stretch. This is great to do right before bed and keeps calves from shortening over-night. This is an overview of how to perform it:

• Sit on the bed or floor with legs straight
• Loop a towel or scarf around the ball of your foot
• Gently pull your toes towards your shin

Hold this strech for 20-30 seconds and repeat it for 2-3 times.

Ankle dorsiflexion and circles. This helps improve ankle mobility and improves nerve-muscle communication. This is done by pulling toes towards the shin and making slow ankle circles in both directions. You can hence (dorsi)flex the ankles for 10-15 times and do 10 circles with each foot.

Gentle calf raises with daytime mobility can also help reduce night-time cramping. This is done by slowly standing and rising on your toes and lowering back down with control. Conducted 10-15 repetitions of this movement and perform these throughout the day in your daily routine to prevent night-time cramping.

How Sleep Position and Bed Ergonomics Influence Muscle Cramping

The following is an overview of some optimum sleep positions and bed ergonomics that can help reduce muscle crampings and answer questions such as; “What helps muscle cramps at night”?

Avoid pointing your toes downwards (as most people naturally do). This matters as pointing your downwards can shorten calf muscles and keep them contracted for many hours. This makes it more likely to experience muscle spasm when you do move. Try dorsiflexing (toes point upwards) when you sleep.

Avoid wearing tight or heavy bedding. Heavy duvets/bedding can push the feet downward and hold the calves in a shortened position. This can trigger cramps when a muscle tries to stretch and is especially common in the colder months. Try using lighter duvets and sleeping in a warmer room if needed.

Poor leg and spine alignment can occur if the body is not well supported during sleep. This can occur if muscles constantly stay tense instead of relaxing. In such positions nerves can be compressed and circulation can be reduced. Improper leg and spine alignment can increase cramps. Sleeping supported with various positions can be better for body and spine alignment. Side sleepers can sleep with pillows between knees, back sleepers can sleep with pillows under knees. Small pillows or rolled towels under the ankles can help with calf support during sleep.

Choose a mattress that is neither too firm. nor too soft. If the mattress is too soft, the body sinks unevenly and the muscles work overnight to stabilise posture. If the mattress is too firm, then pressure points form and muscles stay slightly contracted.

For more specific guidance on sleep positioning and ergonomics that will work for you to reduce cramping, please seek the guidance of your healthcare provider.

Medications and Supplements Commonly Used for Muscle Cramp Prevention

If you are looking to answer questions such as, “How to reduce muscle cramps at night with medicines” or “How to stop leg cramps at night medically”, then this article is for you.

The following is an overview of some of the medications and supplements that can be commonly used for nocturnal cramp prevention. If you need more specific guidance – please consult your healthcare provider.

Supplements used in cramp prevention:

• Magnesium supplements
  • These are common and popular in cramp prevention as they help muscle relax after contractions and give calming signals to the nerves. People with low magnesium intake, those suffering from dehydration or older adults are most likely to benefit from magnesium intake. Some side effects include loose stools at higher doses.
• Potassium supplements
  • Potassium helps nerves and muscles send and receive appropriate electrical signals. It can heavily help dehydrated people, people who sweat heavily or those with low dietary potassium.
  • Please note that potassium supplementation cannot be taken regularly without medical advice – especially for those with kidney or heart conditions.
• Calcium supplementation
  • Calcium plays a key role in muscle contraction and release . Those who benefit most from calcium supplementation are those who are on low diary diets, have low calcium in their diets or are post-menopausal.
  • Calcium often works best when paired with vitamin D

Medicines used in cramp prevention:

• Muscle relaxants:
  • Sometimes these are used short-term if cramps occur at night and are linked to severe muscle spasms or neurological conditions
  • These only should be used if prescribed and are not recommended first-line for muscle cramps
• Pain relief (such as paracetamol/ibuprofen):
  • Sometimes pain relief options can be used for muscle cramps if they occur at night
  • These should not be used as a preventive measure against cramps

Usually good lifestyle habits such as good hydration, adequate dietary minerals, gentle stretching before bed and improving sleep positioning before bed are better at long-term dealing with cramps as opposed to supplements and medicines.

When Muscle Cramps May Indicate an Underlying Health Condition

Most muscle cramps at night are usually harmless, and related to dehydration, muscle fatigue and sleep positions. However in some unusual cases, infrequent or severe cramps can indicate an underlying health condition.

The following maybe signs that cramps may indicate a more serious condition:

• Very frequent cramps
• Severe or prolonged cramps
• Only affecting one leg repeatedly
• New and unexplained leg cramps (later on in life)

Some symptoms accompanying cramps that suggest an underlying condition include:

• Muscle weakness
• Numbness and tingling in the legs
• Swelling or redness in the legs
• Skin colour and temperature changes
• Pain during walking that improves with rest
• Muscle cramps plus weight changes and fatigue

These signs and symptoms can indicate the following health conditions:

• Nerve related conditions such as:
  • Peripheral neuropathy
  • Nerve compression from the spine

Signs and symptoms like pins and needles, burning or numbness alongside cramps can indicate nerve related conditions

• Circulation related conditions such as:
  • Peripheral arterial disease
  • Chronic venous insufficiency

Clues that these might be the conditions you are experiencing include cold feet, colour changes, leg swellings or slow-healing wounds

• Muscle or connective tissue disorders (rarely) such as:
  • Inflammatory muscle disorders
  • Connective tissue disorders

Clues that these conditions might be causing your cramps indicate persistent weakness and muscle pain between cramps.

Some different health conditions (apart from dehydration and electrolyte imbalances) in rarer cases than benign lifestyle conditions. Some have been listed above for you, however if you require more specific guidance, please speak to your healthcare advisor.

When to Seek Medical Help

Most nocturnal muscle cramps are usually harmless and often improve with lifestyle changes, better hydration and stretching. However in some cases, cramps should be checked by a healthcare professional.

The following are instances in which to see a doctor for nocturnal muscle cramps:

• Cramps are frequent and worsening
  • If cramps are occurring on most nights or are becoming more intense and lasting longer
• Cramps are one-sided and more persistent
  • If cramps are repeatedly affecting one leg/ one muscle and not alternating between sides
  • This can sometimes be a sign of nerve or circulation problem
• Cramps are associated with other symptoms such as:
  • Muscle weakness
  • Muscle numbness or tingling
  • Muscle swelling, redness or warmth
  • Changes in skin colour and temperature
• If cramps are new and unexplained (especially later in life)
  • Cramps suddenly start later in life
  • There is no trigger for the cramps (such as exercise, lifestyle or posture)
  • They begin after starting a new medication

These are some of the examples in which you may desire to seek medical help for cramps. The following are some situations in which to seek medical care for cramps urgently:

• Sudden leg redness, swelling or pain
• Chest pain or shortness of breath
• Sudden severe weakness or loss of sensation in the leg
• Fevers or signs of infection accompanying leg pain