Leg cramps are the painful result of the spontaneous tightening of muscle tissue, below the knee, usually in the calf area and sometimes in the foot. These contractions often happen at night and more often affect older rather than younger people. Although leg cramps at night are a very common condition, extensive research has not been able to determine a singular definitive cause. However, there are some specific activities and risk factors that can contribute to the development of leg cramps.

The stimulus for muscle contraction typically starts with the brain sending a signal to the muscles via nerves. While it is not likely that leg cramps are related to a brain issue, it is possible that there is some defect or cause within the nervous system that signals muscles to contract involuntarily, without the brain telling the muscle to contract. Some scientists believe that the mechanism which prevents the response of muscles to dream-generated brain activity may be involved. A compromise in that mechanism could allow certain signals through to the muscles.

Some research points to a problem with the transition from wakefulness to sleep. Many individuals who have nocturnal leg cramps have them at the time of dreaming. That's why some researchers think that these cramps result from a subtle malfunction in the control system that normally separates our brain from triggering body movementsbased upon what our bodies are doing in the dream. However, most scientists believe that the problem is not a disorder within the brain.

The following disorders occur in this transition from wakefulness to sleep or from sleep to wakefulness. All of these disorders can occur often or to a severe degree in otherwise healthy persons. These parasomnias include:

• Rhythmic movement disorder
• Sleep starts
• Sleep talking
• Nocturnal leg cramps

Here are some of the more identifiable and treatable contributing factors for nighttime leg cramps:

• Insufficient fluid intake
• Extended periods when legs and/or feet are in unusual positions
• Prolonged standing and standing on very hard surfaces
• Atypical bone formations
• Unusual exercise patterns
• Weight gain during pregnancy

In addition, an imbalance or low level of magnesium can cause cramping. Low levels of others like potassium, calcium and even sodium are known to result in leg cramps. Excessive levels of sweating as with extreme exercise may deplete certain nutrients and lead to cramping. Although certain exercises can be a cause, those with limited leg exercise, and those confined to an electric wheelchair have also experienced leg cramps. Both the use of diuretics, and kidney dialysis have been linked to leg cramps. Other causes include thyroid problems, diabetes and Parkinson’s disease.

If the necessary mineral levels of magnesium, sodium, potassium and calcium are insufficient, supplementation is recommended. Many have found that stretching before going to bed helps to prevent cramps. Application of heat after stretching may also be useful. Sudden motions or undue extension of the feet while in bed may trigger a cramping response. Unusual positions of the feet while sleeping may also cause the onset of leg cramps at night.

When cramps occur, it is a good idea to attempt to exercise and stretch the affected leg. One method is to lean forward against the wall, keeping the affected foot flat on the floor and bring the knee to a straightened position. This puts pressure across the back of the calf. Stretching is also useful to return the muscle to its resting position until the contraction subsides. While in bed or sitting down, grab the ball of the foot and pull upward in opposition to the cramp. Others attempt to massage the cramping muscle, take a warm bath, or apply ice massages to the muscles.

Placing a bar of soap between the sheets by your feet overnight has been reported by a number of people to work for them. And this after trying many other things and not believing it would work. The mechanism of action is unknown, and YMMV.

What can you do when natural therapies aren't helping? Medications such as diphenhydramine hydrochloride (Benadryl) may be required. Certain muscle relaxants like meprobamate (Equanil, MB-TAB, Miltown, Trancot) and verapamil hydrochloride (Calan, Covera, Isoptin, Verelan) may be prescribed, though this is an off-label use.

For safety reasons, quinine is no longer recommended as a treatment, but some find benefit from drinking tonic water before bed. Caution is advised – check with your doctor - even though quinine has been demonstrated to decrease the frequency of cramps, but not their intensity or duration. [ Should people with nocturnal leg cramps drink tonic water and bitter lemon? Psychol Rep. 1999 Apr;84(2):pp.355-67.]

Hopefully, by reading this, you have found some effective suggestions to help ease the discomfort or even eliminate nocturnal / nighttime leg cramps.