Nocturnal Nuisance - Calf Muscle Cramps at Night!

Do you suffer from calf muscle cramps at night? Are you used to waking up in the middle of the night due to calf pain? Is a good night's sleep a momentary and fleeting occurrence? Fret not, you are not alone!

Calf cramps that occur at night are also called “nocturnal cramps.” They cause sleep disruptions and poor quality of life. Calf cramps usually happen in the middle of the night when you are asleep and your muscles are inactive. The frequency of leg cramps may vary from person to person. You may experience them every night or only once a year.

1. What Is a Calf Cramp?

Calf or lower leg cramps (spasms) are sharp, intense, and spasmodic pains that occur in your calf muscles. The calf muscles, the gastrocnemius, and the soleus are present behind the shin bone and extend from the back of your knee down to your ankles. Under the effect of a cramp, these muscles hurt, tighten involuntarily, and refuse to relax. According to MedLine Plus, Medical Encyclopedia, cramps are also called “Charley horses.”

Out of all reported calf cramp occurrences, 75% happen at night. A calf muscle cramp may last for as little as a few seconds or as long as 10 minutes.

Those who suffer from cramps also complain about soreness and tenderness in their calves that last for a few days even after the cramps end.

It has been reported that the calf muscle is the most common site for cramps and every 1 out of 3 adults suffers night-time cramps in the calf muscles
(Gulich M, Heil P, Zeitler H. Eur J Gen Pract)

2. Who Can Get Calf Muscle Cramps at Night?

Nocturnal calf muscle cramps are exceedingly common. People of all ages are susceptible to night cramps. 40 % of children get calf muscle cramps and the tendency is even higher in adults at 60%.

People who are 60 years old or older are more prone to nocturnal calf muscle cramps and report frequent episodes. This is because the older you get, the shorter your tendons become. Muscle tendons are tissues that connect the bone to the muscles. These tendons shrink in size with age.

3. What Are the Types of Nocturnal Calf Cramps?

There are mainly two types of calf muscle cramps that happen at night:

1. Idiopathic Cramps: Cramps that occur for no specific reason.
2. Secondary Cramps: These can be complicated and indicate a serious health condition.

4. What Causes Nocturnal Calf Muscle Cramps?

4.1. Causes of Idiopathic Calf Muscle Cramps

There is much room for debate on what causes idiopathic cramps at night. Some of the proposed reasons are:

Physiological Causes

• Psychological and physical stress can cause muscle tightness and cramps.
• Myokymic Discharge (involuntary nerve discharge):
  Categorized by hyperexcitability of nerves, myokymia causes uncontrolled quivering in the muscles. Calf muscles are skeletal; skeletal muscles are under voluntary control. The involuntary movement of calf muscles due to myokymic discharge is similar to cramps.
• Pregnancy:
  Idiopathic, nocturnal calf muscle cramps may happen during pregnancy. There are conflicting opinions on whether leg cramps due to pregnancy and nocturnal cramps are the same. Nevertheless, 40% of pregnant women suffer from night-time leg cramps. Pregnant women carry extra weight which strains the muscles more.

Behavioral Causes

• Overexertion or High-Intensity Workout:
  Exercise causes muscle fatigue. Calf muscles already do enough work every day. When you target calf muscles during exercises, they become cramped mostly at night.
• Sitting:
  Sitting for prolonged hours during the day with a bad posture shortens the muscle fibers. These tight muscles suffer cramps at night.
• Standing:
  The calf muscle - the soleus - supports postural standing.Standing for long hours on hard floors without taking a break can cause cramping.
• Alcohol Consumption:
  There is anecdotal evidence that excessive alcohol consumption can damage muscle fibers. This may explain why muscle cramps are prevalent in people aged 60 or above.
• Dehydration:
  The amount of water your body needs depends on your level of activity and the climate you live in. Exercise or physical labor (work) without protection from the sun can leave you dehydrated. This may be the reason you experience muscle cramps while sleeping.

Medication

Medicines can have side effects, leg cramps being one of them. Diuretics, conjugated estrogen, antibiotics, and pain medicines for fibromyalgia and diabetic neuropathy may cause cramps as a side effect. Cancer treatment like chemotherapy can cause leg cramps as well.

If you are following a prescription, check for side effects with your doctor so that he may prescribe medicines that do not have cramps as a possible side effect.

4.2. Causes of Secondary Calf Muscle Cramps

Secondary leg cramps happen due to a disease or a disorder. They are a symptom of a health condition that should not be ignored.

Sometimes leg cramps are a sign that you might be suffering from a disease that has yet to be diagnosed.

Amyotrophic Lateral Sclerosis:

It is a neurodegenerative disease that affects the neurons in the brain and spinal cord. ALS patients experience constant muscle twitching which is usually harmless. Some studies have reported that night-time cramps of the lower legs help diagnose the early stages of ALS disease.

Cardiovascular Disease:

Night-time leg cramps may occur due to clogged arteries. Blocked arteries in the leg are markers of heart disease due to blocked arteries being in the heart as well.

Osteoarthritis and Sciatica:

Patients of the most prevalent type of arthritis suffer from calf muscle cramps. Calf muscle cramps are related to severe osteoarthritis of the spine in which the nerves of the spine get pinched, causing muscle spasms.

Sciatica:

The same situation happens in sciatic pain (sciatica). According to research, 90% of sciatica cases are associated with a lower back (lumbar) herniated disc. When you move, the herniated disc presses and irritates the sciatic nerve which originates from the lumbar region and extends down to the calves. Since the sciatic nerve innervates the calf muscles when compressed, it causes pain and calf muscle cramps.

Diabetes:

Diabetics have hyperglycemia; high levels of glucose in the blood that cause nerve damage, a medical condition best known as diabetic neuropathy. Diabetic neuropathy is also a cause of calf muscle cramps.

Peripheral Artery Disease:

This is a disorder in which blood vessels in the limbs constrict and obstruct blood flow, especially to the legs. Patients with PAD (peripheral artery disease) develop claudication; they suffer from leg cramps when walking. When the condition is mild, cramps subside during rest and sleep. In severe cases, cramps occur during sleep too.

5. Can Night-time Leg Cramps Occur Due to a Deficiency?

Not eating a healthy diet can cause multiple vitamin and mineral deficiencies in the body. Some common deficiencies are:

• Zinc
• Vitamin B12
• Vitamin D
• Calcium
• Magnesium
• Albumin protein.

Fortunately, calf muscle cramps at night are not associated with any of these deficiencies.

6. Nocturnal Leg Cramps and Restless Leg Syndrome - What’s the Difference?

Nocturnal leg cramps and restless leg syndrome both have one thing in common - they occur at night, a time when your calf muscles are most inactive. These signs will help you distinguish between nocturnal calf cramps and restless leg syndrome.

Restless Leg Syndrome

1. Restless leg syndrome is not nearly as painful as nocturnal leg cramps.
2. In restless leg syndrome, you will experience slight discomfort but no real pain.
3. An “insect crawling feeling.” Your legs will tingle and you will want to move them more.
4. When you move your legs, the restless or tingly feeling goes away.

Cramps on the other hand torment you. You will feel mild to agonizing pain.

Calf Muscle Cramps at Night

1. You dread sleeping.
2. Muscle contractions that force you awake at night.
3. Tightness in the muscles that are beyond your control.
4. Sheer pain in the calf muscles.
5. Tenderness after cramps that lasts for days.
6. Treatments fail to alleviate the pain.

7. How to Get Rid of Calf Muscle Cramps at Night?

Managing night-time leg cramps is a frustrating affair for both clinicians and patients.

that 68% of the participants of a scientific study claimed that the methods of treatment are “useless” or of “little help.”
(PubMed Central Publications)

This fact doesn’t aim to discourage you from adopting a treatment method, but it is important to fathom the incessant nature of night cramps.

When muscle cramps interrupt your deep sleep, you want them to go away as quickly as they came. Therefore, leaving them be and not doing anything to get rid of them is not an option. Try these customary methods to soothe the pain.

Massage:
You don’t need to buy any fancy equipment. Always keep a foam roller by your bed. Even if you don’t own a foam roller, your hands should be enough. Splay out your legs before you, massage, then squeeze and rub the area that feels cramped and sore. It should soothe the pain.

Stretch:
As you massage your affected leg, flex your ankles and toes inwards. This will give your calves a nice stretch. Your hands and foot should move in sync. Massaging and stretching are said to provide maximum relief.

Here are some examples of stretches to soothe calf muscle cramps at night.

Medication:
A report by the American Academy of Neurology states that medicines have yet to prove their efficacy against night cramps in calf muscles.
Ibuprofen and other painkillers are still being used to try and provide pain relief.

Heat and Cold Therapy:
Some people find relief with heating pads. Others prefer ice packs. You can use both hot and cold methods - whichever suits you best - to help reduce the pain.

Walk:
Cramps make sleeping impossible. Try getting out of bed and walking. Walking will distract you and divert your focus from the nagging, convulsive feeling. The trick will surely lessen your distress, if not your pain.

Sleeping Position:
Keep your toes pointed upward as you sleep on your back. You can use a pillow to adjust the position of your lower legs. Your sheets should be loose around your legs and toes so they are not confined and can move unrestricted.

Shoes:
Wear supportive shoes during the day. You might be feeling cramps at night because your muscles are getting tired during the day. Supportive shoes reduce the pressure on the calf muscles and reduce the amount of work they have to do.

Quinine:
Some sufferers of nocturnal leg cramps blindly use quinine to treat the pain. The Australian Therapeutic Goods Administration stopped supporting the use of quinine back in 2004. This is because the use of quinine greatly increases the risk of thrombocytopenia (decreased platelet count).

8. When to See Your Doctor for Night-time Calf Muscle Cramps?

Leg cramps sometimes are a symptom of a more serious disease. 

See your doctor if your leg cramps last longer than 10 minutes or become more frequent and unbearable.

Note: Leg cramps do not cause fainting, nausea, or numbness. If you feel any of these signs, along with involuntary calf muscle contractions, seek medical help immediately.

9. Takeaway

Calf muscle cramps at night are infuriating. They hinder you from getting much-needed sleep. Lack of sleep adversely impacts your whole day and, if the vicious cramp cycle continues, lowers the quality of life.

The exact cause of night-time calf muscle cramps is an unraveled mystery. Traditional treatment methods may help your pain somewhat, but they are not a permanent solution.

Maintaining a healthy lifestyle, regular medical checkups, and mitigating stress can prevent these occurrences from happening in the first place.