Most of us have experienced an occasional charley horse, that sudden, intense muscle pain that grips the calf muscle. Many people have, inexplicably, felt this pain in the middle of the night. Unfortunately, there is as yet no clear explanation of why it occurs.
"Leg cramps that happen during sleep are quite common but not fully understood," says Dr. Jonathan Kirschner, assistant professor of interventional spine and sports medicine at the Icahn School of Medicine at Mount Sinai in New York City. A 2012 report in the journal American Family Physician found that nearly 60 percent of adults have experienced what the experts call nocturnal idiopathic leg cramps — and we become more prone to the pain as we age. One in 3 people over the age of 60 report having been awakened by a charley horse at least once in the previous two months; 6 percent of those over 60 say they deal with the problem on a nightly basis.
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Nighttime leg cramping, Kirschner says, is an involuntary spasm that's often the result of random signals from the brain telling the muscles to contract. "A charley horse is uncomfortable, to be sure, but usually harmless. Many times it doesn't mean there's anything wrong," he says. "But if the cramps are getting worse or disrupting your sleep to the point where it's impacting your waking hours, then it's something you should bring up with your doctor."
Possible Causes for Concern
A charley horse can be a sign of several conditions. The cramps can be related to spinal stenosis, a natural wear-and-tear condition that leads to the narrowing of the open spaces within your spine, which in turn puts pressure on the nerves that travel through it. Many people may not be aware they even have this condition until a doctor is able to connect it to certain symptoms, including nighttime leg pain.
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Overnight cramps could also be the result of dehydration, especially in warm weather, which can also bring on electrolyte imbalance, or deficiencies of certain nutrients, typically calcium, magnesium or potassium. The pains have also been linked to some medications, including beta blockers and blood-pressure drugs.
Nighttime charley horses could also stem from peripheral artery disease, which causes the narrowing and hardening of arteries that supply blood to the legs and feet. But, as Kirschner points out, that condition should also produce cramps while walking.
Some assume a connection between nighttime leg pain and restless leg syndrome, but the conditions are not related. Restless leg syndrome typically produces not sudden cramps but leg discomfort that can last for hours.
How to Handle It
There are myriad ideas for handling nighttime leg cramps. If you search online for "charley horse treatment," you'll see a range of tips, from self-massage to listening to classical music to eating mustard. Many of these treatments have been studied, but the results are far from conclusive.
Fundamentally, Kirschner says, since there's no clear "rhyme or reason" for the cramps, the best thing people can do to prevent them is to generally maintain a good baseline level of fitness and stay well hydrated. The Mayo Clinic advises other steps to prevent flare-ups, like stretching leg muscles before going to sleep and loosening the covers at the foot of your bed.
When cramps do hit and force you out of bed, Kirschner says, his patients have found relief in remedies including:
- Cold Applying ice to the muscle can relax tension.
- Heat A hot shower or bath can reduce pain.
- Massage Firmly press on the aggravated muscle for several seconds with your thumb or fist, then gently knead the area.
- Movement and stretching Get out of bed and start walking, then stretch the muscle. Face a wall and extend the affected leg backward, then lean toward the wall until you feel tension in the leg and hold the stretch for several seconds.
- Aromatherapy Chamomile, in the form of a cream, a scented candle or a cup of herbal tea, can be effective as a natural muscle relaxer.
Kirschner discourages people from purchasing supplements that claim to relieve cramps without having them checked out with a doctor. "My fear," he says, "is that some will have harmful doses of something like quinine, which can cause heart arrhythmias."
What About Soap?
Then there's the soap remedy. Believers swear that sleeping with a bar of soap under your bottom sheet, below the affected leg, will ward off the pain. Any casual online search will turn up numerous enthusiastic testimonials. There is, however, no scientific evidence that it works, or even why it would, except perhaps the placebo effect. "The evidence is anecdotal at best," Kirschner says. "But if it doesn't hurt and it makes you feel better, go right ahead."