Leg Cramps at Night

Mark A. Edelman, MD, DABVLM, is the lead vein physician at Center for Vein Restoration clinic locations in Norwalk, CT, and Stamford, CT. Dr. Edelman is board-certified by the American Board of Radiology and specializes in interventional radiology. He is an expert in diagnosing and treating venous disorders such as varicose veins, blood clots, and leg ulcers.

Nighttime leg cramps (sometimes called charley horses) are the painful spasms or contractions of the calf, thigh, or foot muscles. These occur at night without warning, often jolting a person from a sound sleep. Lasting from a few seconds to several minutes, stretching the muscles or pushing blood to the area of the cramp using massage often helps relieve the intense pain during these uncomfortable episodes.

To learn what causes these painful nighttime spasms and how to prevent them, we spoke to Center for Vein Restoration (CVR) lead physician Dr. Mark Edelman.

What is the difference between leg cramps and restless leg syndrome?

Dr. Edelman explains that leg cramps during the day may differ from restless legs syndrome (RLS), although the two can share a root cause: venous insufficiency, also known as vein disease. Vein disease is suspected if other symptoms of venous insufficiency are present in addition to the cramps—such as leg swelling, skin color or texture changes, or varicose and spider veins.

According to Dr. Edelman, restless leg syndrome is a condition characterized by the uncontrollable urge to move one's legs at night and is a subset of the more global term "leg cramps." Leg cramps are aching, heaviness, soreness, or burning of the legs.

While often thought of as a neurological problem, Dr. Edelman cites research that finds that as many as 22 percent of patients with restless leg syndrome have underlying chronic venous insufficiency. Surprisingly, a quick online search rarely reveals CVI as a possible cause of leg cramps.

Chronic venous insufficiency (CVI) occurs when dysfunctional leg valves don't allow blood to flow from the lower extremities back up to the heart. As a result, blood collects (pools) in the legs, causing pain, swelling, heaviness, etc. That is why moving trapped blood by walking or leg massage can help overcome the painful symptoms of leg cramps.

What are the causes of leg cramps at night?

Many causes are associated with night leg cramps, including:

Venous insufficiency

Also known as vein disease, this is the underlying cause of varicose veins and is a common cause of nighttime leg cramps.

When working correctly, leg veins, working against gravity, return blood from the lower extremities back to the heart. Tiny valves in the veins regulate blood flow, stopping blood from flowing backward. When these valves weaken or become dysfunctional due to advanced age, family history, inactivity, obesity, or pregnancy—blood can flow backward and collect (pool). This extra pressure causes the veins to stretch, bulge, twist, and appear as varicose veins. Changes in skin color and texture emerge, as does and pain, swelling, achy, and feelings of heaviness.

Other causes of night leg cramps:

• Heredity
• Anemia
• Diabetes
• Dehydration
• Electrolyte imbalance
• Caffeine use
• Nicotine use
• Medications such as antihistamines and antidepressants
• Renal deficiency (poor kidney function due to a reduced blood flow to the kidneys)

How will I know if vein disease is the cause of my leg cramps?

The only way to know that vein disease is the cause of leg cramps is through an evaluation by a qualified vein specialist. Dr. Edelman strongly recommends that patients be assessed for vein disease, as this is an easily treatable cause of restless leg syndrome.

As part of the global assessment provided at CVR, the doctor will review the patient's medication to assess if this might cause leg cramps. Other causes of leg cramps, besides vein disease, are best managed by a primary care physician.

The good news is that if vein disease is diagnosed, it is "easily treatable," says Dr. Edelman. This is especially true if the patient also suffers from other signs of CVI, such as swelling, varicosities (varicose veins) and skin changes, he adds.

Dr. Edelman says that "there is value in having an evaluation by a vein specialist, even if vein disease is ruled out because the primary care provider can then focus on the other potential causes of the leg cramps."

"If the cause of leg cramps is vein disease, the reason walking and massaging the calf relieves the leg cramp is because doing so helps move the blood that has pooled in the area. Vein blood, which contains metabolic waste products, irritates the nerves and causes discomfort." -Dr. Mark A. Edelman

How to prevent night leg cramps and restless leg syndrome

Because night leg cramps and restless leg syndrome are so closely associated with CVI, many of the same methods used to prevent symptoms of vein disease are also used to thwart nocturnal leg cramps and restless legs. These include:

Treat vein disease

The most obvious signs that vein disease is the root cause of one's leg cramps is the presence of varicose veins or spider veins and feelings of leg achiness, heaviness, soreness, or burning. Patients at CVR start their journey to wellness with a thorough health history and an imaging test called a duplex ultrasound which assesses the speed and direction of blood flow.

Based on test results, the doctor will develop a custom treatment plan which may include many non-surgical and minimally invasive procedures such as sclerotherapy, endovenous laser ablation or radiofrequency ablation (RFA), or ambulatory phlebectomy.

Wear compression stockings

One easy, practical trick that Dr. Edelman uses to assess if vein disease might cause nocturnal leg cramps is to have patients wear compression stockings during the day or even over a couple of nights. These stretchy garments gently squeeze the leg veins closer, helping blood circulate and keeping fluids from pooling.

Dr. Edelman explains that "if the patient notices that wearing compression stocking alleviates symptoms, it's a reason to hypothesize that their discomfort might be due to venous insufficiency."

Walk during the day

Standing or sitting for long periods allows blood to pool and is a known risk factor for vein disease. Walking engages the calf muscles, which act as a pump—moving blood through the blood vessels in the right direction toward the heart.

What to do if you have night leg cramps

Contact the vein specialists at Center for Vein Restoration to schedule a comprehensive vein evaluation. If vein disease is found to be the root cause of your leg cramps or restless legs, CVR's board-certified physicians use state-of-the-art, minimally invasive treatment options to help you finally achieve restful sleep—free of painful night leg cramps.

Most insurances, including Medicare and Medicaid, are accepted.

Call 240-965-3915 or visit centerforvein.com for more information.