Medically reviewed by James Fonger, MD, FRCS, on July 23, 2025
Few things ruin a good night’s sleep faster than a sudden jolt of pain in your calf or thigh. If leg pain keeps waking you up, you’re not alone, and while it may seem like there are many causes, they often point to one unifying issue: poor circulation caused by venous insufficiency.
Many people experience leg cramps, aching, or restlessness at night and assume it’s just part of aging. But the real cause often lies in basic physics: when the valves in your leg veins are leaky, blood can pool in your lower legs while you’re lying down. Over time, this increases pressure in the calf, stretching surrounding tissues and sending a distress signal to your brain, which triggers a cramp to contract the muscle and force blood back toward the heart. The pressure drops, symptoms ease, and you fall asleep again…until it happens all over.
In this blog, Dr. James Fonger, MD, FRCS, lead vein physician at Center for Vein Restoration (CVR) in Lawrenceville, GA, looks at seven of the most common ways leg pain shows up at night and explains how they’re all linked by one core circulatory issue. He then describes what you can do to break the cycle and finally get the sleep (and relief) you deserve.
Don’t lose another night’s sleep to leg pain. Click here to schedule your consultation with Dr. Fonger in Lawrenceville today and take the first step toward lasting relief.
Not near Lawrenceville? Click the button below ⬇️ or call our Patient Service Representatives at 240-965-3915 to book your appointment.
The top, yet most overlooked, contributor to nighttime leg pain is calf pump inactivity during sleep. Here’s what’s happening:
When you lie down to sleep, your calf muscles aren’t moving, so they stop helping push blood back up to your heart. If your leg veins have faulty valves (a sign of venous insufficiency), blood starts to pool in your lower legs. As pressure builds inside your calves, it stretches the surrounding tissue, triggering your brain to interpret that pressure as a cramp. In response, your brain tells your calf muscle to contract, which pumps some of that blood upward and eases the pressure. That’s why cramps can wake you up at night, then fade once the muscle contracts.
The same thing happens when you're awake: pressure builds, your brain interprets it as discomfort, and your legs feel restless. This pressure-driven cycle helps explain both night cramps and daytime symptoms like restless leg syndrome. When your veins can’t pump blood back to your heart efficiently, pressure builds and leads to discomfort.
While most leg pain isn’t dangerous, some symptoms need immediate attention, including:
🚨 Sudden swelling in one leg
🚨 Calf pain with warmth or redness
🚨 Shortness of breath or chest pain (possible sign of a blood clot)
🚨 Open sores on the lower leg that won’t heal
🚨 Progressive numbness or weakness
Don’t wait to seek answers for pain that’s ongoing or occurs nightly. A visit to your primary care provider is a good start, but if your symptoms include swelling, visible veins, or heaviness, consulting a board-certified CVR vein specialist directly can provide you with faster answers.
📞 Call CVR at 240-965-3915
📅 Or book online HERE
Now, let’s break down the other culprits of nighttime leg pain:
Muscle cramps are sudden, tight squeezes in your leg muscles, often in the calf, that can wake you from a sound sleep. These painful spasms happen when muscles contract and won’t relax. They can last anywhere from a few seconds to a couple of minutes.
Dehydration, tired muscles, or low levels of certain minerals, such as potassium and magnesium, typically cause cramps. If you’ve been standing or walking a lot, especially in hot weather, you’re more likely to get one. Make sure to drink enough water, stretch before bed, and eat foods such as bananas and leafy greens that support healthy muscles to help prevent cramps.
Also known as Willis-Ekbom disease, restless legs syndrome (RLS) causes your legs to feel as if something is crawling, tingling, or buzzing under your skin. The sensation causes an urge to move your legs, which may help for a little while. These symptoms often start in the evening and worsen when you’re lying down or sitting still, making it hard to fall asleep or stay asleep.
Doctors don’t know exactly what causes RLS, but it can run in families and may be linked to low iron or changes in brain chemicals. If you’re experiencing similar symptoms, consider cutting back on caffeine, getting regular exercise, and talking to your doctor about professional treatment options.
Varicose veins form when valves inside your leg veins stop working well. Instead of blood flowing smoothly back to your heart, it collects in the veins, causing them to stretch and bulge. This can lead to aching, heaviness, or burning in your legs, particularly at night or after prolonged periods of standing throughout the day. When accompanied by symptoms such as swelling and skin changes, the condition is known as chronic venous insufficiency (CVI).
Symptoms often ease when you elevate your legs, since gravity is the natural enemy of weakened veins. Medical-grade compression stockings, calf-pump exercises, and quick office-based treatments such as endovenous ablation can restore healthy blood flow and bring the nighttime relief many people thought was out of reach.
Peripheral Artery Disease (PAD) occurs when the arteries in your legs become narrow, making it harder for blood to reach your muscles. This can cause pain, cramping, or tiredness in your legs, even when you’re resting or sleeping. Some people feel pain that improves when they hang their legs over the side of the bed.
According to the American Heart Association Journal Circulation, PAD is underdiagnosed because its early symptoms mimic normal aging or muscle fatigue, but ignoring it can lead to serious complications, including slow-healing foot wounds. Walking plans that slowly build endurance, heart-healthy eating, and medication to improve blood flow all help keep your nighttime legs calm and your daytime walks enjoyable.
Deep vein thrombosis (DVT) is a blood clot that forms deep in your leg, usually in the thigh or lower leg. It can cause sudden swelling, pain, or a warm feeling in the leg. Sometimes, the skin looks red or feels tight. DVT is serious because the clot can break loose and travel to your lungs, a life-threatening condition called a pulmonary embolism (PE).
Sitting still for long periods of time, such as during long flights or after surgery, raises your DVT risk. If you ever experience these symptoms, get medical help right away. Blood tests and an ultrasound can help locate the clot, and medications can prevent it from worsening.
Peripheral neuropathy means the nerves in your legs aren’t working properly. This can cause strange sensations such as tingling, burning, numbness, or sharp pain, especially at night when you're trying to sleep. Diabetes is the most common cause, but nerve damage can also come from vitamin deficiencies, alcohol use, or certain medications. Some people feel as though their feet are cold or buzzing, even when they aren’t touching anything.
If this sounds familiar, your doctor can do tests to find the cause. Treatments include managing blood sugar levels, taking vitamins, or using medications that help calm nerve signals to improve sleep quality.
Your daily habits, as well as certain medications, can cause leg pain at night. Standing for long hours, sitting for too long, or not getting enough movement during the day can cause your legs to feel tired and sore. Pregnancy adds pressure on your veins, which can also cause aching legs.
That’s not all: some medications, including statins (used for cholesterol) or diuretics (used for blood pressure), may cause cramps or muscle pain as a side effect. The good news? Small changes, such as staying active, drinking more water, and discussing your medications with your doctor, can make a remarkable difference in your day-to-day symptoms.
Imagine sleeping through the night without pain or heaviness in your legs. That can start today with one easy visit. Book your consultation with CVR now through our ONLINE SCHEDULING PORTAL or by calling our Patient Services Representatives at 240-965-3915.
Nighttime leg pain isn’t just frustrating; it’s a signal from your body. Cramps and nerve damage aren’t exactly the causes; they’re the symptoms of blood accumulating in the calf due to poor circulation, and the most important thing is not to ignore the pain.
You deserve better sleep and healthy legs that support your lifestyle, pain-free.
🌙 Tired of being woken up by leg pain? Don’t wait. Call 240-965-3915 or click below to book your appointment with CVR.
➡️ To make an appointment with Dr. Fonger in Lawrenceville, GA, click here.
➡️ To make an appointment at one of CVR’s 110+ locations nationwide, click here.
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