By Yu Zhouwei (Master of Neurology)
Last week, a classmate from my hometown called for consultation. He said that in the past few weeks, he often had calf cramps while sleeping and often woke up with pain. I heard that it was calcium deficiency, so I went to the pharmacy to buy calcium tablets to eat, but it seemed to be of no use. what to do?
I have carefully asked the reason and found that my classmates have been busy renovating their home recently, sweating profusely all day, and the taste is usually bland, I guess, is it because of excessive sweating and no lack of Reasons for adding salt.
Because in medicine, the loss of salt is called “low sodium”, which is a type of electrolyte imbalance, which can cause painful cramps in the legs at night, which is often referred to as “night legs.” cramp”.
Therefore, I suggest that he drink more sports drinks (the one containing sodium in the ingredient list) after sweating at work recently, and the taste should not be too light recently, after all, he will lose a lot of sweat after sweating a lot. Lots of salt.
Later, he sent feedback that this method worked, and there was no cramping afterwards.
So, not all leg cramps are calcium deficiency. In fact, the vast majority of nocturnal leg cramps are idiopathic — with no or no specific cause — and rarely due to calcium deficiency. Even the case of “lack of salt” in the above case is actually rare.
Nocturnal leg cramps are a very common problem, from children to the elderly. Moreover, the incidence increases with age.
For people over 50 years old, the prevalence rate is 40%[1] – 4 out of 10 middle-aged and elderly people, regardless of gender, have experienced leg cramps at night.
Image source: Zhanku Hailuo
1. Since calcium deficiency is not the main reason, are there other reasons?
Although the cause cannot be found in most cases, if there is a problem, it is still necessary to look for it first. Overall, the following 5 broad categories of reasons are relatively common:
1. Abnormal leg anatomy
People with flat feet, for example, are prone to nighttime leg cramps.
2. The usual posture is wrong
The main thing is sitting for a long time.
3. Nervous system related diseases
Friends with Parkinson’s disease or myopathy are also more likely to have painful nighttime leg cramps.
4. Metabolic-related diseases
Diabetes, hypoglycemia, and thyroid disease can all cause painful nighttime leg cramps. Of course, calcium deficiency is also one of the reasons.
If cramps occur repeatedly in multiple parts of the body, “hypocalcemia” should indeed be considered.
By the way, leg cramps in pregnant mothers [2, 3] are more likely due to “magnesium deficiency” than calcium deficiency.
5. Taking certain medications
Diuretics are most commonly seen in [4]. In addition, there is a blood pressure drug with “sartan” in its name that may also cause painful leg cramps at night.
But don’t worry too much, the benefits of these antihypertensive drugs far outweigh the risk of nighttime leg cramps, and as long as you don’t have frequent leg cramps, don’t worry.
In addition to drugs, alcohol can also cause painful nighttime leg cramps. If you have been socializing a lot recently and have nighttime leg cramps at the same time, you need to control your alcohol intake.
Image source: Zhanku Hailuo
Second, I have cramps at night, what should I do?
Nocturnal leg cramps, which mean sudden muscle contractions, most often in the calf, foot, or thigh.
As the name suggests, the attacks are painful and may persist for hours after the acute spasms have resolved. If the cramping occurs in the thigh, the pain will last longer.
The most important thing to do during an attack is, of course, to stop the pain as soon as possible.
The most effective method is to stretch the affected muscle [5].
Take calf cramps as an example, it is recommended to straighten the knee joint, and then actively lift the dorsum of the foot – force the toes to face the direction of your head (both lying down and standing), and maintain this position 10-20 seconds, can be veryPain relief fast.
Alternatively, going to the bathroom and rinsing the cramped area with a hot water jet for 5 minutes can also relieve acute cramping pain.
Alternatively, going to the bathroom and rinsing the cramped area with a hot water jet for 5 minutes can also relieve acute cramping pain.
3. Is there a way to prevent it?
If you have frequent attacks, such as a few nights a week, you should consider preventive measures.
Before prevention, go to the hospital to find out if there are possible secondary causes, such as suspicious drugs, neurological diseases, etc.
In the vast majority of cases, no specific cause can be found, in which case the “exercise method” can be used first to prevent painful nighttime leg cramps.
The most recommended method is to do daily stretching exercises to stretch the muscles behind the legs [6].
There is a randomized trial demonstrating the effect of stretching. This trial selected 80 patients over the age of 55 years, who experienced an average of 3.2-3.4 nocturnal cramps [7].
The trial found that stretching the gastrocnemius (the muscle behind the calf) before bed for 6 weeks significantly reduced the incidence of nocturnal leg cramps compared to no stretching. Also, the severity of cramps was reduced in the stretching group.
There are many ways to stretch. For example, you can choose to lunge, with your feet on the ground, lean forward, support a wall with your hands, and feel a muscle stretch in your calf.
Image source: Internet
Hold this position for 10-20 seconds and repeat 3-5 times in a row. Do it 4 times a day for the first week, then 2 times a day after that (once in the evening and before bed). Sometimes, just doing it once before going to bed may do the trick.
There are other things you can try.
For example, if you are a sedentary person during the day, ride a stationary bike for a few minutes before bed.
In addition, avoid some triggering factors in life, such as:
Avoid dehydration. Replenish water and electrolytes in time after sweating.
Avoid alcohol and coffee.
Avoid exercising in the heat.
What if the stretch above doesn’t work?
Medications can be tried at this time. However, to be on the safe side, it is recommended to supplement with minerals and vitamins first.
You can start with oral B-complex vitamins, 1 capsule each time, three times a day.
Taipei Wanfang Hospital once conducted a randomized double-blind controlled trial [8], and found that after 3 months of vitamin B complex treatment, 86% of the patients had nocturnal leg cramps in frequency, intensity and intensity. Duration was significantly reduced. There was no significant difference from baseline in patients taking placebo.
However, here is a detail, that is, the content of each component of vitamin B complex in the experiment is:
Furathiamine【Long Acting Vitamin B1】50mg
Vitamin B2: 5mg
Pyridoxal phosphate [the main metabolically active form of vitamin B6] 30mg
Hydroxycobalamin [Vitamin B12 Congener] 250μg
And I checked the B complex vitamins produced by various manufacturers in mainland China, and most of the ingredients are as follows:
Vitamin B1: 3mg
Vitamin B2: 1.5mg
Vitamin B6: 0.2mg
You will find that the specifications are completely different from those in the experiment, and, moreover, there is no vitamin B12.
Honestly, I’m not sure if I can achieve the results in the experiment. However, considering that B vitamins are safe, you can give them a try. According to the maximum dosage of the instructions, adults take 3 capsules at a time, 3 times a day.
In addition, if there is iron deficiency, it is recommended to supplement iron first. Pregnant mothers can try magnesium supplements if they experience nighttime leg cramps [3, 4].
If supplementing with these vitamins and minerals still doesn’t work, try other medicines, such as diphenhydramine (12.5-50mg per night) by mouth at bedtime. Note that it is advisable to consult a doctor or pharmacist before choosing a medication, as a precaution.
Overall, nocturnal leg cramps are common, and most do notThere are specific reasons, and some cases are related to certain drugs, sedentary, certain neurological diseases, etc.
Calcium deficiency can cause painful nighttime leg cramps, but it is fairly rare.
In acute attacks at night, active dorsiflexion of the feet—toes pointed toward one’s head—can relieve pain.
There are many ways to prevent it. The first choice is to stretch the muscles of the back of the legs every day.
References:
[1] Grandner MA, Winkelman JW. Nocturnal leg cramps: Prevalence and associations with demographics, sleep disturbance symptoms, medical conditions, and cardiometabolic risk factors. PLoS One 2017; 12:e0178465.< /p>
[2] Nygaard IH, Valb A, Pethick SV, B hmer T. Does oral magnesium substitution relieve pregnancy-induced leg cramps? Eur J Obstet Gynecol Reprod Biol 2008; 141:23.< /p>
[3] Sebo P, Cerutti B, Haller DM. Effect of magnesium therapy on nocturnal leg cramps: a systematic review of randomized controlled trials with meta-analysis using simulations. Fam Pract 2014; 31 :7.
[4] Garrison SR, Dormuth CR, Morrow RL, et al. Nocturnal leg cramps and prescription use that precedes them: a sequence symmetry analysis. Arch Intern Med 2012; 172:120.< /p>
[5] Davison S. Standing: a good remedy. JAMA 1984; 252:3367.
[6] Daniell HW. Simple cure for nocturnal leg cramps. N Engl J Med 1979; 301:216.
[7] Hallegraeff JM, van der Schans CP, de Ruiter R, de Greef MH. Stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults: a randomised trial. J Physiother 2012;58:17.
[8] Chan P, Huang TY, Chen YJ, et al. Randomized, double-blind, placebo-controlled study of the safety and efficacy of vitamin B complex in the treatment of nocturnal leg cramps in elderly patients with hypertension. J Clin Pharmacol 1998;38:1151.
This article comes from the public account “Sleep and Science”, please contact the original author for reprinting.