ASK DR. BAUGHAN                                                                          February 23, 1996

LEGS THAT CRAMP IN THE NIGHT

Cramping of the lower legs at night is a very common  symptom, more so as we get older.  The medical term for this problem is “benign nocturnal leg cramps.”  The “benign” emphasizes that no one dies from this problem, and it is rarely a sign of a serious internal disease. There are some diseases to consider, but they are usually fairly obvious: a few progressive neurological diseases, nerve injuries, blockage of blood vessels in the legs, kidney disease patients on dialysis.  Certain medications, such as diuretics (“water pills”), certain blood pressure medicines, asthma medicines, and a few others, may be causes.  Alcohol intake sometimes brings them on.  Doctors often check for calcium and potassium imbalances, but rarely do we find abnormalities if the symptoms are limited to nighttime and the person feels well during the day.  Even though most of the time, patients are otherwise healthy, the repeated painful disruption of sleep can make for a great deal of misery, though.

This condition has received  some indirect attention recently because one of the longstanding treatments for leg cramps has recently come under question.    Quinine has been used since the 1930s for leg cramps, with many patients testifying to its effectiveness.  Several small but decent studies since 1980 have documented that it could be helpful for some patients more so than placebos.  Quinine has been available as an over-the-counter medication until  February of 1995, when the FDA banned non-prescriptions products containing quinine.  Since the drug companies are not likely the spend the money to get FDA approval for a small market niche drug like quinine, when the existing supplies of Quinnam (the prescription brand quinine) are gone, it may be difficult to obtain quinine in any  form other than quinine water (which I have had some patients say works all right if you can stand the taste).

Why did the FDA ban OTC quinine?  Thorough review of causes of thrombocytopenia (a condition of a low count of blood platelets, the small cells that are necessary to form blood clots to stop bleeding) found quinine to be a related cause.  Estimates are one person in every 1,000 to 3,500 taking quinine may develop this low platelet count.  Thrombocytopenia  can be life-threatening if a small amount of bleeding the body usually controls becomes severe internal or external blood loss.

What treatment options are there other than quinine?  Since stretching the calf can relieve the cramp, many believe that regular stretching during the day and before bedtime can help prevent nocturnal cramps.  Having a footboard on the bed to press against during the night may help avoid having to get completely awake and walking around.  One recommendation I found suggested letting your foot hang over the edge of the bed so the ankle will not be extended out straight – this might be easier in warmer times or climates.  Drinking plenty of fluids during the day makes sense – slight cases of dehydration or electrolyte (sodium, potassium, magnesium) imbalance may be part of the problem.  Several nutritional supplements or medicines have been suggested, such as vitamin E or riboflavin, verapamil, certain seizure medicines, antihistamines or muscle relaxants, but these have not been carefully studied, and of course they have their own set of risks.  If anyone knows of any other effective remedies, I would be delighted to hear from them.

A brief question  from a reader:  “I would like you to explain when to use a humidifier and when to use a vaporizer.  Some say cool mist is best, while others say a warm vapor is the way to go.  Needless to say, I’m confused.”

Moisture in the air is the primary issue, so it rarely makes a difference whether you use a $15 vaporizer or a $300 climate-controlling humidifier for acute problems like sinusitis, bronchitis or other respiratory infections.  Hot steam vaporizers can be a hazard for accidental burns if there are small children in the home.  If you find the addition of  a eucalyptus or other oil to the vapor helpful, then you will need a warm vaporizer.  Warm vaporizers may need more frequent cleaning to prevent mold growth.  Once you get three feet away, the temperature will be pretty much the same, though.  Moisture is the issue much more than temperature.