Restless Legs and Night Cramps in Older Adults

Restless legs syndrome or night cramps?

| | Restless legs syndrome | Night leg cramps | |---|---|---| | Feeling | An urge to move the legs, with creeping, crawling, pulling, tingling or aching deep inside the legs | A sudden, painful, hard knot or tightening of a muscle, usually the calf or foot | | Timing | Evening and night, when resting or lying still | During sleep or on waking, or after long sitting | | Relief | Moving, walking, stretching, rubbing | Stretching, massaging and walking, over seconds to minutes | | Duration | Can last for hours and recur nightly | Usually seconds to a few minutes; the muscle may stay sore | | Sleep | Difficulty falling asleep | Waking suddenly from sleep |

Some people have both. Restless legs may come with jerking movements of the legs during sleep, which the partner notices.

Restless legs syndrome: causes and triggers

• Low iron stores, even without anaemia; see iron and anaemia in older adults.
• Kidney disease, especially advanced or on dialysis; see chronic kidney disease: home care guide.
• Diabetes and nerve damage; see peripheral neuropathy and balance.
• Parkinson's disease; see Parkinson's disease at home: a practical guide.
• Thyroid disease, vitamin B12 or folate deficiency; see thyroid problems in older adults and vitamin B12 in older vegetarians.
• Medicines: some antidepressants, anti-nausea and allergy medicines, certain medicines for psychosis and others can trigger or worsen symptoms; do not stop any medicine yourself, but tell the doctor so it can be reviewed; see medicine side effects families should watch for.
• Caffeine, alcohol and tobacco, particularly in the evening.
• Poor sleep and sleep apnoea; see sleep apnoea in older adults: signs and next steps and insomnia in older adults: sleep hygiene and when to get help.
• Family history: it often runs in families.
• Inactivity and long sitting.

Night cramps: causes and triggers

• Dehydration and electrolyte changes, from sweating, diarrhoea, vomiting or certain medicines that increase urine; see hydration for older adults: how much and how to remember.
• Muscle fatigue or overuse, or too little movement during the day.
• Long sitting or standing, and awkward leg positions in bed, with the feet pointed down under tight bedding.
• Poor circulation or narrowed leg arteries.
• Nerve compression, such as spinal narrowing; see spinal stenosis and sciatica: walking, pain and aids.
• Medicines that affect fluid or minerals; ask the doctor to review.
• Conditions: diabetes, thyroid disease, kidney disease, liver disease, low calcium, magnesium or potassium.
• Low vitamin D can contribute; see vitamin D deficiency in India.
• Often no clear cause is found, and cramps are common and usually harmless in older adults.

What to tell the doctor

Keep a sleep and symptom diary for one to two weeks: - When symptoms start in the evening, how long they last, how often they wake your parent. - What the sensation is like, and where. - What helps or worsens it, including food, drinks, evening tea, medicines, activity. - All medicines, supplements and traditional preparations. - Daytime sleepiness, mood, falls. - Other symptoms: swelling, numbness, leg pain on walking, breathlessness, weakness.

See care diary and handover notes for an easy format.

Tests the doctor may consider

• Blood tests: haemoglobin, iron stores (ferritin and related tests), kidney function, blood sugar, thyroid function, vitamin B12, folate, calcium, vitamin D, magnesium and others.
• Pulse checks and, if needed, circulation tests of the legs.
• Nerve and spine assessment.
• Sleep study if sleep apnoea is suspected.

Do not take iron, calcium, magnesium or other tablets on your own. Tests show whether they are needed; too much iron and some minerals can harm, and some interact with medicines; see supplements and medicine interactions: a safety guide and calcium and vitamin D after 60: doses, food and sun.

Home measures for restless legs

• Keep a regular sleep routine, with the same bedtime and waking time; see sleep problems in older adults.
• Limit evening caffeine, alcohol and tobacco; avoid heavy meals late.
• Gentle activity in the day, such as walking, stretching or yoga, but avoid hard exercise late in the evening; see chair exercises for seniors and stretching for stiff older bodies. A pedal exerciser used earlier in the evening may help some people; see pedal exerciser guide.
• In the evening, try warmth or coolness: a warm bath or shower, a warm cloth on the legs, or a cool cloth, whichever relieves; see hot pack safety for older skin.
• Leg massage, gentle stretching of the calves and thighs, or a short walk when symptoms start.
• Distraction: reading, puzzles, music, a quiet conversation, rather than lying still watching the clock.
• Keep the legs comfortable in bed, with a supportive pillow for the knees or legs if it helps; see leg elevation pillow guide.
• Treat contributing conditions such as low iron or sleep apnoea, as the doctor advises.

Home measures for night cramps

During a cramp - Stretch the muscle: for a calf cramp, straighten the leg and pull the toes and foot up toward the knee, or stand and press the foot flat on the floor with the support of a stable surface or helper. - Massage the muscle gently and apply warmth with a warm cloth for comfort; avoid strong heat or pressure on skin with poor sensation or circulation. - Walk a few steps if safe, and then sit. - Afterwards, rest and drink water; soreness may persist for a day.

Prevention - Stretch calves and hamstrings gently in the evening for a few minutes, holding each stretch, without bouncing; a physiotherapist can show safe methods. - Stay active and avoid long sitting; change position hourly. - Drink enough fluids through the day, unless fluid-restricted; see heart failure at home: daily checks and warning signs for those with heart failure. - Loose bedding at the foot of the bed so toes are not pointed down; sleep with the feet in a relaxed position. - Comfortable footwear in the day; see choosing shoes for older feet. - Foods: a balanced diet with fruits, vegetables, dairy, nuts and legumes; do not self-treat with mineral tablets or "cramp" tonics. - Review medicines with the doctor if cramps are frequent. - Avoid unproven remedies, such as bars of soap in the bed, which have no proven benefit; and be wary of expensive supplements promising relief. - Falls: cramps at night can cause falls on the way to the toilet; see night-time toilet trips and falls and motion night lights for seniors.

Medical treatment

If symptoms are frequent, severe or disturb sleep and daytime life, the doctor may treat underlying causes, adjust medicines, or prescribe treatment for restless legs. Some medicines used for restless legs and cramps carry side effects in older adults, such as dizziness, sleepiness and, for some, compulsive behaviours, so they are used carefully and reviewed. Never use leftover or someone else's tablets.

Warning signs: when to see a doctor

See a doctor promptly for: - Restless legs or cramps that are new, severe, daily or worsening. - Leg weakness, numbness, tingling, or loss of balance. - Leg swelling, particularly one-sided swelling, redness, warmth or tenderness; see swollen legs in older adults. - Leg pain on walking that eases with rest, cold or pale feet, sores or colour change (possible circulation problem); see diabetic foot care at home. - Pain in the back spreading down the leg. - Daytime sleepiness, low mood, falls or confusion. - Cramps with muscle wasting, twitching or weakness.

Call 112 for: - Sudden painful, swollen, red or pale, cold leg (possible clot or blocked artery). - Sudden breathlessness, chest pain or coughing blood, especially after leg swelling or recent immobility. - New leg weakness with loss of bladder or bowel control, or numbness in the groin. - Stroke signs: face droop, weakness, speech difficulty.

When to ask a professional

Ask the doctor for a review of symptoms, blood tests and medicines. Ask a physiotherapist for a stretching routine, and a sleep clinic if snoring and pauses in breathing occur. Ask a pharmacist before buying any tablets or tonics. Seek urgent help for the emergency signs above.