Aching legs at night

Disturbed Sleep and Aching Legs

Many things can affect our sleep. As we all know, good sleep is very important since it boosts our energy, which is necessary for proper functioning throughout the day. However, our sleep can be impaired due to many environmental factors, but also due to many health disorders or conditions.

Almost every person has experienced an ache in the legs during the night. It is a quite common condition that may be induced by various reasons. However, the ache in the legs can vary in intensity and severity.

Many people only feel mild aches in the legs during the night, while some cannot sleep at all due to intense pain in the legs. When one suffers from aching legs at night, he/she usually experiences a tingling sensation in the legs, as well as a burning sensation and fatigue.

Nocturnal Leg Cramps (NLC) is a musculoskeletal disorder characterized by suddenly occurring, episodic, persistently painful, involuntary contractions of the calf, hamstrings or foot muscles at night. Up to 33% of the general population over 50 years of age have complaints related to NLC. In 20% of these cases, cramps also occur during rest periods in the daytime. Sleep disturbances, which may seriously affect well-being and quality of life, are common among patients with NLC. Symptoms, as well as prevalence and incidence, progress with advancing age. There is no consensus about aetiology of NLC, however it is suggested that shortened muscle length among older less physically active people is a risk factor. Medical pathologies associated with NLC are chronic liver and renal failure (haemodialysis), vascular diseases, magnesium or calcium deficiency, dehydration and varicose veins. A pre-stretching protocol by physical therapists, as well as medical treatment blocking the medial branch of the deep peroneal nerve after lumbar surgery, may be effective in treating NLC.

In contrast to the restless leg syndrome (RLS) and the idiopathic periodic limb movement disorder (PLMD), diagnosing NLC is hindered due to lack of a categorical definition of NLC. Moreover, different types of muscular cramps such as idiopathic, rest, leg, or pregnancy-related cramps are similar to NLC symptoms and are often confused in the literature. Diagnostic criteria for RLS are clearly stated as follows: uncomfortable and unpleasant sensations in the legs, feet or arms associated with an urge to move; relief of symptoms by moving the affected limb; occurrence during rest in the evening or at night.
A systematic literature study was executed from December 2015 to May 2016. This study comprised of a systematic literature review of randomized clinical trials, observational studies on nocturnal and rest cramps of legs and other muscles, and other systematic and narrative reviews. Two researchers independently extracted literature data and analyzed this using a standardized reviewing protocol. Modified versions of the Cochrane Collaboration tools assessed the risk of bias. A Delphi study was conducted to assess agreement on the characteristics of nocturnal leg cramps.
After systematic and manual searches, eight randomized trials and ten observational studies were included. On the basis of these we identified seven diagnostic characteristics of nocturnal leg cramps: intense pain, period of duration from seconds to maximum 10 minutes, location in calf or foot, location seldom in thigh or hamstrings, persistent subsequent pain, sleep disruption and distress.

✓ Fact confirmed: Criteria in diagnosing nocturnal leg cramps: a systematic review Joannes Hallegraeff, Mathieu de Greef, Wim Krijnen & Cees van der Schans; 28 February 2017

Causes of Aching Legs at Night

Aching legs at night usually appear due to varicose veins in the legs, peripheral artery disease, muscle spasms, and restless leg syndrome. Varicose veins tend to appear in the calves of the legs. This condition is marked by swollen veins that tend to pop out from the outer surface of the skin. The pain occurs due to obstructed blood flow, which tends to flow backward. This pain appears also during the day. The main causes for the incidence of varicose veins in the legs are obesity, pregnancy, aging, and menopause, as well as prolonged standing and injury to the legs.

Peripheral artery disease is also a cause for the appearance of pain in the legs at night. The main cause of peripheral artery disease is atherosclerosis, or the accumulation of fat materials and cholesterol on the walls of the arteries, causing the narrowing or blockage of the arteries. When this happens, the blood flow is obstructed, and the legs do not receive enough oxygen through the blood and start to ache.

The pain in the legs also occurs due to muscle cramps, especially in the calves, thighs, and arch of the foot. This condition is very painful and usually appears when these areas are deprived of oxygen and electrolytes. One of the causes of aching legs at night is restless leg syndrome. This syndrome is marked by the restless movement of the feet or legs when a tingling or burning sensation occurs in the muscles of the legs. Lack of iron and vitamin B12 may lead to the occurrence of restless leg syndrome.