Nocturnal Leg Symptoms

Nocturnal Leg Cramps

• r/o hypocalcemia, r/o drug (inhaled LABA, diuretics)
• Acute treatment
  • Forcefully stretch affected muscle (eg. active dorsiflexion of foot with knee extended for calf cramp)
  • Heat or ice
• Non-pharmacological treatment
  • Daily stretching
  • Stationary bicycle before sleeping
  • Keep bed covers loose
  • Avoid alcohol, caffeine, dehydration
• Pharmacological treatment
  • Vitamin B complex TID
  • Vitamin E 800 units qHS
  • May consider iron and magnesium (although no evidence)
  • Diphenhydramine
  • Diltiazem or Verapamil
  • Gabapentin

Restless Legs Syndrome (RLS)

• Unpleasant sensation in the legs (and occasionally the arms), accompanied by an urge to move, that emerges during periods of inactivity, is most prominent in the evening, and is transiently relieved by movement
  • Commonly associated with periodic leg movements of sleep (PLMS)

Treatment

• Non-pharmacological
  • Avoid caffeine, alcohol, chocolate, smoking
  • Good sleep hygiene
  • Stretching/exercise/massage
  • Applied heat
  • Mental alerting activities (working on computer) at times of rest/boredom
  • Pneumatic compression prior to symptom onset
• Pharmacologic
  • Trial of oral iron therapy if ferritin<75mcg/L
  • Severe RLS
    • Comorbid depression, obesity/metabolic syndrome - Dopamine agonist (Pramipexole, rotigotine)
    • Comorbid pain, anxiety, insomnia - Gabapentin
  • If ESRD, consider Vitamin C or E (alone or in combination)