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Nocturnal cramp: a nightmare

A third of over 60s suffer night cramps but no one seems to care. Joyce Williams writes from first-hand experience

If you are under 60 you probably haven't yet experienced it, but 33 per cent of people over 60 get night cramps and 50 per cent of over 80s, often up to three times a week.

You emerge from a deep sleep, start to turn over and, wham! Total, instantaneous, screaming cramp in say, the adductors. It can be painful to the point of fainting and if you are alone, terrifying.

Simple calf or foot cramp you can manage by climbing out of bed and attempting to stretch. But for older people, and in the dark, it is dodgy.

We know that it will go of its own accord – after about 10 minutes. But thigh cramp is almost impossible to stretch and any attempt triggers more.

Those 10 minutes or so are a scary. And frequently it returns. The fear and sleep disturbance are seriously distressing. If the cramp is severe, you are left limping the next day from sore muscles.

So you seek help, but most GPs provide platitudes and ineffective pills, while chemists sell expensive ones. Whatever the cost, few medications provide relief.

It’s not harmless

Try looking for help on the net, and medical sites are delighted to assure you that it's harmless. It is not! For older people it is potentially dangerous.

Or try looking up the cause and treatment. I mean it – do try! I have never seen so many ‘might be’ causes and ‘maybe useful’ treatments. No one seems to have a clue.

They just don't know the cause and, I suspect, don't care. It is not a medical problem, it doesn't block beds and there is no apparent profit for big pharma.

Worse, no one is doing any significant research about cramp in older people, and almost all published research on cramp relates to sport and athletics.

Research institutions don't see it as a problem, and anyway who would fund it? Medics under retirement age haven't experienced it and, understandably, they link our complaints to the cramp they do know about, related to sport and exercise.

So what is going on?

Night cramp in older people is nothing to do with exercise, possibly it is the opposite. First, it happens after you have been lying very still, or for that matter, sitting playing bridge or watching a play.

Second, it does not – as most of medical website seem to think – wake you up. It commonly happens after stirring from deep sleep.

The initiation of movement appears to trigger a convulsive total motor unit contraction, usually in a specific muscle, which is anatomically quite clear and helpful to a physio!

In the absence of evidence about causes, nocturnal cramp is labelled idiopathic. There are plenty of hypotheses, apart from the spurious exercise one, including circulation, temperature, liver problems and dehydration.

Minetto et al* were exploring cramp, again in relation to athletes, but I suspect they were on the right track by looking at spinal inhibition failure, nerve conduction and motor unit stimulation thresholds.

I believe that, almost certainly, this research proved that nocturnal cramp in older people is due to a change in threshold frequency and links to malfunctioning spinal inhibition.

Why have I written this? Because having experienced it I know it must no longer be ignored. And it might well be a field in which the expertise of physiotherapists could make a significant contribution.

* Journal of Muscle and Nerve ,Vol 40 Issue 4 Oct 2009

File 195691Grandma Williams blog

Visit the Grandma Williams Wordpress blog to catch up on other posts from Joyce. You can also follow her on Twitter: @JoyceWilliams_

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Post date:

18 August 2017

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