How do you treat nocturnal leg cramps?  

Nocturnal leg cramps are similar to daytime leg cramps, but stretching may be less convenient to use as a remedy, as sleep can be further disrupted. Treating and preventing leg cramps typically utilizes some combination of hydration and electrolytes but sometimes, medications can help. Consider the...

Magnesium glycinate 360 mg nightly is highly effective. In addition, exercising muscles during the day is helpful and should be encouraged.

It is important to note that we almost never identify a cause for nocturnal leg cramps. In my experience, the most common correlate is aging. After a targeted history, physical examination, and medication review, offering reassurance is also part of the therapeutic armamentarium.

I agree with a few of the comments above - magnesium seems to be extremely helpful for treatment of cramping. Using magnesium in the form of magnesium glycinate has the added benefit of improving sleep quality (a few papers easily found with this search: https://pubmed.ncbi.nlm.nih.gov/?term=gl...

I have had great success with magnesium supplementation (magnesium glycinate or citrate 400-600 mg at bedtime) for patients with no clear other metabolic explanation for the muscle cramps. 

Some patients misrepresent the experience of leg cramps as the experience of restless leg syndrome. When conventional approaches fail, I have recommended a sleep study to look for evidence of restless leg syndrome and found a few patients who responded to therapy for restless leg syndrome once corre...

Nice discussion by all of the contributors!One significant cause of nocturnal leg cramps, not mentioned thus far, is lumbar spinal stenosis. The prevalence of leg cramps in this population seems to correlate with the severity of the dural sac cross-sectional area, as noted on the LS spine MRI. Furth...

I have found mexiletine to be very helpful (about 2/3 of patients I have given this have remarkable improvement). There was a randomized crossover study of mexiletine vs. placebo in ALS patients, and there was a significant reduction in the frequency and severity of cramping when the patient was on ...