Achy Legs at Night: Causes, Symptoms, and Effective Relief

Medically reviewed by Zoe Deol, MD,FACS, DABVLM

Achy legs at night do more than disrupt sleep. They can indicate severe underlying health issues.

But there is good news.

Whether the cause is musculoskeletal, nerve related, or a circulatory problem, identifying the root cause is the first step toward the correct treatment option.

And you are on the right page.

Keep reading to explore the common reasons behind nighttime leg pain and discuss practical treatment strategies to improve your sleep and overall leg health.

Common Causes of Leg Pain at Night

1. Age

As you age, your muscles naturally lose mass and elasticity. That is why some of our clients experience increased stiffness and discomfort, especially at night.

The arteries in your legs may also harden, reducing blood flow, or the veins in your legs may malfunction leading to cramps or achy legs. Another effect of age is that these nerves in your legs may become less efficient at sending signals.

The result is a delay in muscle relaxation, leading to tired, achy legs and feet at night, as well as leg cramps.

2. Dehydration

Dehydration leads to an imbalance of electrolytes like potassium, magnesium and calcium.

You might not know it, but these minerals are essential for muscle function. When your body lacks these minerals, involuntary muscle contractions or cramps are a common symptom.

Interestingly enough, these cramps happen most often in the legs.

Why? Not only do our legs have the largest and most used muscles in our body, but they also are the lowest part of our body, making gravity a factor in our blood circulation.

At night, when your body is less active, these cramps become more pronounced due to the buildup of lactic acid from the day’s activities. That can lead to achy legs which disrupt sleep.

3. Medication

Certain medications, such as diuretics or statins, lead to leg pain and achy feet at night as a side effect.

How? Here’s how that works.

Diuretics, which are usually prescribed for high blood pressure, can deplete your body of water and essential electrolytes, which can then lead to muscle cramps.

Statins, used to lower cholesterol, can sometimes cause muscle pain or weakness, too. This occurs most often at night when your muscles are at rest. The addition of a simple vitamin supplement called CoQ-10 can aid in counteracting the negative side-effects of statin medications.

4. Pregnancy

The pregnant body undergoes significant changes that can cause severe leg pain at night, contributing to leg health issues during pregnancy.

Let’s break it down.

First, the increased blood volume and extra pressure on your veins can cause varicose veins and swelling, both of which are painful.

Hormonal changes can also affect your muscle and nerve function, causing cramps or a heavy feeling in your legs, particularly during the third trimester.

5. Alcohol Consumption

Alcohol consumption contributes to nightly leg pain by dehydrating your body and disrupting your electrolyte balance, which can cause muscle cramps, much like general dehydration.

But there’s another aspect to alcohol and achy legs at night.

Alcohol also affects your nervous system, which can increase nerve pain or muscle spasms during the night. Regular alcohol use exacerbates these symptoms, making your nighttime leg pain more frequent and severe.

6. Muscle Cramps

Muscle cramps, or "Charley horses," are sudden, involuntary muscle contractions. You typically experience them as a result of joint/muscle aging, fatigue, dehydration,electrolyte imbalances, or hereditary varicose vein disease. These cramps can result in intense pain and stiffness that disrupt sleep quality.

Potential Health Conditions Associated with Achy Legs and Feet at Night

close up view of what causes varicose veins

1. Restless Legs Syndrome (RLS)

RLS is a neurological disorder marked by an irresistible urge to move the legs. Also known as the Willis-Ekbom Disease, it’s usually accompanied by tingling or itching sensations. Symptoms typically worsen at night when the body is at rest and can severely disrupt sleep. This condition is linked to low levels of iron stores and dopamine imbalances.

2. Varicose Veins

Varicose veins are enlarged malfunctioning veins that cause aching, throbbing, and a heavy feeling in the legs, especially after prolonged sitting or standing. This common condition occurs when valves in the veins fail, leading to blood pooling and reduced circulation. This condition can exist under the surface, even without visible surface varicose veins.

3. Peripheral Arterial Disease (PAD)

PAD is caused by fatty deposits in the arteries. These deposits restrict blood flow to the limbs and cause pain, particularly during physical activity and at night. If untreated, PAD can lead to severe complications like amputation.

4. Nerve Pain

Nerve pain has a slew of causes such as arthritis and bulging discs in the spine, but one of the most common causes is diabetic neuropathy. Nerve pain tends to worsen at night. You can experience it as burning, numbness, tingling, or severe pain, which prohibits restful sleep.

5. Blood Clots

Deep vein thrombosis (DVT) involves blood clots forming in deep veins, usually in the legs. This condition causes swelling, redness and intense pain, especially during periods of immobility when your blood flow slows down.

6. Chronic Conditions

A slew of chronic diseases can lead to knee, leg and foot pain at night. For example:

Gout: This is a type of arthritis characterized by sudden, severe attacks of pain and swelling, often affecting the joints in the lower limbs.
Arthritis: Arthritis, including osteoarthritis and rheumatoid arthritis, can cause inflammation and stiffness in the knees and other joints, leading to uncomfortable sensations and pain, especially at night.
Sciatica: Caused by irritation or compression of the sciatic nerve, sciatica results in radiating pain from the lower back down through the legs. This pain often worsens at night and makes restful sleep challenging.

What are the seven best ways to stop leg aches at night?

1. Compression Stockings and Socks

Compression socks are an effective solution for heavy, achy legs at night. That’s because they enhance blood circulation AND reduce swelling.

Here’s how that works.

Compression socks apply graduated pressure to promote better venous return. The result is enhanced blood flow back to the heart.

That means you can get significant relief from the symptoms of varicose veins, chronic venous insufficiency, and even Restless Legs Syndrome.

The benefits of compression socks are extensive because they help:

Manage muscle cramps
Reduce the risk of blood clots
Provide relief from pain associated with swelling

graphic illustrating how graduated compression helps with the treatment of chronic leg disorders

2. Stretching and Foam Rolling

Stretching and foam rolling twice a day (after hot shower or bath) is great for management of achy legs and feet. That’s because both improve blood circulation and relieves muscle tension. The point is to improve ROM (range of motion) which in turn prevents aching and cramping in leg muscles after a day of intense use or, even worse, complete inactivity.

3. Heat Therapy

Applying heat, such as with a heating pad or even a hot bath, soothes sore muscles and joints because it increases blood flow. The result is fewer muscle spasms and pain relief so you can sleep better.

4. Cold Therapy

Cold compresses reduce swelling and soothe sore tissues in inflammatory conditions or injuries. Cold therapy constricts your blood vessels. This leads to slower blood flow, which, in turn, decreases inflammation and pain signals.

5. Pain Relief Medications

Over-the-counter (OTC) pain medications like ibuprofen or acetaminophen reduce inflammation and block pain signals to the brain. This will help you get rid of nightly leg pain or achy feet. There are even OTC topical creams that you can rub directly into the sore area if you prefer. Consult a healthcare professional before starting any new medication. An old-fashioned remedy for leg cramps at night is Tonic Water. Tonic water contains quinine which can be effective at relieving leg cramps.

6. Lifestyle Modifications

Maintain a healthy weight and balanced diet, stay hydrated, and exercise regularly to prevent heavy, achy legs at night. Practice ankle flexion exercises while on the job. You should also avoid alcohol and caffeine before bed, which can worsen symptoms like Restless Legs Syndrome, along with your sleep.

For example, you should maintain a cool, quiet sleep environment and stick to a regular schedule. The point is to reduce your stress and fatigue, which can exacerbate leg pain.

7. Physical Therapy

Physical therapy addresses underlying causes of leg pain by strengthening your muscles, improving your mobility and enhancing your circulation. A physical therapist will know exactly what type of exercises can reduce your symptoms and how best to adjust your daily activities.

Top Warning Signs That It's Time to See a Doctor for Leg Pain

doctor performing ultrasound on leg veins

1. Severe or Persistent Pain

If you experience severe pain that doesn't improve with rest or over-the-counter medications, it's a sign to find a qualified doctor. Persistent pain can indicate underlying conditions such as joint disease, nerve damage or circulatory problems.

2. Pain with Swelling, Redness, or Warmth

These symptoms can indicate an infection or inflammation, such as cellulitis. Swelling and warmth might also suggest blood clots or Deep vein thrombosis (DVT) especially if the area is tender to touch. If you have these symptoms, you need immediate medical evaluation to prevent more serious complications.

3. Changes in Skin Color or Temperature

Legs that are pale, discolored, or feel cooler than usual can be signs of poor blood circulation or a blockage in the arteries. These changes can stem from arterial disease or Peripheral Arterial Disease. Again, you need prompt medical attention to restore proper blood circulation.

4. Numbness or Tingling Sensations

Numbness or a "pins and needles" feeling usually indicates nerve damage, such as from diabetic neuropathy or sciatica. These symptoms suggest that the nerves in your leg are not functioning correctly. Unfortunately, this can lead to long-term damage if not treated promptly.

5. Inability to Put Weight on the Leg

If pain or injury prevents you from putting weight on your leg or if you have difficulty walking, schedule a visit with your healthcare provider. This could be due to a serious injury, such as a fracture or severe muscle or ligament injury.

6. Fever Accompanying Leg Pain

A fever alongside leg pain can indicate an infection, such as cellulitis or osteomyelitis. These conditions require medical intervention to prevent the spread of infection and more serious health complications.

7. Sudden Onset of Symptoms

Any sudden or abrupt symptoms, like intense pain, especially with swelling and warmth, can be signs of a serious condition like a blood clot or DVT. You need immediate medical treatment to address potentially life-threatening complications.

Rest Assured: How to Overcome Heavy, Achy Legs at Night

Achy legs at night shouldn't keep you from a restful sleep.

Here’s our advice: understand what causes your leg and feet aches at night.

Then, learn the right treatment combination for your needs. Doing the necessary lifestyle adjustments and using compression socks will give you the relief you need.

Explore our website for more tips and solutions to maintain your leg health and overall wellness.

FAQ

Why do my knees and legs ache at night?

Knees and legs can ache at night due to poor blood circulation, arthritis, or nerve issues like peripheral neuropathy. Reduced movement during sleep decreases blood flow, which can cause stiffness and discomfort. Conditions such as Restless Legs Syndrome and Varicose Veins can also trigger nighttime leg pain.

Why do my legs ache at night like growing pains?

Nighttime leg aches, similar to growing pains, often result from muscle overuse, stress, or conditions like Restless Legs Syndrome. These aches are typically caused by muscle fatigue, reduced blood flow, or nerve irritation.

What deficiency causes leg cramps at night?

Nocturnal leg cramps can be due to deficiencies in minerals like magnesium, potassium, or calcium, which are essential for muscle function. An imbalance can lead to involuntary muscle contractions and cramps. That’s why you need a prompt physical examination.

What are red flag symptoms of leg pain?

Red flag symptoms include severe pain with swelling, redness, or warmth, indicating possible blood clots or infections. Numbness, tingling, or inability to bear weight may suggest nerve damage or serious circulatory issues.

How to stop aching legs?

To relieve aching legs, try stretching, massaging, or applying heat therapy to relax muscles and improve blood flow. Staying hydrated, exercising regularly and using compression socks can also help.

Why do my legs hurt at night only?

Nighttime leg pain often results from reduced blood flow or muscle relaxation during sleep, which can worsen conditions like Varicose Veins or Restless Legs Syndrome. Your levels of serotonin and dopamine also decrease during sleep, so they can make pain more noticeable. Besides, low dopamine is linked to conditions like Restless Legs Syndrome.

How can you tell the difference between muscle pain and bone pain?

Muscle pain is usually a dull ache that worsens with movement or pressure, while bone pain is sharp, constant, and often will be more severe at night, possibly indicating fractures or infections.

Who should I see about my achy legs at night?

If you experience persistent aching in your legs at night, you should first consult a primary care physician. They can evaluate your symptoms, provide initial treatment, and determine if you need to see a specialist. Depending on the cause, you might be referred to:

A Vein Specialist for varicose veins or a vascular specialist for Peripheral Arterial Disease.
A neurologist if your symptoms point to nerve-related conditions, like Restless Legs Syndrome spinal nerve entrapment.
An orthopedic specialist if the pain is due to musculoskeletal issues, such as arthritis or tendinitis.
A rheumatologist if the pain is related to autoimmune inflammatory conditions, like Rheumatoid arthritis or Lupus.

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