DEAR DR. DONOHUE: Leg cramps ruin my sleep. When they come on, they wake me with a start, and they come on almost every night. My doctor told me to take warm baths before going to bed. I did that for a week, but I still cramped up. Have you any suggestions? — B.W.

ANSWER: I just covered restless leg syndrome, the treatments for which are somewhat similar to nighttime leg cramps. The cause of these cramps hasn’t been found. Many have offered explanations, but their proof leaves much to be desired.

Some say deficiencies of calcium, magnesium and potassium bring on the cramps. A sluggish thyroid gland is another suggestion. It might be that nerve cells send a barrage of messages to leg muscles, which leads to sustained, painful muscle contractions. Older people are the ones most likely to develop nocturnal cramping. It might be that they are susceptible because they get less exercise during the day. Exercise (walking) is a prevention.

Medicines are involved, in a few cases. Diuretics that deplete body potassium can trigger cramping. The situation is corrected by switching diuretics or supplying potassium.

Quinine was a favored treatment, but it has been taken off the market for that purpose. It can lead to dangerous complications. Tonic water has a touch of quinine in it, and some people swear that it is effective for cramp prevention. It doesn’t hurt to try it.

Other preventive methods are making sure your feet do not flop downward when you sleep on your back. Keep them propped up by loosening the blankets and sheets at the foot of the bed or by wedging pillows between the soles of the feet and the end of the bed. Stretching before retiring is another way to stop cramping. Stand 3 feet from a wall with one foot in front of the other. Lean into the wall, supporting yourself with your hands or your forearms. Hold that position for 10 to 30 seconds and then switch foot positions. Five repetitions for each leg are the minimum.

DEAR DR. DONOHUE: For two weeks, I used an athlete’s foot cream that I got from my drugstore. It didn’t work. What would you recommend? — K.R.

ANSWER: Athlete’s foot is a fungal infection. Fungi love dark, moist places, so part of your treatment has to be airing out your feet by wearing sandals. Two weeks isn’t enough time to judge a medicine’s effectiveness; four weeks is required. Continue to apply the medicine for another week after all signs of infection have gone. You didn’t mention your medicine’s name. Lotrimin AF, Micatin and Tinactin are reliable products, obtainable without a prescription.

DEAR DR. DONOHUE: I couldn’t tolerate Lipitor for my high cholesterol, so my doctor put me on Niaspan. Since taking it, I have an itch. Could it be due to Niaspan? I’m thinking of stopping it. — G.D.

ANSWER: Niaspan is a slow-release form of niacin — nicotinic acid. It lessens the production of LDL cholesterol (bad cholesterol) and increases the production of HDL cholesterol (good cholesterol). It also lowers blood levels of triglycerides, fatty materials that work in concert with cholesterol to plug arteries.

Side effects of Niaspan include flushing, itching and tingling sensations. If you can tolerate aspirin and if you have no contraindications to using it, take one 325-mg aspirin or one ibuprofen half an hour before taking the Niaspan, and your itching might stop.

If you discontinue Niaspan on your own, do so for a week at the most to see if the itching goes. Notify your doctor if it comes back when you resume taking the medicine.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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