What advice should I give to patients regarding lifestyle modifications to prevent nocturnal leg cramps?

Advice for patients on lifestyle modifications to prevent nocturnal leg cramps:

• Reassure patients that idiopathic leg cramps are common, usually have no serious underlying cause, and often resolve spontaneously without intervention.
• Advise patients to try stretching exercises of the affected muscles (calf and hamstring) three times daily, as combined daily stretching may reduce the severity of nocturnal leg cramps, although evidence of effectiveness is limited and no standard protocol exists.
• Recommend stretching and massaging the affected muscle during an acute cramp to alleviate symptoms, for example, straightening the leg and dorsiflexing the ankle if the calf is affected.
• Suggest self-care measures during sleep to limit foot dorsiflexion, such as propping feet up with a pillow when lying on the back, hanging feet over the bed edge when prone, and keeping bed covers loose to avoid toes pointing downwards.
• Encourage patients to maintain these self-care measures if they find them beneficial, but inform them that there is no strong evidence that these lifestyle modifications definitively prevent cramps.
• Advise patients to return if the frequency, severity, or nature of cramps changes or if cramps significantly impact quality of life.

Note that pharmacological treatments like quinine are generally not recommended due to safety concerns and limited benefit, and other drugs lack strong evidence for use in idiopathic leg cramps.

Written self-care advice, such as NHS patient information on leg cramps including instructions on calf stretching, can be offered to support these recommendations.

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