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.
• 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 uncertain and no standard protocol exists.
• During an acute cramp, recommend stretching and massaging the affected muscle, for example, straightening the leg and dorsiflexing the ankle for calf cramps.
• 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.

These lifestyle recommendations are based on expert opinion and limited evidence, reflecting good clinical practice rather than strong trial data.