My Legs Hurt When I Wake Up

You’re lying down on top of your bedspread and you notice that your legs hurt. You don’t know why they hurt so much — maybe it’s because you’ve been sitting for too long? Maybe it’s just from sleeping on your stomach? You try putting them up onto your pillows, but they hurt even more. The only thing you can do with them is lie there and wait until morning.
This scenario may sound familiar to many people who have diabetes. It also might be something you experience if you take certain medications such as diuretics. Or perhaps it could be part of a problem experienced by those who suffer from high blood pressure. And yes, it could also be something you experience if you have kidney disease or heart failure. But what about all those other types of leg pain? What causes this type of nighttime pain?
The good news is that it isn’t uncommon. In fact, the National Sleep Foundation estimates that approximately one-third of American adults over the age of 30 report having symptoms of insomnia, waking up several times during the night, not being able to fall back asleep, waking up stiff and tired, and feeling unrefreshed upon awakening [sources: Linnik; NIH]. This condition is called nocturnal intermittent claudication (NIC), which means that your calves are hurting at night due to reduced blood flow.
Peripheral artery disease (PAD) leg pain occurs when blood flowing through the arteries going into your legs becomes restricted. This reduced blood flow leads to muscle pains, cramps and fatigue. Although PAD is quite rare, according to the Cleveland Clinic, it affects an estimated 23 million Americans.
In order to find out how this process works, let’s first talk about what happens when we walk around throughout our day. Our hearts beat faster when we exercise, causing increased amounts of oxygen to reach our bodies’ cells. However, it’s important to note that although exercising increases the amount of oxygen in our body, it doesn’t increase the oxygen levels inside our vessels. Once oxygen reaches our cells, it reacts with enzymes present in our blood. These enzymes then combine with hydrogen molecules to form water, which keeps our blood fluid and healthy.
But when we sit still for too long, our heart rate slows down and so does the amount of oxygen available to our bloodstream. This is known as “ischemia,” which means lack of nutrients — specifically oxygen — reaching our tissues. So while walking around provides us with lots of oxygen, sitting still deprives our blood of oxygen. The result is that our blood becomes thicker and less efficient at transporting the oxygen-rich blood needed to nourish our muscles and bones. If our blood gets thick enough, it will clot and cause a blockage.
So how does this happen when we stand or sit? As mentioned before, our blood vessels become constricted with time. We’ll look at exactly how this happens on the next page.
How Do Arteries Get Stiffer With Age?
When we get older, it seems like our blood vessels start to weaken and lose elasticity. Blood vessels are made of two layers — the inner layer consists of a network of smooth muscle fibers that expand and contract to pump blood around the body. On the outer surface lies a thin film of elastin, which helps keep the walls flexible. Over time, however, damage to this outer layer causes the vessel to harden, and its ability to stretch decreases.
As we get older, the effects of these changes are felt more acutely. For example, when an elderly person stands up after sitting down, their blood pressure drops temporarily. A similar reaction takes place when someone has been standing for an extended period of time. This drop in blood pressure is caused by the sudden decrease in work put on the heart by gravity, and it’s known as postural hypotension.
With reduced elasticity and flexibility, our vessels are more likely to narrow and restrict the flow of blood. This narrowing is called atherosclerosis, which is a buildup of plaque along the interior of the vessels. As plaque builds up, it reduces the space across which the blood flows. Because of this narrowed area, blood must slow down, which makes it harder for oxygen to pass through.
If the narrowed section of the artery is located near the bottom half of your leg, you could develop pain in your calves at night. The reason is that during the course of normal activities, the foot pumps blood upward toward the heart and lower legs. At night, when you’re sleeping, the foot stops pumping blood and the upper legs relax. When you wake up, your calves are deprived of the blood that would normally go to supply them. This deprivation leads to numbness and tingling sensations.
While the exact reasons behind NIC are unknown, researchers believe that inflammation plays a role. Inflammation is the immune system’s response to injury, infection or stress. During periods of elevated activity, the inflammatory process kicks into gear. Normally, inflammation serves to protect our bodies from injury by fighting off bacteria, viruses and fungi. However, if inflammation goes unchecked, it can lead to problems such as rheumatoid arthritis, COPD and skin conditions like psoriasis. Since the inflammation associated with NIC is believed to be linked to poor circulation, it’s thought that controlling it should help reduce the severity of the pain.
To learn more about the causes and treatments for leg pain, check out the links found on the following page.
Leg pain related to the narrowing of blood vessels may be alleviated with medication. Those suffering from severe cases may need to undergo balloon angioplasty, stenting or bypass surgery. Unfortunately, some patients end up needing amputations due to complications arising from blocked blood vessels.

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