Why Did I Wake Up with My Legs So Swollen?

Waking up with swollen legs can be due to many causes, such as excess salt in the diet, obesity, arthritis, infection, venous insufficiency, lymphedema, alcoholism, blood clots, preeclampsia, and others.

Waking up with swollen legs can be a symptom of a number of conditions, some of which are minor and will go away on their own with rest or home treatment, and others that need to be treated medically. Abnormal buildup of fluid in the legs and swelling is called edema.

13 Causes of Swollen Legs

Common causes of waking up with leg swelling include:

• Excess salt in the diet
• Overweight/obesity
• Arthritis and other autoimmune conditions
• Infection
• Venous insufficiency, often due to varicose veins
• Lymphedema, a build-up of fluid in the fatty tissues under the skin
• Alcoholism
• Kidney, liver, or heart problems
• Blood clots, such as deep vein thrombosis (DVT)
• Pregnancy or pregnancy complications such as preeclampsia
• Injuries such as strains or sprains
• Insect bites or stings
• Side effects of some medications
  • Some blood pressure medicines including calcium channel blockers
  • Hormones such as estrogen and testosterone, such as in birth control pills or hormone replacement therapy
  • Antidepressants, such as MAO inhibitors and tricyclics
  • Steroids

Waking up with leg swelling may be accompanied by: 

• Swollen or puffy feet or ankles
• Skin redness or other changes in skin color
• Pain or tenderness
• Shiny, stretched skin

Call 911 or get to a hospital’s emergency department (do not drive yourself) if you wake up with leg swelling and have: 

• Chest pain, tightness, or heaviness
• Shortness of breath or difficulty breathing

If you wake up with swollen legs, a doctor will take a patient history and perform a physical examination. 

Tests used to help diagnose the cause of leg swelling may include:

• Blood tests
  • Complete blood count (CBC) 
  • Blood chemistry
• X-rays of the chest and/or legs 
• Doppler ultrasound examination of leg veins
• Electrocardiogram (ECG)
• Urinalysis

Treatment for swollen legs first thing in the morning will help reduce swelling and depends on the underlying cause. 

Home remedies to reduce or prevent waking up with swelling in the legs includes: 

• Reduce salt consumption 
• Lose weight if overweight or obese
• Gentle exercise, such as walking when you wake up, to help improve blood flow
• Lie down and prop up the swollen legs above the level of the heart
• Avoid wearing tight bed clothing or socks 
• Wear support stockings

Treatment for waking up with legs swollen due to arthritis and other autoimmune conditions depends on the condition and may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Steroids
• Disease-modifying antirheumatic drugs (DMARDs)

Treatment for waking up with legs swollen due to infection depends on the type of infection and may include:

• Antibiotics
• Wound cleansing and management
• Surgery

Treatment for waking up with legs swollen due to venous insufficiency/varicose veins may include:

• Leg elevation 
• Exercise
  • Foot and ankle exercises such as pointing the feet down and up (with the movement coming from the ankle) several times throughout the day to help move blood from the legs back to the heart
  • Repeatedly lifting the heels off the floor to stand on the toes
  • Walking to activate the calf muscle pump
  • Limit or avoid strenuous or vigorous exercise which might make varicose veins worse
• Compression therapy 
• Compression stockings 
• Intermittent pneumatic compression pumps 
• Compression bandages  
• Medications 
  • Diosmiplex (Vasculera), a medical food for people with veinous insufficiency
  • Antibiotics for skin infections
  • Creams or ointments for itchy skin

Treatment for waking up with legs swollen swelling due to lymphedema includes:

• Weight management
• Skin care (This is important because injury or infection can make swelling worse) 
  • Keep skin clean and dry 
  • Avoid hot baths, saunas, and steam rooms which may increase swelling
  • Moisturize daily
  • Clean any wounds right away with clean water, apply an antiseptic cream, and cover the area
  • Protect skin from the sun with SPF or clothing
  • Use insect repellent containing at least 50% DEET
    • For insect bites or stings, avoid scratching and use antihistamine cream for itch
  • Avoid weather extremes, including hot, cold, or windy weather
  • Don’t wear tight clothing or jewelry
  • Avoid sitting or standing for long periods of time if leg swelling is present
  • Don't have injections, blood draws, or blood pressure checks on an affected arm
• Compression therapy (i.e., compression bandaging, compression garments)
• Physiotherapy
• Surgery, in severe cases

Treatment for waking up with legs swollen due to kidney, liver, or heart problems includes: 

• Treating the underlying condition
• Reducing the amount of salt (sodium) in the diet
• Diuretics to eliminate excess fluid
• Compression stockings

Treatment for waking up with legs swollen due to blood clots such as deep vein thrombosis (DVT) includes:

• Anticoagulants
• Inferior vena cava (IVC) filter 
• Thrombolytic therapy, in severe cases

Treatment for waking up with legs swollen due to pregnancy or pregnancy complications includes:

• The only way for preeclampsia to go away is to deliver the baby
• If preeclampsia occurs before term, there is an attempt to delay delivery to 37 weeks 
• Home remedies may help relieve some swelling and discomfort

Treatment for waking up with legs swollen due to injury such as a sprain or strain includes:

• RICE method
  • Rest: keep weight off the leg
  • Ice: to decrease pain, swelling, and redness
  • Compression: to support the leg and prevent inflammation
  • Elevation: propped up the affected leg to help reduce fluid buildup 
• Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain
  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve)
• Range of motion exercises (depending on the type of injury)
• Splints and braces
• Surgery

Treatment for waking up with legs swollen swelling due to medication side effects includes:

• Stopping or switching medications or changing the dosage or regimen
• Don’t stop taking prescribed medication or change the dose or regimen without first talking to your doctor