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Without night time mestinon I was waking up short of breath and with low oxygen saturation so there was a reason to take it overnight. I tend to get muscle cramps at the end of the day that seem to be affected by my mestinon dose timing, worse in the first hours soon after I take the 60 mg pill. But I take a sleep aid when I go to bed so I can get the benefit of the better breathing while not being woken up by cramps. I do get the toe cramps that someone else described here but they are easier to tolerate than waking up short of breath during the night. I reckon MG is a little different for each of us so we each have to find a coping regime that works for us.