This article was reviewed and co-authored by Dr. John Tiberi, M.D.,OS (board-certified orthopaedic surgeon).
Ripping the blankets off. Pulling the blankets up. Fluffing your pillow. Throwing a pillow to the ground. Tossing and turning. Groaning and moaning. Few things are more frustrating than lying awake at night unable to sleep. Pair sleeplessness alongside total exhaustion and uncontrolled pain, and you’ve got a recipe for a post-op breakdown.
It seems unfair that after enduring a joint replacement surgery that’s been stressful on your mind and body, you’ve found yourself unable to get a good night’s sleep. Unfortunately, you’re not alone. In fact, it’s very common that those recovering from a hip or knee replacement find themselves unable to sleep at night. It’s a double-edged sword: your body needs sleep to recover from the procedure, however, it’s the pain and side-effects of surgery that are contributing to your insomnia.
Read on as we share why you’re not sleeping and what you can do to fall asleep and stay asleep.
Why Sleep Matters for Your Recovery
Chances are, you already know that sleeplessness is affecting your mood and impacting your recovery. However, do you know that in the first weeks of recovery, sleep is extra important? Here’s why sleep matters more than ever.
- Sleep helps you physically heal. Sleeping lets your body rest and go into healing overdrive. It’s an opportunity for your inflammation, bruising and swelling to go down while you’re not physically active. WebMD adds to this: “While you sleep, your brain triggers the release of hormones that encourage tissue growth”.
- Sleep helps reduce stress and anxiety. A good night’s sleep can work miracles for combatting mental exhaustion, reducing blood pressure, and getting you back into the right headspace. Recovery can be mentally taxing. Sleep helps you mentally recharge so that you can think logically, keep an even mood, and more easily overcome setbacks.
- Sleep gives you the energy you need for ReHab. You need energy to work through physical therapy, to challenge yourself physically, to prepare healthier foods etc. Sleeping charges your batteries and gets you ready to take on the day’s challenges.
- Sleep boosts overall health. Sleeping 7-8 hours a night is linked with good heart health, an active metabolism, lower obesity rates, a better mood, lower anxiety, controlled blood sugar/diabetes, fewer accidents, and more.
3 Reasons Why You’re Not Sleeping at Night
Depending on the stage of recovery you’re in, there may be a few things contributing to your lack of sleep. Pain is a likely underlying reason you’re awake at night. In addition to the pain culprit, there are other contributors that are creating your ‘perfect storm’ of sleeplessness. Let’s break em’ all down.
- Pain and Discomfort: First and foremost, whether you’ve had a hip or knee replacement, you’re going to be in pain. This pain will last for several weeks (even months) until it’s well under control again. In the meantime, it’s undoubtedly affecting how well you’re sleeping at night. After you hit the 2-3 week mark in recovery, your narcotic pain medication may be cut down or eliminated entirely. At the same time, your activity level has likely increased due to the demands of your ReHab program. This can cause even more physical pain that can spike during bedtime.
- Narcotic Pain Medications: It seems there are several vicious cycles you’re a part of when it comes to joint replacement recovery and sleep. Another one of them is pain and painkillers. Painkillers combat pain, which helps you sleep, but the medication itself can cause insomnia. Some prescribed pain meds affect your natural REM cycle and disrupt sleep patterns. In addition, as you wean yourself off these medications and change your routine, you may notice increased trouble falling asleep. Note: Talk to your doctor about the side effects of any medications you’re taking.
- Depression and Anxiety: It’s not uncommon for someone who’s undergone a joint replacement to have feelings of depression. After all, your body has gone through something traumatic and the dependence associated with your recovery can make you feel isolated. Depression, stress and anxiety all can contribute to restlessness at night. *Note: The depression you feel should be temporary. Talk to your doctor if you notice that depression is getting in the way of your recovery. *
When will I start sleeping again? There’s no clear-cut answer for this. However, around the 6 week mark you should be experiencing less pain, be off pain medications that cause side effects, and you will likely get the green light from your care team to sleep in more comfortable positions.
Tips to Get to Sleep…and Stay Asleep!
Like the number of factors that are working together and causing you to lie awake at night, a bunch of things work together to help you sleep better. By employing a handful of tactics that are proven to promote better sleep, you should be able to catch more zzz’s at night. Here are some tips you can follow ASAP, to rest easy.
- Time a ‘Power Hour’ – Set an alarm 1 hour before bedtime to remind you to start your bedtime routine. If you’re still prescribed pain medication, now is the time to take it. Having a routine that you follow every day will help your body know when it’s time to fall asleep. During this hour-long unwinding, turn off electronics like TV, internet or tablet games. Why not try reading a book!?
- Ice, Ice Baby– Ice right before bed. This should help numb your joint and reduce pain without the use of pain medication. Alternatively, you can use an ice machine.
- No Light, Goodnight! – Bright lights caused from electronics like a tablet, cell phone, or TV can cause shallow, incomplete sleep. Artificial light confuses the part of the brain (affecting circadian rhythm) and this can set you out of your natural sleep pattern. Sleep in a dark room.
- Avoid Alcohol like the Plague– Not only should alcohol be avoided when taking pain medication, it alone contributes to poor sleep. Although alcohol can help one fall asleep, it actual activates parts of the brain that can wake you up and keep you awake.
- Limit Liquids– Cutting down on all drinks after dinner can mean dodging a bathroom trip in the middle of the night. There’s nothing worse than having nature call when you’re in the middle of a great dream!
- Avoid Stimulants (caffeine, cigarettes, foods)– This one may seem obvious, but a lot of teas, sodas, and even treats (like chocolate bars) contain caffeine. Caffeine builds up in the body, meaning that even if you drink an extra cup of coffee at 10am, it can still affect your sleep at night. Monitor your intake and read labels (especially beverages) as there could unexpectedly be caffeine. Also, if you’re a smoker, avoid any nicotine before bed (it’s a stimulant as well).
- Recline in the Bedroom– A recliner in your bedroom may seem odd, but not when it comes to joint replacement recovery. With limited positions that are safe to sleep in after surgery, you may actually find a recliner chair more comfortable and more promoting of your recovery (e.g. for knee replacement patients, having a leg raised).
- Keep it Cool— Cracking a window, turning the heat down, or turning on a fan can help you sleep. Dr. Christopher Winter, Medical Director at Charlottesville Neurology & Sleep Medicine, says “most studies agree that a temperature between 60 and 67 degrees Fahrenheit is optimal for sleeping”. This may be cooler than you’d typically keep your house during the day.
- Take Sleep Aids…With Caution— This is a tip we suggest with caution. Always talk to your doctor about taking any over-the-counter sleep aid, like Benadryl or Melatonin, and certainly about mixing any prescribed medications you may be on with prescription sleeping pills. There can be serious side-effects when it comes to mixing medications, let alone the habit-forming nature of some of these sleeping aid meds.
- Nap as a Last Resort– This one may be easier said than done. When you’re exhausted, sometimes the only way to make it through the day is with a nap. However, if you get into the habit of napping daily, you are without a doubt making it harder for yourself to fall asleep at night. Fighting through a day without napping could offer the full night’s sleep you’ve been longing for!
Safe Sleeping Positions: Do’s and Don’ts
Not being able to sleep in your go-to position can certainly keep you up at night. Unfortunately, when it comes to the safety of your new artificial implant, there are some positions that are off-limits. It’s important that you stick to safe positions and pay attention to your body.
Around the 6 week mark, once your physician gives you the greenlight, you may be able to return to sleeping in your preferred position (such as on your stomach or surgical side). Until then, stick to these positions.
Safe Hip Replacement Sleeping Positions:
Physicians Note: Sleep restrictions are tied to stability precautions. There are more sleep precautions for the posterior approach than the anterior approach. Ask your physician about positional precautions for sleeping to see if she/he have any for your joint replacement type. For instance, Dr. Tiberi adds that, “The position recommendations are variable. Personally, I don’t have any hip replacement position restrictions on sleep.”
- Back: This is the optimal position. This is the best position to avoid twisting your leg in the wrong direction. Do not turn your feet inward toward your surgical side. Try and keep toes pointed toward the ceiling.
- Non-Operative Side: You can sleep on the opposite side of your replacement. This means your operating side will face the ceiling. You must keep 2 pillows between your legs and supporting your foot. Use pillows between legs for 6 weeks or more more. Do not shuffle one leg forward and never cross your legs. If you’ve had a posterior approach hip replacement, do not turn toes inward.
Note: It is not safe to sleep on your stomach after hip replacement surgery. Do not attempt to lie in this position. It is also unsafe (and painful) to sleep on your surgical side. Consult your doctor to see if there are other positions you should avoid. After the 6 week mark, speak to your care team again to see if it’s safe for you to return to other sleeping positions.
Safe Knee Replacement Sleeping Positions:
- Back: This is the optimal position. Prop your surgical leg up with 2-3 pillows. Do not put pillows behind the knee. Alternatively, you can use a foam wedge/foam elevator to sturdily keep your leg above your heart. Some doctor’s don’t recommend foam wedges so ask your physician before using one.
- Non-Operative Side: You can sleep on the opposite side of your replacement. This means your operating side will face the ceiling. You must keep 2 pillows between your legs. Use pillows between legs for 6 weeks or more more. Do not shuffle one leg forward and never cross your legs.
Note: It is not safe to sleep on your stomach after knee replacement surgery. Do not attempt to lie in this position. It is also unsafe (and painful) to sleep on your surgical side. Consult your doctor to see if there are other positions you should avoid. After the 6 week mark, speak to your care team again to see if it’s safe for you to return to other sleeping positions.
Your recovery requires all the dedication and energy you have. If you’re not sleeping properly through the night, your batteries aren’t getting fully charged. For early access to articles like this, join the peerwell blog. Having a joint replacement? Sign-up for PeerWell and you may be able to PreHab on your smartphone alongside proactive peers!
John Tiberi, M.D.,OS is a board-certified orthopaedic surgeon who specializes in minimally-invasive hip and knee replacement surgery and reconstructions. He attended medical school at the Harbor-UCLA Medical Center in Torrance, California. Dr. Tiberi completed his fellowship at Massachusetts General Hospital and Harvard Medical School in Boston, Massachusetts. He is a published orthopedic in journals such as The Journal of Arthroplasty, Journal of Bone Joint Surgery (JBJS), and Clinical Orthopaedics and Related Research. Dr. Tiberi is the winner of Dana M. Street Orthopaedic Research Award.