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This post was reviewed by Dr. John Tiberi, M.D, O.S.

Let’s face it, after joint replacement surgery sleeping sucks. It’s tougher to fall asleep and even harder to stay asleep. A lot of this has to do with the pain and discomfort you’re experiencing, the medications you’re taking, the emotional distress you are recovering from, and not being able to sleep in your preferred position (like on your side). In other words, after surgery, there’s a perfect storm for insomnia.

If you’ve found this article, chances are you’re suffering from a lack of sleep after orthopedic surgery or you’re asking “when is it safe to sleep in my favorite position again?”. Well, you’ve come to the right place! Read on to learn why you’re not sleeping and when it’s safe to sleep on your side again.

Before we dive in, let’s do a quick recap on why sleep is so important in your recovery.

Why Sleep Matters After Joint Replacement Surgery

  • Sleep lets you heal. Sleeping puts your body in an unconscious, relaxed state. Since you’re not exerting any physical energy while sleeping, your body can channel this energy into healing. Sleeping allows your inflammation, bruising and swelling to go down and even triggers the release of hormones that grow tissue.
  • Sleep reduces anxiety and depression. After surgery, there is an emotional healing that must take place. A lot of patients also experience post-op depression. Sleep is hugely important for fighting mental exhaustion and hitting your emotional reset to put your all into recovery.
  • Sleep gives you the energy you need for ReHab. Working through your at-home ReHab routine, physical therapy, and everyday tasks require extra energy when you’re in physical pain. If you’re not sleeping at night, you’re not going to have the physical or mental stamina to perform your best and recover as quickly as possible. 7-8 hours of sleep at night is linked to a better emotional mood, less depression, better health, faster healing, and fewer accidents.

Read our popular post, “Trouble Sleeping After a Joint Replacement?” Here’s What to Do” for why you’re not sleeping well and for tips on how to stay asleep.

Why You’re Not Sleeping Well

not sleeping well

  • You’re in Pain and Discomfort: After a replacement, pain will last for several weeks. Naturally, being in pain will affect your ability to sleep at night. You may notice that your sleeplessness coincides with spikes of pain. These spikes of pain in recovery can occur when your physical therapy intensifies, after physical therapy sessions, when your narcotic pain medication dose is reduced. Read this article, “What Pain Can I Expect After Joint Surgery.”
  • Pain Medication: Prescribed pain medication can actually contribute to insomnia. The medication interfere with your natural REM cycle, disturbing your sleep pattern. Before self-adjusting your pain medication schedule or dose, speak to your physician. He/she may be able to offer you a different pain medication that won’t interfere with your sleep or temporarily prescribe sleeping medication. Learn more about safely taking narcotic pain medication after joint replacement surgery.
  • Depression: Although you may be beating yourself up for feeling “down” after surgery, know that a lot of people experience anxiety, stress and depression. Having surgery makes you dependant on others, has you cooped up at home, has you in pain, and on medication. All of these things can add to anxiety and post-op depression. Depression can affect your ability to fall asleep and to sleep soundly at night. Learn more about depression after hip and knee replacement surgery and how you can overcome it.
  • Can’t sleep in your favorite position: Sleeping with your leg propped up on a foam wedge or pillows, in a recliner, or on your back, simple isn’t that comfortable. If you’re used to sleeping on your side, it can be hard to get to sleep in a less natural position. Read on as we share when you can start sleeping on your side after a hip or knee replacement.

Safe Sleeping Positions After Hip and Knee Replacement Surgery

Safe Sleeping Positions After Hip and Knee Replacement Surgery

Not being able to sleep in your go-to position can keep you up at night in the best of times. Unfortunately, after a hip and knee replacement there are some positions that are off-limits. Safe sleeping positions (like safe sex positions after a replacement) depend on the type of replacement you’ve had and the approach.

If you follow our “sleep position cheat sheet” below, consult your physician, and self-regulate, you should be in the clear. If you self-regulate your sleep positions, you’re unlikely to force yourself into a painful position too early in recovery.

Safe Sleeping Positions After a Hip Replacement: When Can I Sleep on My Side?

Safe sleeping positions can depend on your hip replacement approach (anterior or posterior). In order to be safe and to follow your hip precautions, you should always consult your physician about his/her recommended sleep positions for you. As a general rule of thumb, sleeping on your back is the best position. In opposition, sleeping on your stomach is never recommended after surgery. Your non-operative side can be okay if you’re careful.

Generally, if your surgeon signs-off, it is usually safe to sleep on your surgical side when it feels comfortable. This will not be until about the 6 week mark. Do not sleep on your surgical side before consulting with your doctor.

Play this video to hear what Dr. John Tiberi, orthopedic surgeon in Los Angeles and Southern California has to say about sleeping on your side after a hip replacement.

Hip replacement sleep position cheatsheet:

  • Back: Yes! This is the safest position. Remember not to turn your feet inward toward your surgical side and try and keep toes pointed toward the ceiling.
  • Side: Maybe. You can sleep on the opposite side of your replacement. Always keep 2 pillows between your legs. Use pillows between legs for 6 weeks or more more. Never cross your legs. Remember: if you’ve had a posterior approach hip replacement, do not turn toes inward. Do not sleep on your surgical side until your physician has said it’s okay.
  • Stomach: No. This is not a safe position for the first weeks of your recovery. Talk to your doctor around the 6+ week mark if you think you’re ready to test new sleeping positions.

Safe Sleeping Positions After a Knee Replacement

The safe sleeping positions after a knee replacement are similar to a hip replacement. It’s important to keep your surgical leg elevated while you’re sleeping but to not put pillows directly behind your knee (this can cause stiffness and put you at a greater risk for a manipulation). Rememeber, your surgeon knows you and your replacement best. Always consult him/her about the safest sleeping positions for you.

Knee replacement sleep position cheatsheet:

  • Back: Yes! This is the best position for safety. Prop your surgical leg up with 2-3 pillows. Do not put pillows behind the knee. You also use a foam wedge/foam elevator. Some doctors don’t recommend foam wedges so ask your physician what their preference is.
  • Side: Maybe. You can sleep on the opposite side of knee replacement (surgical side facing the ceiling). Keep 2 pillows between your legs for 6 weeks or more more. Do not shuffle one leg forward and do not cross your legs. Do not sleep on your surgical side until your physician has said it’s okay to do so.
  • Stomach: No. This is not a safe position early in your recovery. Talk to your doctor around the 6+ week mark if you think you’re ready to try out some new positions reserved for later in recovery.

Have joint pain? Join PeerWell and get to the root cause of your pain now!

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.

In pain? Preparing for surgery? PeerWell Health helps you fast forward to better with 1:1 doctor visits, physical therapy, and a custom at-home program for your condition. 

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