by Kathleen A. Hogan, M.D.
One of the most common complaints after knee or hip replacement is difficulty sleeping. By six weeks after surgery, most people are having less pain in their new joint and increasing their activity. But they often lay awake at night, unable to sleep. Why does this happen and what can be done about it?
Many people have difficulty sleeping in the hospital immediately after surgery. This has many causes, including the stress response to surgery, cytokine release from soft tissue injury, the pain, medications, and the hospital environment. REM sleep (associated with dreaming) is diminished for the first few days after surgery.
Surprisingly, there are no published studies on the frequency of sleep disturbance several weeks or months following joint replacement surgery. However, in one study of patients with broken bones, 41% of patients with shoulder fractures and 36% of patients with knee fractures had difficulty sleeping 3 months after the injury. Even a year later, 20% of patients still reported insomnia.
Insomnia after joint replacement surgery can have many causes. Pain and discomfort are common complaints. Narcotic pain medicines can also disrupt sleep patterns, and decrease the time spent in REM sleep.
What can you do if you are still having difficulty sleeping several weeks after surgery? First of all, make sure you discuss this with your doctor, as she or he may have specific recommendations for you. Good sleep hygiene is important. Avoid caffeine and alcohol immediately before bedtime. Avoid napping during the day. Limit the use of electronic devices in the evening, including your phone. Create a quiet, peaceful atmosphere in your bedroom. Create a peaceful bedtime routine which allows you to relax and instead of dwelling on the discomfort you are having from your surgery. Consider using an eye mask, ear plugs, or a white noise machine. Meditation techniques can be helpful in promoting relaxation. Supporting your leg with pillows can improve comfort.
If you are unable to sleep after 30 minutes, do not lay in bed thinking about how you can not sleep. Get up, go to another room, and read quietly listen to relaxing music, or sit in a chair in a darkened room. Do not watch TV or check email! Using electronic devices will stimulate the brain and cause you to become more awake. Make sure you are getting exposed to some natural light during the day and keep your sleep environment dark as this helps to maintain normal sleep cycles.
What about medications? If you just had surgery, taking your pain medication 30 minutes prior to bedtime is recommended. However, keep in mind that your body may become accustomed to this routine and you may develop insomnia when weaning off these medications. Medications which help with sleep are often habit forming and should be avoided. Some people find Benadryl or melatonin to be helpful, but you should discuss this with your doctor.
Depression is not uncommon after surgery. Sometimes the recovery period can be quite overwhelming. Symptoms can include persistent feelings of sadness and hopelessness. Difficulty sleeping, loss of energy, anxiety, and irritability can also be symptoms of depression.
If you are having problems sleeping after surgery, make sure you talk to your surgeon about it. However, it can take quite some time for the sleep issues after surgery to resolve. It can be a very frustrating aspect of the post operative course after joint replacement surgery. It can take several months for your body to fully recover from the effects of surgery.