What to Do If You Have Trouble Sleeping After Surgery

Sad woman suffering from insomnia
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Sleeping poorly after surgery is very common in the days and weeks immediately following surgery. The problem is typically at its worst the first few days after surgery, especially for those patients who are recovering in the hospital or another medical facility rather than in their own home.

Simple factors can certainly play a role, such as using a different pillow than the one at home, the way the mattress feels, and even the inability to assume one’s preferred sleep position. Those types of problems can certainly play a role, but there are additional ways that sleep is inhibited by surgery.

According to research published in Current Opinions in Anesthesiology, sleep disturbances are common occurrences that affect both rapid eye movement (REM) and short-wave sleep (SWS) for around seven days following surgery.

The sad truth is that people usually often need more sleep after the stress of surgery, but the quality of sleep may be poorer than ever.

Causes

There can be many reasons why you unable to sleep after a surgery. Some of the most common include:

  • Frequent waking: If you are recovering in the hospital, you may be having your vital signs taken by staff every few hours, and most hospitals draw labs in the middle of the night. Even if you are napping during the day, you may find yourself waking up in order to take your medications on schedule, for physical therapy, breathing treatments, or to speak with your doctor.
  • Poor airway control: Poor airway control often results in sleep apnea (short periods of not breathing during sleep) and snoring. If you already have a sleep apnea or snoring problem, you may find that it worsens in the days after surgery. Narcotic pain medication can decrease an individual's control over their airway during sleep, as can the very deep sleep that comes from exhaustion.
  • Pain: It can be very hard to sleep when you are experiencing pain, especially when moving in your sleep causes pain and wakes you from a deep sleep. Pain can make it difficult to fall asleep, stay asleep and reach deep sleep.
  • Larger surgeries: Longer and more involved procedures often result in poorer sleep. It makes sense that a person who had open heart surgery will have a harder recovery than someone who had carpal tunnel surgery. Larger surgeries require longer hospital stays, more attentive care from the medical staff, more medication, more anesthesia, and a longer recovery.
  • Steroids and other drugs: Steroids are a wonderful medication to decrease inflammation, but they often cause difficulty sleeping. This may be remedied by taking steroid medications in the morning. There are also painkiller and other medications that can make you feel groggy when you want to feel wide awake.
  • Noise: Hospitals are noisy places and if you are having trouble falling asleep or staying asleep, the noise may seem like a marching band walking down the hallways. Your IV pump may start beeping at random times, and you may have a roommate who snores.
  • Hunger and thirst: Patients who are not permitted to eat may find that their hunger or thirst is annoying enough to prevent sleep.
  • Room temperature: While many hospitals offer temperature controls in individual patient rooms, many do not. If you are an individual who prefers a cold room for sleep and your hospital room is warm, you may have difficulty sleeping.
  • Monitoring devices: If you are in the hospital, you have heart monitor probes on your chest, an oxygen saturation probe on your finger, and an IV in your arm, and drainage tubes in your incision wound. These can make you feel as though you are trying to sleep while tangled in a net.
  • Increased Stress Hormones: Surgery is emotionally and physically stressful. This can lead to an increase in stress hormones in the body, which in turn make sleep more challenging.
  • Morphine: Morphine and morphine-based pain medications have a known ability to interfere with sleep. While pain relief can improve sleep, pain medications can often have a side effect of insomnia or "jitters".
  • Light: If you typically sleep in a very dark room, the constant light in hospital hallways, the parking lots outside your window and even the night lights that may constantly be on in your room for safety may hinder your ability to sleep.

Tips for Improving Sleep

If you are having trouble sleeping during your recovery after surgery, one of the best things that you can do is to try to pinpoint the issue or issues that are preventing sleep.

If you are troubled by ambient light, a sleep mask may be of great comfort, while earplugs may help if you are struggling with the noise.

You may sleep better sitting up in a comfortable chair or with extra pillows, especially if you have sleep apnea or snore. The change in the height of your head can often decrease these symptoms and allow for more restful sleep.

If medications are interfering with sleep, ask your doctor if it's possible to adjust the dose or switch to another drug. If pain medications are the problem, you may benefit from switching to a non-opioid pain reliever like Tylenol or ibuprofen.

Bear in mind that over-the-counter pain relievers may not be as effective as their prescription counterparts. Weight the benefits and potential consequence before requesting a change. Never alter a dose or stop treatment without first speaking with your doctor.

Last but not least, always be aware of your surroundings. If the temperature is an issue, be proactive about changing the thermostat before going to sleep. If noise is an issue, it’s perfectly acceptable to ask the staff to decrease the noise level.

You may also need to ask family members to keep their visits short if they are causing you stress (a big factor in the risk of insomnia). Most all don't silent if you're having trouble sleeping. The less sleep you have, the slower your recovery may be.

Using Sleeping Pills

There are many medications and supplements available to enhance sleep. It is important that you speak with your healthcare provider before starting a sleep aid after having surgery because many medications given after surgery, particularly pain medications and anti-anxiety medicine, can cause sedation.

Combining sedating medications can lead to dangers decreases in the body's drive to breathe. Even an over-the-counter medication, such as Benadryl, can cause breathing problems when combined with pain medication.

Clearly, the biggest concern about sleeping pills is the risk of dependence.

You should never use sleeping pills for more than a few weeks and only when needed. If overused, you may be unable to sleep without them—a clear sign of dependence—or experience a rebound effect in which the drug interferes with your sleep.

Always use sleeping pills under the direction of your doctor and only as prescribed.

A Word From Verywell

Sleep is incredibly important when healing after surgery or a hospitalization. An essential part of taking care of yourself, quality sleep will help speed healing and soothe frazzled nerves. A well-rested person will also be better equipped to deal with the stresses of recovery.

Good sleep hygiene, which includes going to bed at the same time, avoiding caffeine and high-stress activities before bedtime, can make a huge difference in how deeply one sleeps. Medications and supplements, such as melatonin, are available if these simple approaches are ineffective.

Pain Management Following Surgery
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Article Sources
  • Postoperative Sleep Disturbances: Mechanisms and Clinical Implications. British Journal of Anaesthesia.

  • Xian, S. and Dong-Xin, W. Improve postoperative sleep: what can we do? Current Opinion in Anesthesiology. 2018:31(1):83-88. DOI:  10.1097/ACO.0000000000000538.