If you’re having a knee replacement, how disruptive might it be for your sleep?
Like all major operations, the answer really varies from person to person. Some knee replacement patients find their sleeping patterns normalise quite quickly after surgery. For others, it can take weeks, even months, before they feel completely comfortable in bed.
That needn’t be taken as a reason not to have the operation. After all, most people opt for a, replacement because the daily and nightly pain has already become unbearable. And the encouraging thing is that post-surgery satisfaction rates for knee replacement are very high: some 75% of patients say they feel much better after the operation compared to before (NHS Digital, 2020).
But the bottom line is that almost everybody faces some sleep disturbance in the early days after knee replacement. Knowing that from the outset can help you prepare ahead – and make some simple tweaks that will give you the best chance of a good night’s rest and a steady recovery.
Grab sleep where you can
In the very early days after surgery, overnight sleep often comes in waves rather than consistent cycles. So taking naps during the day can be helpful – when, wherever and however feels most comfortable to you. Mix resting on a bed during the day with your feet elevated (it reduces swelling in your legs and feet) with gentle mobility and exercise to encourage muscle strength and good circulation.
Experiment with sleep positions
The standard advice after knee replacement surgery is to sleep on your back. Sleeping on your back helps keep your leg straight, which enables good blood flow while you rest and avoids putting stress on the new joint. But that isn’t a hard-and-fast rule. Indeed you may find it quite challenging if you’re usually a front or side sleeper. If sleeping on your side, doctors usually recommend keeping the operated knee on top. Others, though, find it more comfortable the other way round.
Use a pillow if comfortable
If you need more support in bed, try placing a flattish pillow between your knee and upper leg. Or even two, one on either side of the operated joint. Another option is a knee wedge (or form wedge), a memory foam cushion that elevates your leg while providing good support to the knee. Or you could just use an ordinary, firm pillow that extends up past the knee down to your calf (see Knee Replacement Aftercare: Tips for Patients and Caregivers, Arthritis Foundation). It’s not advisable to place a pillow directly under your knee, though – this can cause stiffness and restrict blood flow behind the joint.
Consider a recliner
Some people find they get better sleep in a reclining chair than in bed, at least in the short term. Recliners give you more control over your elevation and are easier to get in and out of, particularly if your bed is set quite high or low. You can of course buy your own, but it’s possible to rent them too. Search “medical recliner chair” or “riser recliner” online. Bear in mind, though, that reclining chairs aren’t recommended as a long-term sleep replacement for a bed.
Go easy on the drinks
It’s very important to keep well hydrated after surgery. But tea, coffee and alcoholic drinks (alcohol especially) are diuretics that will make your night-time bathroom visits more frequent. Alcohol is best avoided completely – it interferes with sleep cycles, making wakeups more likely. As for tea and coffee, timing is key. You may have heard that caffeine has a “half-life” of around six hours, meaning 50% of it is still in your system six hours later. So, in the short term, it may be better to restrict your caffeine intake to the mornings rather than the afternoons.
Be “wakeup-ready”
Accepting that you may sleep fitfully at first can, paradoxically, remove the pressure to sleep perfectly through the night. Instead, focus on making your periods of wakefulness as pleasant as possible. Have everything to hand: books and magazines, a tablet or phone for listening to audiobooks, as well as your medicines and painkillers. Here’s how one reader on an online knee forum describes their routine. “If I woke up at say 3 am and just couldn’t get back to sleep, I would just sit up in bed, prop up my surgery leg with pillows, and have a snack. I kept water and a small ziplock bag of [crisps] and nuts on my nightstand and that seemed to help.”
Keep the routines going
Before leaving hospital, the nurses or therapists will take you through some of the key exercises and activities you’ll need to do as you recover. It’s really important to keep going with these as much as you can. Regular mobility helps to improve the strength and flexibility of your new knee, reduce swelling, and build better stability over the long term. Always follow your therapist’s guidance for your own rehab, but you can get an idea of the types of exercise in this helpful Patient Information guide from University Hospital Southampton.
Keep the end in mind
If sleep becomes a struggle after surgery, keep focusing on the end goal. Your knee will get stronger and more comfortable over time, life will return to normal, and your sleep disruption won’t last forever (even if it sometimes feels like it in the wee small hours). As one reader on the above-mentioned forum puts it: “If your recovery is anything like mine, one morning you’ll wake up and feel almost normal. And here’s some similar reassurance from one of our own knee replacement patients: “I now look forward to having a life without continual pain, especially at night, which is worth remembering when you have the odd “taking a step back” day of overdoing things! I will very soon be able to join in my fitness activities again that I’d previously missed due to the knee pain. I can now get back to normality again. Life is good!”
For further reading
You may find these blogs helpful…
6 simple sleep tips for arthritic knee pain
Sleep and knee surgery: how to plan around the disruption
ESCAPE-pain review: a course to help you manage knee pain
Are you worried about sleep after surgery? It’s a common question and we’re always very happy to chat and offer advice about this and any other concerns you have. Call the team on 01962 826107 – or book an appointment with Mr Bailey through the website. We’ll be glad to get you the help you need.
