Managing Insomnia and Poor Sleep Quality After Surgery

Common Causes and Solutions to a Lack of Sleep

Anesthesia Isn't Always to Blame For Insomnia After Surgery.

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 position.

Those types of problems can certainly play a role, but there are additional ways that sleep is inhibited by surgery and the care that goes on after surgery.

The sad truth is that patients often need more sleep after the stress of surgery, but the quality of sleep they have is poorer than ever.

Common Reasons For Sleep Issues After Surgery

  • 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 deep sleep. Pain can make it difficult to fall asleep, stay asleep and reach deep sleep.
  • Type of Surgery: Longer and more involved procedures often result in poorer sleep than simple, short procedures. It makes sense that a patient who had open heart surgery will have a harder recovery than an individual who had carpal tunnel surgery on their wrist. This is for a variety of reasons because the larger surgeries require longer hospital stays, more attentive care from staff, more medication, more anesthesia and a longer recovery.
  • Steroids: Steroids are a wonderful medication to decrease inflammation, but they often cause difficulty sleeping and a state of feeling full of energy. I often tell patients to take their steroid medications in the morning, if possible, unless they enjoy organizing their closet at 3am when they cannot sleep.
  • 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.
  • Medications That Change Sleep: Steroids have already been mentioned as a medication that can alter your ability to sleep, but there are many medications that can interfere with normal sleep. There are also many medications that can enhance sleep, and may make you feel groggy when you want to feel wide awake.
  • 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 and Invasive Devices: If you are in the hospital, you may have stickers on your chest that allows your heart to be monitored during your entire stay. You may wear a finger probe that monitors your oxygen saturation as well. You may also have an IV, or even more than one, with IV fluid running. Some patients have invasive lines placed, such as a PICC line or a central line. These may 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--has a known ability to interfere with sleep.
  • 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 my hinder your ability to sleep.

How to Sleep Better After Surgery

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 be of benefit if you are struggling with the constant 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 sleep that isn't constantly interrupted by pauses in breathing or snoring.

At home, you may be more comfortable in your own bed, but medications can still have an effect in and out of the hospital. If you believe that you are having difficulty sleeping because of the medications prescribed, talk with your doctor about the possibility of rescheduling your medications for the best possible sleep. Your physician may also want to add medications that are known to improve sleep.

Be careful about adjusting, increasing and adding medications to your regimen. It may not be safe to take an over the counter or prescription sleeping pill with a dose of pain medication. Some medications don’t mix well together and could potentially cause a dramatic decrease in your rate of breathing, which can be fatal. Take the time to discuss the potential for this problem with your pharmacist or physician.

If pain medications are affecting your ability to sleep, you may benefit from switching to a non-narcotic pain reliever, such as Tylenol or ibuprofen.

Pain Management After Surgery

Last but not least, be aware of your surroundings. If temperature is an issue, be proactive about changing the thermostat. If noise is an issue, it’s perfectly acceptable to tell the staff that the hallways seem particularly loud--they may be able to do something to decrease the noise level. You may also need to ask family members to keep their visits short if they are playing a role in your insomnia. Speak up about your sleep issues, there may be simple yet effective ways to help you get the sleep you desperately need.

Take some comfort in the fact that most people return to their usual quality of sleep within a few weeks of surgery, and find that their quality of sleep (and life) improve each day as they continue to heal.

Source

Postoperative Sleep Disturbances: mechanisms and clinical implications. British Journal of Anaesthesia. Accessed December, 2015. http://bja.oxfordjournals.org/content/76/4/552.full.pdf

Continue Reading