A good night’s sleep is important for your health and well-being every day. It becomes more important than ever when your body is trying to heal after you’ve had a surgical procedure. [8]
But insomnia after surgery, especially major surgery, is extremely common, and there are a number of reasons why it can be hard to sleep well post-op. [9]
This article will look at the most common causes of insomnia after surgery and what you can do to get your sleep back on track—because good sleep should be part of your recovery plan!
What causes insomnia after surgery?
There are many reasons why someone may not be able to sleep well after surgery. “Insomnia is one of surgery’s most common side effects, affecting up to 30% of patients,” says board-certified surgeon Jeffrey Durgin, MD, owner of Medspa of Midland in Midland, Texas.
Here are some of the most common reasons for post-surgical insomnia—and what medical experts say about them:
- Pain: The number-one reason why people have trouble sleeping after surgery is pain—and almost all surgeries cause some degree of pain. If the pain isn’t bad enough, the drugs used to treat it can also keep you awake. “Many pain medications, such as opioids, can have side effects, including insomnia,” says Durgin. [1, 11]
- Inflammatory response: “Surgery has the same effects on the body as any other injury,” says Beth Hawkes, RN-BC. “Nurse Beth,” the owner of Nursecode, explains: “To aid in protecting the body and ward off infection, the immune system triggers an inflammatory reaction. Major procedures can occasionally bring on a broader inflammation cascade that affects the entire body. This postoperative inflammation may cause sleep disruptions many people suffer after surgery.” [7, 9]
- Medication side effects: The sedatives in certain types of general anesthesia can cause insomnia because they interfere with the body’s sleep-wake cycle. Several other types of medication used after surgery can also impair sleep, including some antibiotics, steroids, and some respiratory medications. As noted above, opioids used to manage pain following surgery may also make it difficult to sleep normally. [8, 9]
- Environmental disturbances: “Being in unfamiliar settings such as hospitals can make patients lose sleep,” says Shivaraj Nagalli, MD, a board-certified internal medicine physician and hospitalist at Shelby Baptist Medical Center in Alabaster, Ala. “Some places can be noisy too, especially intensive care units where a lot of patients are extremely sick and require aggressive interventions that can disrupt your sleep.” These include frequent vital checks—such as blood pressure or oxygen level—or being awakened through the night to take medication on a set schedule. [6, 7, 8]
- Anxiety: “Acute procedural anxiety,” often called “surgical anxiety” can cause sleep problems before and after surgery. It can also make pain feel even worse. “Acute procedural anxiety can exacerbate and impair sleep, leading to sleep deprivation,” says Hawkes. “Unfortunately, lack of sleep can make pain and anxiety that a person may already have felt worse.” [8]
How to get over insomnia after surgery
Fortunately, there are things you can do to improve your sleep post-op. Here are five suggestions from our medical experts:
Find the right sleep position
The best sleep position depends on the type of surgery and the location of the incision site. “Many find that sleeping on their back helps insomnia after surgery,” says Durgin. “This is because it allows your head and neck to rest naturally and prevents pressure on the surgical site.
The main thing, says Nagalli, is to find a sleep position that’s comfortable for you. For those who’ve had back surgery, he suggests keeping knees flexed, which puts less pressure on the lower back. After hip surgery, using pillows between your knees can be helpful.
Whatever position you choose, says Durgin, avoid sleeping on your stomach as this can put added pressure on your back and neck and make insomnia worse.
Sparta, NJ-based Specialty Surgery Center offers these suggestions for finding your best sleep position after surgery.
Practice deep breathing
You can use deep breathing exercises to help your mind and body relax. Focusing on your breath can help take your mind off any pain or discomfort keeping you awake. [3, 10]
Start by inhaling deeply through your nose to a count of four, then holding it for another four counts. Slowly exhale through your mouth for six counts. Repeat if necessary, and go slower if it’s not working. In this study, researchers found that subjects assigned to the deep breathing treatment group had better sleep compared to those that were given medications and an exercise regimen to follow. [10]
Set the stage for sleep
Just as when you’re preparing for sleep, it’s useful to practice activities that will calm and relax you to help ensure your best chances of a good night’s rest.
These can include dimming the lights, listening to music, taking a shower or bath, and sipping a cup of decaffeinated tea—whatever you find works best to make you ready for sleep. [5]
Another important way to set the stage for sleep is to keep a consistent bedtime. This helps keep your body’s rhythms in sync. (Here’s the best way to sleep after a C-section.)
Improve your sleep environment
Keep your sleep environment quiet and dark, and try to keep electronic gadgets away from the sleeping place to avoid any distractions resulting from them, says Nagalli.
You might also consider using a sleep mask and earplugs if needed to block out light or noise, says Durgin. Discuss with your care team the possible adjustments you might make to your sleep setting. [2, 4, 5]
Find the right pain medication
Even before your procedure, Hawkes recommends discussing pain management options with your doctor, as well as the anticipated recovery time. After surgery, Nagalli says adequate pain control can help prevent insomnia. [1, 9]
Talk to your doctor
Be sure to talk to your healthcare provider if you’re still struggling with insomnia beyond what might be considered a usual recovery time or if you don’t return to your normal sleep patterns after a few weeks.
Discuss other potential treatment options if what you’re doing is continuing to disrupt your sleep or if the lack of sleep is causing any other problems for you.
FAQs
How long does post-surgical insomnia last?
How long insomnia after surgery last depends on the procedure itself and whether or not it required you to stay in the hospital overnight.
Usually, post-op insomnia is only temporary. While it can be a short-lived problem for some, others may struggle with insomnia for weeks or even months after their operation,” notes Durgin.
Why am I having a hard time sleeping after surgery?
Remember that surgery itself, particularly if it involves general anesthesia, disrupts your body’s normal rhythms, including its sleep-wake cycle. [6, 7]
Pain and inflammation can make it hard to fall asleep, and the side effects of pain medication and other medications to treat you can also give you insomnia. [ 8, 9]
Creating a calming, healing sleep environment is more important than ever when you’re already dealing with these potential post-surgery sleep disruptors. [2, 5, 11]
Is insomnia a side effect of anesthesia?
Nancy Mitchell, RN, with Assisted Living Center, explains that the sedatives used in anesthesia influence parts of the brain that produce a feeling of instant drowsiness as you slip into unconsciousness. “To create that effect,” she says, “the drugs will typically alter your circadian rhythm and melatonin production.”
Research shows general anesthesia tends to affect sleep more than regional anesthesia in which only the area to be operated on is anesthetized. One reason suggested for this difference is that people who receive regional anesthesia typically use fewer opioids before or after their procedure. [6, 8]
How do you get rid of insomnia after surgery?
You can reduce the incidence of insomnia after surgery by following a few simple suggestions. For starters, take things easy in the first few days after your operation. Try and stick to gentle activities and avoid anything too strenuous, says Durgin.
Find a sleep position that lets you relax and doesn’t exacerbate any pain you have from your surgery. Manage your pain with medications or techniques that don’t contribute to insomnia.
Practice deep breathing. [3, 10] If you’ve had anesthesia, Mitchell recommends simply lying in the dark to help your body re-adjust to its external environment and reset its circadian rhythm.
Prepare yourself for sleep by creating a relaxing setting that gently eases you out of whatever the day has been and into a comfortable wind-down to sleep. Make sure your sleep environment supports your sleep by keeping it dim and cool. [5]
Finally, be sure to talk to your healthcare provider if nothing you do seems to be helping you return to more normal sleep.
References
- Horn R. Postoperative pain control. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK544298/. Published September 19, 2022.
- Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Med Rev. 2015;22:23-36. doi:10.1016/j.smrv.2014.10.001
- Jerath R, Beveridge C, Barnes VA. Self-Regulation of Breathing as an Adjunctive Treatment of Insomnia. Front Psychiatry. 2019;9:780. Published 2019 Jan 29. doi:10.3389/fpsyt.2018.00780
- Karimi L, Rahimi-Bashar F, Mohammadi SM, et al. The Efficacy of Eye Masks and Earplugs Interventions for Sleep Promotion in Critically Ill Patients: A Systematic Review and Meta-Analysis. Front Psychiatry. 2021;12:791342. Published 2021 Dec 3. doi:10.3389/fpsyt.2021.791342
- Krystal AD, Prather AA, Ashbrook LH. The assessment and management of insomnia: an update. World Psychiatry. 2019;18(3):337-352. doi:10.1002/wps.20674
- Lehmkuhl P, Prass D, Pichlmayr I. General anesthesia and postnarcotic sleep disorders. Neuropsychobiology. 1987;18(1):37-42. doi:10.1159/000118390
- Lin WC, Chang WH, Bai YM, Li CT, Chen MH, Su TP. The risk of insomnia after surgical operation: A longitudinal, population-based, case-crossover study. J Chin Med Assoc. 2022;85(4):519-524. doi:10.1097/JCMA.0000000000000688
- Rampes S, Ma K, Divecha YA, Alam A, Ma D. Postoperative sleep disorders and their potential impacts on surgical outcomes. J Biomed Res. 2019;34(4):271-280. doi:10.7555/JBR.33.20190054
- Rosenberg-Adamsen S, Kehlet H, Dodds C, Rosenberg J. Postoperative sleep disturbances: mechanisms and clinical implications. Br J Anaesth. 1996;76(4):552-559. doi:10.1093/bja/76.4.552
- Su H, Xiao L, Ren Y, Xie H, Sun XH. Effects of mindful breathing combined with sleep-inducing exercises in patients with insomnia. World J Clin Cases. 2021;9(29):8740-8748. doi:10.12998/wjcc.v9.i29.8740
- Su X, Wang DX. Improve postoperative sleep: what can we do?. Curr Opin Anaesthesiol. 2018;31(1):83-88. doi:10.1097/ACO.0000000000000538
