What to Do If You Have Insomnia After Surgery

Insomnia (trouble sleeping) is very common in the days and weeks immediately following surgery. Insomnia after surgery can happen when sleeping in the hospital or another medical facility rather than in your own home. It can also be due to something like an uncomfortable pillow or mattress, pain from surgery, and medications you’re taking. 

This article discusses why you might have insomnia after surgery and how you can sleep better during your recovery.

Causes of Insomnia After Surgery

There can be many reasons why you are unable to sleep after surgery and it's fairly common for this to happen. According to one study, sleep disturbances can affect both rapid eye movement (REM) and short-wave sleep (SWS) for about seven days following surgery.

Some of the most common reasons for insomnia after surgery are:

• Frequent waking. At the hospital, you may have your vital signs (e.g., blood pressure and temperature) taken every few hours. Most hospitals draw blood samples for labs in the middle of the night, too. You may also have to wake up to take your medications on schedule. You may need to wake up earlier to do physical therapy or talk to your providers. 
• Poor airway control. Poor airway control can cause short periods of not breathing during sleep (sleep apnea) and snoring. If you already have these health problems, they can get worse after surgery. Narcotic pain medication can also decrease airway control during sleep, as can very deep sleep from exhaustion.
• Major surgeries. Longer, complicated procedures often lead to poor sleep after surgery. More involved surgeries also tend to require longer hospital stays, more attentive care from medical staff, more medication, more anesthesia, and a longer recovery.
• Pain. It can be hard to sleep when you are in pain. Moving in your sleep can cause pain and wake you from a deep sleep. Pain after surgery can make it harder to fall asleep, stay asleep, and reach deep sleep.
• Morphine. Morphine and morphine-based pain medications are known to affect sleep. While pain relief can improve sleep, pain medications can often have a side effect of insomnia or the "jitters."
• Steroids and other drugs. Steroids decrease inflammation, but can also cause trouble sleeping. It can help to take steroid medications in the morning. There are also painkillers and other medications that can make you feel groggy during the day when you want to feel wide awake.
• Monitoring devices. If you're in the hospital, you may have a heart monitor probe on your chest, an oxygen saturation probe on your finger, an IV in your arm, and drainage tubes in your incision wound. These devices can make you feel as though you are trying to sleep while you’re tangled in a net.
• Noise. Hospitals are noisy places. Your IV pump may start beeping at random times, and you may have a roommate who snores. If you're having trouble falling asleep or staying asleep after surgery, the noises might be keeping you awake.
• Hunger and thirst. If you're not allowed to eat before or after surgery, feeling hungry and thirsty might keep you from sleeping. 
• Room temperature. While some hospitals offer temperature control in patient rooms, many do not. If you prefer a cold room for sleeping and your hospital room is warm, you may have trouble sleeping.
• Light. The light in hospital hallways, the parking lots outside your window, and even night lights may make it harder to fall and stay asleep. 
• Increased stress hormones. Surgery is emotionally and physically draining. Stress can lead to an increase in certain hormones in the body, which in turn makes sleep more challenging.

Tips for Improving Insomnia After Surgery

If you're having trouble sleeping after surgery, it's important to try to figure out why. From there, you can try different things to try to remedy the situation and get the rest you need. 

Here are a few examples of changes you can make that may help you sleep better:

• If lights are keeping you awake, a sleep mask can make your environment appear darker.
• If you are struggling with noise, ask hospital staff to lower the noise level if possible or see if you can get some earplugs. 
• If the room temperature is an issue, ask about changing the thermostat before going to sleep.
• You may sleep better sitting up in a comfortable chair or with extra pillows, especially if you have sleep apnea or snore. Elevating your head can often decrease these symptoms and allow for more restful sleep.
• You may need to ask family members to keep visits short if they are causing you stress. Too much stimulation can be a big factor in the risk of insomnia.
• If medications are interfering with sleep, ask your provider if they can adjust the dose, switch you to another drug, or change the timing of your dose.

If pain medications are the problem, you may benefit from switching to a non-opioid pain reliever like Tylenol (acetaminophen) or Advil (ibuprofen). Bear in mind that over-the-counter (OTC) pain relievers may not be as effective as prescriptions for post-surgery pain.

Weigh the benefits and potential consequences before requesting a change. Never alter a medication dose or stop treatment on your own without first speaking with your healthcare provider. 

Most of all, don't stay silent if you're having trouble sleeping. The less quality sleep you get, the slower your recovery is likely to be.

Using Sleeping Pills After Surgery

Many medications and supplements are available to help with sleep. However, it’s important to speak with your healthcare provider before trying a sleep aid—even one that you get over the counter.

There are medications given after surgery, like those for pain and anxiety, that can make you feel sleepy (sedation). Some OTC products for sleep can also cause sedation.

Combining sedating medications can lead to dangerous decreases in your body's drive to breathe. Even OTC medications like Benadryl can cause breathing problems if they’re taken with prescription pain medication.

Only use sleeping pills under the direction of your healthcare provider and take them exactly as prescribed. A big concern about sleeping pills is the risk of dependence. Never use sleeping pills for more than a few weeks and only use them when needed. If overused, you might be unable to sleep without them or experience a rebound effect if you stop. 

When to See a Healthcare Provider

While you might expect to have some trouble sleeping in the days following surgery, it should gradually get better.

If you’re still having insomnia in the weeks after surgery, reach out to your healthcare provider. They can help you figure out what’s causing you to have insomnia and recommend treatment that will be safe and effective for you during your recovery.

Summary

Insomnia after surgery is common. Sometimes, it’s related to environmental factors like the noise and stress of being in a hospital. You can have trouble sleeping at home, too, especially if you’re in pain or taking medications after surgery that can affect your sleep. 

Your sleep hygiene can make a big difference in your quality of sleep at any time but can be very important as you’re recovering from surgery and need your rest. Going to bed at the same time and avoiding caffeine and high-stress activities before bedtime can help.