Question:I had surgery on my lower back for removal of spurs pressing on discs. The surgery relieved the pain that I was having in my left leg. However, I have been having a lot of trouble getting to sleep. How long will this last? My surgeon and others said it may last 2 to 3 months.
Dr. Gareth S Kantor, a member of the American Board of Anesthesiology and professor of anesthesiology at the School of Medicine from Case Western Reserve University — a private university in Cleveland, Ohio, answered.
Answer:Sleep disturbance after major surgery is common. The 'surgical stress response', that is the body's response to the trauma of surgery, is quite profound and has an important effect on sleep. Many hormones and metabolites are released, fever is common, the sympathetic nervous system is activated (adrenaline). Pain, pain medications, starvation, psychological factors, age, and a person's usual sleep profile all affect sleep after surgery. Pain decreases sleep, and, conversely, inadequate sleep exacerbates pain.
Environmental factors in the hospital (noise, observation and nursing procedures, temperature and light) can also limit the duration and quality of sleep. The bigger the surgery, the more severe the sleep disturbance.After surgery, the amount of REM sleep (associated with dreaming) is decreased for 1 or 2 nights, then rebounds. Nightmares during the rebound period (around night 4) are common. So-called Slow Wave Sleep is also affected for the first few nights. By around 1 week most people's sleep patterns are restored to normal, but as many as a quarter of people still are not sleeping normally at this point after major surgery.
I am not aware of any studies of sleep patterns that have gone beyond one week after surgery. Interestingly enough, the form of anesthesia (general vs. regional) does not seem to affect sleep disturbance after surgery. This suggests that general anesthesia, often blamed for a wide range of ills and unusual symptoms after surgery, is not responsible for the problem you are experiencing. In fact, study volunteers who underwent 3 hours of general anesthesia without surgery showed only minimal sleep disturbance afterward.
Many people complain of having trouble sleeping after surgery. You may experience a dreaded bout with insomnia from:
- The effects of anesthesia
- Discomfort related to healing
- Changes in your daily routine
- Stress from personal concerns
- The type of surgery
Jennifer Whitlock, a board-certified family practice nurse practitioner who works as a hospitalist providing care for patients who are recovering from surgery or have an illness that requires hospitalization explained, “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.”
Regardless of the reason, insomnia is NOT fun. There are tricks to help you sleep better.
Tips for Getting the Most Out of a Night's Rest
If you have back pain following surgery, take your pain medication about half an hour before bedtime. Some medications can affect your ability to feel tired. Steroid-based medications can also alter your ability to sleep.
A Seattle, Washington Plastic Surgeon, Lisa Lynn Sowder, M.D. advised, “In my experience (as a patient and a surgeon), a lot of the sleep disturbance is from the strong narcotics taken for pain. I try to get my patients off narcotics ASAP after surgery if they are having sleep problems.
“In many cases, after five days or so, patients can transition to ibuprofen and Tylenol (make sure not to exceed recommended doses) if there are no issues with bleeding or liver function. I will often add a long-acting sleeping pill such as Halcion or Lunesta. And sometimes a little Benadryl at night is very helpful. It is sedating and also helps with any itching which is common after surgery.”
In addition, consider these tricks:
- Avoid napping too much during the day. At the same time, remember to balance activity with rest during recovery.
- Arrange the pillows so you can maintain a comfortable position and decrease muscle strain — BackerNation loves its pillows, and we think you do too.
- If you feel nervous or anxious, talk to your partner or a trusted friend. Get your troubles off your mind.
- Avoid caffeine in the evenings (such as chocolate, coffee, tea, and soda).
- Listen to relaxing music or a guided imagery audio program.
- Relax your muscles. Begin with your feet and work your way up to your shoulders.
- Take a relaxing shower (or bath, if permitted). The steam produced from the hot water will help relax you, allowing you to want to crawl into bed and go right to sleep.
If these suggestions do not help you sleep, don't lose hope. When there's a will, there's a way. Your normal sleeping patterns should return within a few weeks after surgery.
Dr. Sowder recommended to, “Work with your surgeon to find the right combination of treatment for you. This too shall pass and when it does, you will never take a good night's sleep for granted again!”
When to Call a Doctor?
You should call your doctor if:
- You notice negative changes in your behavior
- A lack of sleep is affecting your overall quality of life
- Normal sleeping patterns do not return within two to three weeks post operation
“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,” urged Whitlock.
If you are having trouble sleeping following any form of back surgery, just know that the discomfort will not last forever.