It’s easy to take sleep for granted but it plays a crucial role in our body’s natural healing and repair processes.
If you are scheduled to undergo joint replacement surgery, it’s important to get enough sleep both before and after your surgery. To mark World Sleep Day (19 March), we’re looking at some of the recent research into sleep and its importance in recovery from (rehabilitation) and preparation for surgery (prehabilitation).
The link between sleep and postoperative pain
In November 2019, The Journal of Orthopaedic Surgery and Research published the results of a study into pre-operative sleep quality among patients and the impact of this on pain levels following total joint replacement surgery. The researchers wanted to determine whether a person’s sleep makes a difference to post-operative outcomes.
The study looked at 994 patients who were scheduled to undergo joint replacement surgery. Before their operation, the sleep quality of patients was measured using a range of methods including the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale and a ten-point sleep quality scale. Twelve weeks after surgery, researchers used the visual analog scale – a pain scoring methodology – to assess the patients’ pain levels. They also recorded the patients’ consumption of analgesic drugs, length of stay in hospital and range of motion in the affected joint.
The research found that a patient’s sleep quality has an impact on their pain levels after surgery and their range of motion. This was particularly noticeable among patients who underwent a total knee replacement. There was also a link between the amount of analgesics a patient needed after surgery and their sleep quality beforehand. Patients with poor quality sleep were likely to remain in hospital for longer after surgery. The researchers concluded that there is a clear link between the quality of a patient’s sleep before surgery and their clinical outcomes, recommending that doctors should assess how well a patient is sleeping prior to joint replacement surgery and, if necessary, take steps to improve sleep quality.
Why sleep is important for recovery
So, why is sleep so important for people undergoing surgery? Sleep is the time when our bodies naturally repair themselves and restore our health and wellbeing. When we are asleep, our brains trigger the release of hormones that promote tissue growth. This is why wounds heal faster if we get good quality sleep. During sleep our bodies produce white blood cells which attack bacteria and viruses that might otherwise hinder our healing. If we are not getting enough sleep, our immune system can become compromised and less effective at fighting infection.
Sleep gives our bodies a much-needed rest from the busy physical and mental demands of our daily lives. Not getting enough sleep has an impact on our ‘hunger’ and satiety hormones. Levels of ghrelin – which makes us feel hungry – go up and levels of leptin – which makes us feel full – go down. For this reason, poor sleep can lead to overeating and may be linked with obesity in the long-term.
You may have noticed that after a poor night’s sleep your mood is affected. This is because your body needs sleep to focus on restoring itself and resting. When you are asleep your energy levels, stress levels and hormones come back into balance and you can start the day feeling refreshed. Depression is more common in people who sleep for less than seven hours a night and this can slow recovery from surgery.
Improving sleep quality
Many different factors affect how well we sleep and if you are due to undergo surgery it is a good idea to discuss your sleep quality with your orthopaedic surgeon in advance as they may be able to recommend some ways to improve your sleep. Having a cool, dark room to sleep in, avoiding alcohol and caffeine and developing a wind-down routine in the evening, such as a warm bath or reading a book can all help to improve sleep quality.
Of course, after surgery you may find that post-operative pain affects your ability to sleep. Again, your orthopaedic surgeon may be able to help with some practical suggestions. Ideally, after knee replacement surgery you should sleep on your back with your affected leg as straight as possible and if possible avoid a pillow under your calf and knee. If you prefer sleeping on your side, avoid lying on the knee that has been operated on and put a pillow between your legs to cushion the knee.
If you would like more information about joint replacement surgery, contact us. We take a holistic approach to surgery and will always discuss your overall health and lifestyle to ensure you get the best possible outcomes.
Carrothers Orthopaedics Consultations
Carrothers Orthopaedics is still here for our patients during this time. Whilst treatment options have been restricted in previous months, we are still providing online consultations via Zoom or telephone, as well as face to face if the condition necessitates.
We are here for you to talk through your symptoms, provide diagnosis with imaging modalities and discuss the full range of treatments available to you.
If you are experiencing new musculoskeletal symptoms or require support or advice about an existing condition please contact us.