TKR Reassurance needed

[sistersinhim]

PT going well I am not being pushed, he said my ROM is getting there when he went to do the measurement today I said he rather not, he happy to leave it as I am on track.

I like this guy! He is focused on function, not numbers. Right up the Bonesmart way!

 

[Legseleven]

I’m sorry @William1950 that the nights are still so challenging. I’ve simply accepted now I’m older than some nights have two parts. According to anthropologists that was normal in ancient times. I read, or get up for a cuppa, or find a you tube to listen to - a meditation or nature sounds. Then I have a second sleep until I wake. Only use an alarm clock when I’ve got to be somewhere. Currently the waking is not from pain, or post op, which it will be soon but it still happens 2-3 times a week.
I’ve learnt through some tumultuous years not to focus on the negativity, or challenges, because for me that makes them bigger, I’m very good at distracting myself, and finding opportunities. It’s not easy, I know, and you will get through this. This too will pass.
Sounds like you have a great physio, we have that in common. Thinking of you.

 

[William1950]

I think my biggest worry is will my sleep ever get back to normal
Got an telephone appn with my GP next Tuesday and seeing my counselor next Wednesday.
I cannot get my head round waking up but not being able to get back to sleep. I get up walk.around, play podcasts.
I try to think about that it will get better and tell myself to say that I am resting which works for a while but as the night goes on it get harder.
Also I worry about my stable angina and my blood pressure and what impact my lack of sleep has on my body. I did mention it to my GP but they did not seemed that concerned.
I am sleeping less now than at the beginning.
Any help please.

 

[William1950]

I forgot to say I have no pain just swelling after exercise and walking.

 

[sistersinhim]

Worrying about not sleeping is making your sleep worse. Try not to think about it. I know it's hard, because I do the same thing sometimes. Sleeping for me has always been a problem. I find if I read a boring book, that helps lull me back to sleep.

 

[benne68]

I have no pain just swelling after exercise and walking.

That's great news! Another indication that your recovery is coming along well.

 

[Layla]

Hi Lesley,
Great pic, things are looking good!
Are you tracking your sleep with any type of device? Like a fitness watch? If so, you may want to consider giving that up as it may only exacerbate the problem by making you feel more anxious about your sleep. You may need to seek out solutions to deal with anxiety / depression with the hope that sleep will then improve.
I'm so sorry you're struggling with this. It has to be difficult and I pray that with the help of your GP, and counselor, you're able to find a solution to get the restorative rest you're longing for.
@William1950

 

[Legseleven]

Your knee is improving so much and you’re doing so well. I hope you can see this @William1950 The fact that the pain has eased is wonderful. Focusing on the sleep issue may be exacerbating it, and I do know first hand how hard it is to be short of sleep.
I sometimes take a word, or even two or three and then use the letters in that word to find other words - three words for each letter in order. It’s a known technique to reset the brain by giving it a neutral challenge. I read it somewhere and have used it ever since.
I alternate this and the Benson Meditation which I mentioned before and can be googled. This meditation is to say the word ‘one’ to oneself on every out breath. Sometimes other words like calm, or peace are used.
Every time my mind wanders in the early hours (and it does) I bring it back either to the word ‘one’ or the word game which I give an example of below.

Eg Beige is the word
B - banana, bank, begin
E - elephant, egg and eccentric
I - ink, ice cream and incredible
G - gorilla, grapefruit and gorgeous
E - excitement, elongated, and exercise.

Please try these when you’re focusing on the sleep and I hope the GP and counsellor are helpful. Trust it’ll get better, and it will.

Edited to add: I forgot to say that a blackout mask helps too. Especially as the nights get lighter. Mine is black silk and I wouldn’t be without it.

 

[Layla]

How clever is that, Legseleven! First time I ever heard of that word game. I hope you'll try it, Lesley, and if you do, hopefully it works!
@William1950

 

[eaglemom]

Thank you for sharing that word game. I've never tried that word association. I do believe in due time everything you sleep cycle will straighten out.

 

[William1950]

Me again about my lack of sleep.
Is anyone else had this issue week 11 post op. I have seen some older post on here but not recently.
I am not in pain my PT is on track ,
ROM on track. The meds I am taking I think I have tolerance for them so going to ask my GP if I can taper off and see how best to proceed.
Unfortunately I have read that sleep comes back usually about week 8 so you can see where I am going.
Trying to do all the right things just now thinking why me. If others have sleep issues after week 11 even months after I would love to hear so I don't feel alone.

 

[benne68]

I have read that sleep comes back usually about week 8 so you can see where I am going.

Please try to not to buy into these recovery schedules. There is no universal timeline for recovery. Every one is different and every single recovery is different -- even in the same person.

I can't begin to explain how awful my sleep was after my first hip replacement. I wasn't on BoneSmart back then and didn't keep a journal, so I don't have specifics. But am I quite sure it took 4 months for me to reach the point where I could sleep through the night. My sleep following my first knee replacement was poor as well.

However, my second knee and second hip recoveries were both much easier. I think the first joint replacement surgery is hardest because of the fear factor. We don't know what is normal and what is not -- and sometimes our minds go to dark places.

Overall, it sounds like your recovery is going well for less than 3 months post-op. I know it's challenging, but try to be patient. Sleep, like all aspects of recovery, comes in its own time.

 

[Legseleven]

I am not in pain my PT is on track

Hey @William1950 this is where I’d be focusing… that is such good news. Please think about this great news, and please keep your focus firmly on the positive things. I know it’s not easy.
There’s a school of thought that indicates what we focus on grows, so flipping your thoughts to what’s really great about your recovery and away from the sleep issues could help. In truth everyone has sleep issues post op in varying degrees and it can make you feel horrible.
I admit I still have some nights where I wake every week, and perhaps that’s my normal now. I’ve accepted I can’t change it, so I changed how I felt about it and what I do - back to the two sleeps and various exercises I shared. They’re not easy to do and take both concentration and practice so I urge you to stick at it. I also celebrate every morning after I sleep through.
It will get better, and while your body is doing it’s amazing healing I urge you to reflect on these great positives. You are doing great, even if it doesn’t feel like it.

 

[EalingGran]

I have been a poor sleeper for years but it was definitely worse for several months after my PKR. Even tiny amounts of discomfort that we dont notice during the day are enough to keep us awake at night. If you then start worrying about whether this is "normal" for your stage of recovery- it will just keep you awake more.
I slept with my knee resting on the open iced water jacket of my Cryocuff and refreshed the icy water in the night when I went to the loo. I also alternated various sleeping meds ( some prescription zopiclone/ diphenhydramine/ herbal meds/ melatonin).
Discuss your sleep issues with your GP as you are taking mirtazepine. There are some new prescription sleep medications ( orexin antagonists) which promote a more natural sleep- although I think they can take a few days to kick in. It might be worth asking your GP about these.

 

[Layla]

Your body is still recovering from surgery, Lesley.
It's normal to have disrupted sleep post op. For how long? It varies from person to person. I think the more you stress about it, the more it will increase any anxiety you may be dealing with. Try telling yourself
being comfortable and resting is good enough for now and see if that helps. You have a lot of positives happening with your recovery, so count your blessings. You're doing great and the sleep you're hoping for will come eventually. I hope you have a good week!
@William1950

 

[FleuveStone]

@EalingGran , that's so interesting about orexin antagonists. it's what our doctor gave my husband and it has worked better than anything else for him. i didn't know anything about how they worked until looking it up just now. amazing.

@William1950, i hear you! not sleeping well is a real drag. over the years I've tried doing progressive relaxation when i can't sleep at night. even if it doesn't help me get to sleep (although it often does), it feels like I'm relieving my stress and at least relaxing and resting some.

also I've been trying to activate the vagus nerve through a simple breath exercise. I've heard that if you take a nice deep inhale, hold it for a few seconds, then exhale for a few additional seconds (as if blowing gently and slowly through a straw), that can be very soothing. for example inhale for a count of 4 and exhale for 8. a few rounds of that often help me relax in the middle of the night. and not inhaling right away after you exhale is even more potent. even if i don't fall asleep it feels like I'm doing something healthy and good for myself

 

[William1950]

Spoken to my GP and we agreed I would have a face to face with him next Thursday to find a plan on how I can move forward. Going to see my counsellor each week.
At present I stay on the 15mg mirtzapine until I see him. It’s so frustrating that it was working with my sleep and appetite then it was not.
Everything I read says that it’s the healing process still at work even though I do not have pain at night. My head says if it’s not pain why is my head/body making me wake up. My health anxiety is also in play so that I worry about my heart disease and effects of lack of sleep. I wish there was a professional consultant to say what I have said above about healing. The statement in my last post about 6-8 weeks about recovery schedule that not to buy into it thanks for that.
At present I have had on 3 different nights I have got one hour of sleep only very scary.
Just want my body to say all good here we can go back to sleeping again then my anxiety will calm down. Here hoping.
Thanks for all of your relies. Glad you are there for me.

 

[Layla]

My head says if it’s not pain why is my head/body making me wake up.

My guess is it is anxiety / stress, Lesley.
Your nervous system is on high alert right now. You've been through major surgery and your body is still healing, even without pain. It's good your keeping up your med schedule and remain in contact with your counselor, GP and OS. I hate to repeat things you've heard over and over again, but these sleep issues can last for months. Any pain, inflammation, reduced activity, changes in meds and anxiety can all feed into each other. Because you're likely exhausted you may be drifting in and out of sleep without even realizing it. We've all done that. Continue to rest, even if sleep doesn't come, lying quietly with your eyes closed will still help you recover. Try really hard to refrain from counting or worrying about how many hours of sleep you're missing. Instead focus on and daydream about things that you find relaxing. Sitting on a beach, spending time at a cabin, watching a burning fire in a fireplace, cuddling up with a blanket on a rainy day. May sound silly and none of these appeal to you, but try reframing the worry with positive thoughts and memories and see if it helps at all to relax you.
I'm sorry you continue to struggle and hope you're having a peaceful day today.

 

[benne68]

I agree with trying to calm your mind when you are feeling sleep anxiety.

Personally, I find deep breathing is helpful -- especially "box" breathing. If you aren't familiar with it, the practice is simple. Inhale slowly to a count of four, hold your breath to a count of four, exhale to a count of four, hold it out for a count of four. Focusing on the breath and the simple counting engages the brain enough so I don't ruminate.

Worth a try?

 

[Legseleven]

That’s great advice @benne68
The other breath work exercises to consider are either 7/11. Breathing in for the count of 7 and breathing out for 11. If that’s too hard you can start with breathing in for 4 and breathing out for 7.
They all concentrate the brain in the present moment and the longer out breaths calm our nervous systems. I use both these and the box breathing in different situations.
Hope you’re having a better week @William1950 and the knees are doing well.