TKR Still can’t get comfortable at night

[Deknees]

I had knee surgery on March 26th.
I‘m at nearly 6 weeks since the op. Whilst my knee is healing as it should my biggest challenge is sleeplessness coupled with restless legs. I have always been a pooor sleeper and have had restless legs occasionally causing the insomnia. But since the knee replacement I have had only two nights in almost six weeks where I slept a maximum of three hours at a stretch. The rest of the time I exist on 2 to three hours a night, sometimes even less. whilst generally a well-motivated person, good energy and good outlook, all of this is rapidly decreasing, my mood is very low at times, energy and motivation hard to find, exhausted physically and mentally almost every day. Doctor prescribed a short dose sleeping tablets, they failed to deliver and I felt toxic and like a zombie the following day. The restless legs at night is very hard on my poorly leg as I am driven off the bed to move or tense my muscles, for hours at a time. Falling asleep mostly eludes me.

 

[sistersinhim]

@Deknees, welcome to Bonesmart! I will leave you our Knee Recovery Articles to help with your recovery.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

KNEE RECOVERY GUIDELINES

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.

Nutrition is of paramount importance. Available here are dietary tips, nutrition basics and additional food supplements. These articles are both general advice on food and specific guidelines aimed at people both pre- and post-surgery.

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.

4. PT or exercise can be useful BUT take note of these:
the BoneSmart view on exercise
BoneSmart philosophy for sensible post-op therapy

5. At week 4 and after you should follow this
Activity progression for TKRs

6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?
Post-op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here

Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[mendogal]

Hi...
If you haven't tried an evening magnesium supplement it is worth a try ... some of us find it calms leg spasms.

Insomnia is a real bummer for many of us!! I did a round up of some nonprescription remedies....

If you're lactose tolerant, a glass of warm milk! If you're not diabetic, a teeny bit of honey makes it even more comforting... plus milk is high in magnesium! Helps us relax!

If you aren't a milk drinker, or want an easier way to, an evening magnesium supplement has been very helpful for some members.

OTC diphenhydramine, an antihistamine also used as a sleep aid (Benadryl) because it makes you drowsy; it's also included in some cold, flu, etc "nighttime" combination meds.

Low dose melatonin, sustained release - not for long term use but I have used for a week at a time without ill effect. It should be taken an hour to hour and a half before going to bed, and during that time stay in a dimly lit area to allow this hormone to activate.

Valerian root - an herbal remedy, it can be taken in capsule form but that dose might be high compared to my preference, herbal "sleep" blends that include a smaller dose of valerian and make me pleasantly drowsy. Plus the other tea flavorings make it nice tasting! Celestial Seasonings and Traditional Medicinals sell teabags by the box. Their sleep blends without valerian have never ever made me sleepy.

Personally, the combo of herbal tea with valerian followed by low dose melatonin, plus having my knees up on the Lounge Doctor, worked wonders.

Be aware: even benign herbals and supplements can interact with your routine or post op prescription meds, either making their effects weaker or stronger. If you're on meds you may want to check with your doctor or pharmacist, or even check online for interactions.

 

[sistersinhim]

Unfortunately, sleep disruptions are a normal reaction with this recovery. Sleep deprivation is pretty much inevitable - but what causes it? Many find that taking numerous day time naps help recoup some of the missed sleep during the night. It doesn't matter when or where you sleep, as long as you get that much-needed sleep. Are you elevating and icing at night? That will help with the pain.

 

[Jockette]

Hi and Welcome!

Here is another helpful article from the Recovery Guidelines:

Post op blues is a reality - be prepared for it

Post op blues is feeling depressed, weepy, nervy, shaky, fearful of the future, anxious, overwhelmed by what is happening to you, convinced it's never going to get any better and finally, uttering that most intense of all cries "I wish I never had this done!" It arises out of a variety of...

bonesmart.org

 

[Layla]

I am sorry you're finding it difficult to get the restorative rest you're hoping for.

Pillows certainly help me get comfortable in bed, making it easier to drift off.
I suggest making up the bed with your most comfortable bedding / blankets along with a few extra bed pillows of different degrees of firmness. Try to block out the light if it's daytime. Minimize noise unless you feel listening to calming relaxation music, a fan, or white noise may help lull you to sleep. Make sure the room temperature is not too hot or too cold. Try to disconnect from the devices at least an hour before the targeted nap or bed time, so it's easier to wind down. Limit caffeine throughout the day and consider natural sleep aids such as Valerian, Chamomile or, Magnesium, my personal favorite, which can assist in muscle relaxation and nerves and promote healthy sleep (falling asleep and staying asleep)

Something my mom found helpful is to drink 4-6 oz of Q-Tonic before bed which is a water that contains quinine. Read the label as some of the waters do not contain quinine, but quinine flavoring instead.

I do hope sleep improves for you soon!
@Deknees

 

[kiwicurls]

Hi. I take a homeopathic remedy for restless legs called
rhus tox 30
it works for me.

 

[Deknees]

I had my TKR six weeks ago and my biggest challenge is finding a comfortable position for sleeping. I’m a poor sleeper at the best of times but the sleep deprivation I’m experiencing is very hard to bear. I still average two to three hours maximum a night. I can find no resting place for my operated leg which doesn’t cause me to fidget within moments and so sleep doesn’t have A chance to establish. It’s not excruciating pain but a deep feeling of discomfort, aching, sore and tight. The only position I get any sleep is downstairs on a sofa with a ski slope of pillows to elevate my legs, and I apply ice beforehand. It’s six weeks and there is simply no improvement, though the knee itself is making good progress according to the physio. But the rest of me is struggling to get through each day and each very long night.

 

[lovetocookandsew]

I remember those days of sleep deprivation. It's a very normal occurrence, and, with time, will improve. What helped me was using my ice machine all night long and as much during the day as needed-the cold really did help numb me from the pain, and allow me to be comfortable enough to get some sleep. I would also take some OTC meds (many people use Tylenol) to help with the discomfort. A lot of people have found that sleeping on a recliner helps a lot; if the sofa helps you, I'd continue sleeping there for a while as needed.

I know you're frustrated thinking you should be farther along at 6 weeks, but it's really early in recovery still. It takes, on average, a year to fully recover, although many people feel much better somewhere around 3 months. If you look back to the first day of your recovery, week by week, I think you'll find there is improvement; it's just often not as fast as we expected or hoped for.

If you're having more discomfort, aches, soreness and swelling (the tight feeling is from swelling), you might want to take notice of when it happens. Is it from overdoing your daily activities, or maybe after PT? If so, you might consider backing off the activities until your knee stops reacting. If your knee isn't ready for an activity, it will let you know by becoming sore, achy, painful and more swollen, (sometimes external you can see and sometimes internal you can feel but not necessarily see).

 

[Deknees]

Thanks so much for your reply. Each time I feel overwhelmed by the physical challenge which has a knock on effect on the mental challenge the more exhausted I become from sleep deprivation, if I remember to look at this site I become that bit more relaxed when I remember that what I am feeling and experiencing is a shared phenomenon. It’s not just me and I’m not doing anything wrong and others have been there and are going through it right now. It doesn’t change how exhausted and battered about I feel but it does lower the stress or desperation I might be feeling.

 

[Jtmav]

If it’s any consolation I have been sleeping in a recliner for the past three months. I had my first TKR on Feb 1 and my last on April 25. I am a side sleeper and couldn’t get comfortable in bed. I agree with the ice machine, I sleep with mine on and have been able to get 6 hours or more many nights. Also napping during the day is fine, catch the sleep whenever you can. As they say “this too shall pass”.

 

[Jockette]

@Deknees, I merged your newest thread with your original recovery thread, as we prefer that members in recovery have only one thread.

This benefits you because all your information is in one place, easy to find, and maintains a nice journal for you.

This also benefits our staff, as your information is all in one place, and we often go back through your thread for previous details, so we know what you‘ve been through which helps us advise you better.

So, please keep all your posts in this thread. If you’d like a new title, let us know what you want, and we’ll change it for you.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
How can I find my threads and posts?

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There are a couple of ways you can find categories of threads on the forum. You are able to use links in the main forum toolbars at the top of the screen to quickly access certain types of threads: your own threads, threads with your posts in them, and watched threads. You can also use links...

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Best wishes on your continuing recovery!

 

[Deknees]

The ongoing sleep deprivation is very much connected to discomfort and aches in operated leg but biggest issue is restless leg. I suffered from this episodically prior to surgery but since the op the restlessness and almost constant impulse to move, tense, fidget that leg means it mostly overrides body’s desire to rest and sleep. Also it makes my wounded leg feel so very tired and weak as it hardly gets to rest with the perpetual impulse to tense and release the muscles which I have no control over. It’s so exhausting and I’m even too tired to weep about it in the wee small hours, and this can last well into the morning. At some point my body/mind decide it’s time to wake up even if I’ve barely slept and the restlessness starts to subside. I am iron deficient and I know this can be a factor but it’s the TKR operation which has brought the restlessness to a totally crazy level and mainly in the one leg.

 

[lovetocookandsew]

I seem to remember some members with the restless leg issue saying their doctors prescribed meds which helped. If you use our search function for "restless leg", you'll find some other posts talking about it. I hope you can get it taken care of so you can rest.

 

[Deknees]

Many thanks for your response.

 

[sistersinhim]

The ongoing sleep deprivation is very much connected to discomfort and aches in operated leg but biggest issue is restless leg.

Are you elevating at night? If not, doing so might help with the RLS. Elevating Dos and Don'ts