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TKR Trouble sleeping after LTKR

TurtleKnee

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It has been 14 weeks since my surgery on August 18th, 2020. The largest problem has been sleeping in my bed. After lying in bed for 30-60 minutes, my knee starts to ache, radiating down to my foot and up to my thigh area. Then, I take a pillow and put lengthwise under my leg, where I am able to sleep about 60 minutes before it starts to hurt again. At that point, I get up and go sit in a recliner. I have NO pain while sitting in a recliner, but have some pain in the reclining position after 30-60 minutes. Then after 3-4 hours rotating between reclining and sitting, I go back to bed for about another two hours repeating the above sequence of lying in bed without and then with a pillow (so about 2 hrs in bed, 3-4 hrs in a recliner, then 2 hr in bed).

This has been a problem since the day of surgery where pain was starting after only several minutes in bed; this has since improved to 5 minutes, 15 minutes, and so on over the months to today's status above. Otherwise I have progressed very well. Had 2 weeks of home PT and about 7-8 weeks of outside PT. I have a home PT program I do daily. I am walking around almost normally only using a cane to walk across parking lots, etc. I am a swimmer and swim 6 days a week over a half mile at a time. I am able to clean house, drive, go the stores, and do most of what I used to do EXCEPT SLEEP. I have been an athlete most of my life and in good health and not used to this.

I knew this would be a long recovery, but am getting discouraged about not being able to sleep normally in a bed after 14 weeks. It has got better, but at a turtle's pace. Are others having problems sleeping like this 14 weeks after surgery, or am I just being impatient? When should I expect to sleep normally again and is there anything I can do to make this happen, or do I have to wait and let time take care of this problem?
 

TinAB

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I'm new here and nearly 8 weeks out. Just wondering what you are taking for pain or any other medication to help you sleep? What you are experiencing sounds exhausting for sure.
 

Peaches0000

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@TurtleKnee Sounds like everything is going great for you ,except the sleeping part. My primary Dr gave me a prescription for Ambien and it worked like a charm. I used it for a few months and did Not have any trouble quitting it. I think after the surgery, that I got into the habit of waking up from the pain all of the time and even as I got better, I still kept waking up all night long. There is nothing like a good nights sleep to make this journey a lot easier. Lack of sleep made me feel crazy, depressed and kind of mean during the day.
 

PegGar16

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It was awful trying to sleep after my surgeries. My shoulder surgeon had a discharge bundle which was pain med, nausea med and sleeping pills. You might want to check with your doctor.
 

Nancan

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Wow! You are my twin! I had my surgery 8-17 and have the exact same sleeping issues. My GP prescribed Ambien as well but I still wake up several times at night due to knee pain. I have found that if I get up and walk around the house for a few minutes my pain subsides and I can go back to sleep for about two hours. I used to go to the recliner for an hour or so when I got up but that got so “old” that I decided I wouldn’t go to the recliner when I woke up in pain and as it turns out I’m getting more sleep by just walking around the house for a few minutes.
 
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TurtleKnee

TurtleKnee

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Even the strong narcotics did not help me sleep, I just could not get comfortable. It is not a sleeping issue but a pain issue when lying in bed. However, it is better than it was 6 weeks ago. I am trying to get off the recliner also, and have tried walking around the house for awhile, it helps some, but still going to the recliner. Doc said I still have inflammation and swelling that might be keeping me from being comfortable at night, so on naproxyn 500 mg/ 2x a day, but upsets my stomach, so just take it at night. Have been on that 2 weeks, and think it might be helping some.

Has anyone else been through this and is OK now? If so, at how many months/weeks were you able to sleep again or started getting better?
 

PegGar16

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I used to have the knee up on a pillow with the Iceman when I went to bed. It helped me a lot with pain relief and I slept much better.
 

sistersinhim

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@TurtleKnee, welcome to Bonesmart. :flwrysmile: Pain at night is usually an indication that you are doing too much during the day. Try cutting back on your activities during the day and see if that helps your sleeping problem.

Then after 3-4 hours rotating between reclining and sitting, I go back to bed for about another two hours repeating the above sequence of lying in bed without and then with a pillow (so about 2 hrs in bed, 3-4 hrs in a recliner, then 2 hr in bed)
I alternated between the bed and the recliner for a couple of months. My sleeping has always been on the not so good side, but after this surgery it was awful. I found that the narcotics disrupted my sleeping even worse. When I was able to cut down on those I began to sleep some better. My GP also gave me a prescription for a generic Ambien that helped a little. Once off of the Oxycodone the Ambien helped more.
 

sistersinhim

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The following are our basic guidelines and should help get you started. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect and what not to do, especially regarding PT.

Knee Recovery: The 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
ice
take your pain meds by prescription schedule (not when pain starts!)​
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
5. Here is a week-by-week guide for Activity progression for TKRs


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.
 
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TurtleKnee

TurtleKnee

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Thanks everyone for your input. :) I spent time this afternoon reading the different articles and links to more information. There is a wealth of information here. It is helpful to read from others what helps and what doesn't, and that I am not alone with my problems. I appreciate the time that all of you took to post and organize information (mods).

Yes, I have probably been pushing myself too hard, but as an athlete I was used to this regimen, so have been working hard to achieve the goal of being normal again and stronger than before. It has been important to me to regain my independence of being able to do things for myself.

I am fortunate in that I have not had any trouble with flexion, having done 120, less than 2 weeks after surgery. NO pain ever when sitting.

Extension has been my problem, after 2 weeks, just a 3 or 4. Keeping my leg extended for a period of time is when the pain comes in. That has to be one of the reasons I am not sleeping well and having pain after lying in bed after a period of time (also emphasized by the doc and PT). The PT people had me doing multiple stretching exercises many times a day. I can straighten my leg out fully now, but not for a long period of time. Are others having problems with extension? It seems that most ROM problems are with flexion? Are there any suggestions to help with my "extension problem"? :scratch:
 

Jockette

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Extension often takes longer but as you heal, it will improve. Walking is a very good, gentle way to help it. This is a long, slow recovery and it just takes a long time to heal. In this year long recovery you are only 25% healed, so you have lots of time to improve.

I wonder if you are trying to keep your leg totally straight? Many of us are told that, but a gentle bend is fine, and is more comfortable while we are healing.

And, 3-4 degrees from straight is really not that much, you’ll be fine in time.
Extension: how to estimate it and ways to improve it
 

sistersinhim

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Many of us had our extension lag behind our bend. Mine did. How I helped to improve mine was to walk with a longer stride making sure I walked with a heel to toe gait. This helped to stretch out those huge back soft tissues, improving my extension. But this didn't happen overnight. It took a few weeks. Before I knew it, though, I was able to hold my extension longer. I did sleep with my knee slightly bent and still do, but this has not hurt my extension at all, just helps me sleep better.
 
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TurtleKnee

TurtleKnee

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Well, just about 3 weeks later than last post above. I have followed some of the suggestions above and also cut down on my exercise. I am now at 17 weeks, 4 days post surgery. Last night I spent the first full night in bed since my surgery. I have progressed from my first post to now sleeping about 1 hr in bed without the pillow under my leg; then get up and walk around for 5 minutes (as suggested above); then back to bed for 1-2 hrs with a pillow under my leg; and then back and forth all night. No recliner last night finally (plus it is too cold now here). Hopefully my time actually sleeping will increase, but happy that I actually can stay in bed. :)

❓I have noticed that most of the pain causing me problems at night is located on the outside of my left knee. Is there any reason for that? Any exercise that might help? Anything I should not be doing for this problem?
 
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TurtleKnee

TurtleKnee

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I was thinking IT band also, but no problem on hip down to the knee, just the outside of the knee area. I may try the stretch on the table, forget some of the other ones.

Still have inflammation which I understand can be slow to resolve in some people. Taking naproxen for that at night. I am thankful for the progress I have made, albeit turtle style.
 

Triker

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I'm about 15 weeks out from the knee replacement and still have pain sleeping. I think some of it comes from not moving it while sleeping and it just begins to ache until I wake up and bend it 4 or 5 times. I also have pain and tenderness in my hip revisions that were a year and a half ago. I can only sleep on my side for an hour or so before they force me on my back . I'm still getting up at 3 in the morning to get Tylenol so I can get another 3 hours of sleep. I'm hoping over time this will gradually decline.
 
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TurtleKnee

TurtleKnee

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Yes Triker, same with me, hurts when not moved for awhile, but the last several weeks it has got better, as I am sleeping longer than 3-4 weeks ago. It seems the longer I sleep, the more stiff and pain I have. It is only when I am lying down, never when sitting. The naproxen they gave me is supposed to help the inflammation which the doc thinks is the reason I am having trouble keeping my leg extended. Upsets my stomach, so only take it at night, but better than weeks ago as slept as long as 2 hours last night then getting up was as stiff as a board and really hurting. This has to get better does it not?
 

np7

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I found that backing off on physical activity really helped me with pain and sleeping as Sistersinhim suggested above. Taking Tylenol PM at bedtime helps too. Also, in my case proper timing of opioids have helped with sleep. My first TKR was August and the second was 12/2.

Good luck. You will make it through this.
 
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TurtleKnee

TurtleKnee

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NP7, you said that your first TKR was in August like mine. At what point (weeks, months) were you able to sleep normally without pain? Anyone else?

In general, I have cut down on physical activity like 30 reps of my home PT to 10 or less; the swimming appears to really help, as I have been doing that all my life. It seems though I need to balance the amount of physical activity in order to retain mobility against doing too much that it causes more inflammation and swelling.
 

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