Been reading so many threads. Had my BTKR March 21, 2109. Had to have 4 blood transfusions at hospital, so battled anemia . I am now 10½ weeks out from surgery. No PCA for pain, only two shots in hospital for severe pain, first two days, then switched to Tramadol 50mg and took 2 to 3 a day till April 21st then stopped. At 6 weeks I had 130 degrees flexion in both knees, walking without cane in house. April 24th started PT outside house. Now I am driving, up on my feet for hours and day and running up to 4 or 5 errands some days. Problem I created for myself is just what my surgeon warned me about. He said between 8 and 16 weeks is the biggest challenge because I will feel I can do so much and so I do it and then pay the price at night. For past 6 to 8 weeks, with no pain meds but Tylenol, I have developed severe insomnia, because I get in bed and no position is pain free enough for me to sleep with or without pillows. I ice like crazy during the day. I also have bipolar 2 disorder and have been under psychiatric care for much of my life and for past 25 years have been managed with clonazepam for sleep and low dose Remeron as antidepressant. As insomnia got worse, my doc said to keep my clonazepam dose at levels it has been for sleep for past two months. Increasing it slightly didn’t help. Yesterday, I had a full blown panic attack and went to cardiologist. They suggested I go back on Tramadol 50s, just at night instead of just Tylenol. I can’t take any NSAIDs, and even Tramadol interacts with both my psych meds. So last night I took one Tramadol at 11:30 and slept two hours, woke up at 2:30 and took one Tylenol and slept from 3 to 5 and then couldn’t get comfortable so took second Tramadol 50 (since it had been six hours) slept 4 more hours. But I woke up weak, shaky, anxious, irritable. Worst day yet but I did get sleep at last. Also depression after surgery was bad, little to no appetite. Had 32 pounds of edema, lost all of that and another 8 pounds of pre-surgical weight. So my dilemma, 10½ weeks out and going back on pain meds at night, seems like the wisest thing to do. Psychiatrist agreed clonazepam didn’t help with sleep since night-time pain was the issue, so going to stick with the Tramadol and hope that as I heal, the night-time pain will get better and maybe lessen the number of activities I do. As I said, I started driving at 8 weeks (as per surgeon’s ok) and running errands and doing household things require standing sometimes hours in different parts of the day. From those of you who have had BTKR, does it make sense to go back on pain meds to get sleep I need? I don’t drink alcohol (29 years now) and hadn’t taken a narcotic pill in 30 years prior to this surgery. I think I pushed myself too fast too far and the pain increase was to be expected. I am on total rest at home today. I have no energy and somehow feel that now that I finally got some sleep one night my body is letting down and the fatigue is depletion. Depression too is depletion. I think the intermittent nausea is also from that. I felt as though I was better 3 weeks ago than I am now in terms of energy, like my engine just stopped!!