Hi @mom4twins4me, welcome to Mayo Clinic Connect. You'll notice that I moved your message to this existing discussion called "Trouble sleeping after TKR." I did this because I thought you'd appreciate some of the tips members like @10nsmom @sleepy0 @debbbraw @u13496 @ellerbracke @johnbishop and others have shared with each other and to get responses about your situation where your sleep is interrupted around 4am from stiffness and pain.

Do you get any stiffness and pain during the day or is it only caused by the lack of movement? What do you do at 4am to relieve the pain?

Good evening @mom4twins4me, I would like to add my welcome to Connect. You are very brave. I only know one other person who has been awakened by pain and discomfort at 4:00 a.m. after just one TKR. And that would be me. You on the other hand have two knees to take care of. I talked with my surgeon about the night pain and he acknowledged that it happens. Mine always began around 4:00 a.m. The trick is to have whatever medication you need or other treatment devices, placed at the head of your bed so you don't have to get up and walk around. My surgeon gave me Ambien and I hated it. I quit cold turkey and called my to tell him that we needed to find another option. Well, after a while with consistent sleep habits, it just went away. We call that taking a "poof" as in "Poof, go away....you are gone."

My real comfort was Miss Roxie, who got up to go outside and then came back and planted her self right alongside me. I don't know why but that really helped. Of course, so did the medical cannabis tincture. I added this picture because it shows you how she can take a pillow and twist it about until it becomes a bed. Sometimes when she would come back inside to find me still in bed, she just looked at me with a sense of almost disgust....like....what are you doing still in bed? She was my constant companion through all the surgeries. I couldn't have done it without her.

I also learned about fascia. The tightened fascia around the surgical area becomes layered and restricted. With gentle and soothing pressure, an MFR therapist can separate the layers and release the restrictions. If you have not tried MFR therapy, you may wish to give it a try. Here is the link to the website.
https://myofascialrelease.com/
If you are already awake with no chance of going back to sleep you may profit from doing the "legs up the wall" yoga pose. If you are interested there are images on youtube or just google it.

And I will say goodnight with one of my very favorite Roxie images. Sleep well. Let me know if there are any other tidbits of my experience you might like to share.

May you be free of suffering and the causes of suffering.

Chris

Hi @mom4twins4me, I am a little over a year out from my right knee replacement in April 2019. I had some pain with the knee for the first month or so. I think partially because I am a side sleeper and when my side would ache a little during the night I would roll over and that caused some problems for me. One thing the care team suggested to me was to add a pillow under the mattress at the bottom of the bed to raise it a little to help keep the leg a little higher. I also use a small pillow in between my knees and that helped the most I think.

My first follow up meeting with my surgeon when I wasn't doing really as good as expected, he chastised me for not following his instructions which he repeated to me again - ice and elevate, ice and elevate, ice and elevate. He did say it with a grin and in all fairness I thought I was icing the knee often and elevating it during the day...just not enough according to him so I picked it up and did it multiple times during the day which seemed to help a lot for me.

Did you receive any suggestions from your surgeon or care team?