Knee Replacement: Insomnia post-surgery

Posted by auntmarmar @auntmarmar, Jun 9, 2019

Eight weeks ago I had total knee replacement. The knee seems to be doing pretty well, however I have been suffering from horrendous insomnia ever since. Most nights I get 0 to 2 hours of sleep. I feel like a zombie and have also been suffering from anxiety and depression. I have tried sleeping pills, pain pills, Xanax, meditation, I am seeing a counselor, I go for PT, I am doing acupuncture… I am currently using melatonin and CBD oil. I am completely beside myself and so frustrated. Anyone else experiencing this problem? Any solutions?

@contentandwell

@auntmarmar Is your anxiety due to your TKR? I think you need to figure out what is causing the anxiety and depression before you can tackle it. I know nothing about sleeping pills, I do use melatonin and sometimes Benedryl but have not used any prescription remedies in many years. I tried once a long time ago but didn't like how I felt the next day.
It's good that you are seeing a counselor, hopefully that will help you to sort things out. It does not sound as if pain is what is keeping you awake, if I have interpreted your discussion correctly. I will be interested in hearing what approach is taken to help you because I often have trouble sleeping if I am anxious about anything. These days I do not feel anxious but if I get six hours of sleep I consider it to be a good night.
JK

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No pain is not the problem. And yes the anxiety and depression are since the surgery and seizure. Now mostly from the lack of sleep. Continuing with the counselor.

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You aren’t alone!!!! It will be 8 weeks post op for me on Monday. I was told to try Tylenol PM. I may fall asleep after about an hour after taking it but I wake up about 2 hours later and can’t sleep the rest of the night.

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I am 12 weeks out and sleeping better, but I have to adjust so much during the night (back, right side, left side, rearrange pillows) that I am rarely getting more than two hours of uninterrupted sleep. Then it's often a fight to get back to sleep. When I was still taking Tramadol, I think that helped me sleep–or at least stay "groggy" enough that even a trip to the bathroom wouldn't wake me up completely. I've used Tylenol PM and I think it's so-so — takes about an hour to get to sleep but does not get me 8 hours. Before the surgery I invested in good over-the-ear headphones (the ear buds bother my ears). To fall asleep, and if I woke up to get back to sleep, I'd put on the headphones and a podcast. Kept volume low, goal was white noise more than listening, but this did seem to help me get back to sleep. I also used a CryoCuff by Aircast, and the regular "inhalation/exhalation" of the machine actually helped me fall asleep/get back to sleep. But I feel you! Even now, I know that dealing with this recovery would be so much better if I had consistently good sleep. Good luck with your recovery and getting better sleep!

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I’m now 3 months out and on tramadol and finally getting some sleep. It’s going to take a while to get over 3 months of insomnia though! Good luck to you.

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@auntmarmar

I’m now 3 months out and on tramadol and finally getting some sleep. It’s going to take a while to get over 3 months of insomnia though! Good luck to you.

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I meant trazadone not tramadol.

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@charobarr

You aren’t alone!!!! It will be 8 weeks post op for me on Monday. I was told to try Tylenol PM. I may fall asleep after about an hour after taking it but I wake up about 2 hours later and can’t sleep the rest of the night.

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Hi @charobarr – Welcome to Connect! Glad you found this thread. There's tons of good information and great people here. I've had two TKR's and I agree with you. Tylenol did nothing to touch my pain. I got Tramadol as kind of a transition after I quit taking the stronger pain meds. I've heard others here say they did the same. Would your doctor be willing to prescribe something a bit stronger?

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I had a right total knee on Oct 1st. It will be 5 weeks tomorrow. I have had very little sleep at night because of the what I call cramping in my right knee if I bend it for any amount of time at night. It wakes me up when I try o straighten it . Feels like a bad cramp. I need sleep. Help???? I had the left done on June 18th of his year and never had as much pain as this one.

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Hello @matildaschmidt, welcome to Connect. I combined your discussion with an existing discussion titled, "Knee Replacement: Insomnia post-surgery." I did this so you could meet some of the other members discussing sleeping issues following a total knee replacement. If you are replying by email, you can see the new location of you discussion by clicking on VIEW & REPLY. You may find it worth your time to read through some of the previous posts. @matildaschmidt, what sort of things have you tried to improve your sleep? If you are comfortable sharing a bit more, what is your range-of-motion like? How is your pain and cramping during the day when you are most active?

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@matildaschmidt

I had a right total knee on Oct 1st. It will be 5 weeks tomorrow. I have had very little sleep at night because of the what I call cramping in my right knee if I bend it for any amount of time at night. It wakes me up when I try o straighten it . Feels like a bad cramp. I need sleep. Help???? I had the left done on June 18th of his year and never had as much pain as this one.

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@matildaschmidt I too welcome you to Connect.
I have had two TKRs and both were different. I have heard that even when both knees are done at the same time by the same doctor, there can be differences post-surgery.
I know doctors are very reluctant to prescribe pain medications these days, have you had anything? I have read that ibuprofen is just about as effective as the various opioids. If your doctor will not prescribe pain medication can you at least get a prescription for something that will help you to sleep? I had a similar problem because I cannot take ibuprofen, just acetaminophen, and that is not a huge help at all. I did have a very small prescription for a pain med that lasted a couple of weeks and that did help.
I hope you are able to catch up on your sleep during the day, being sleepless is not good and I believe lack of sleep hinders healing too.
JK

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@amytro

I'm 6 weeks out from my second knee surgery and once again, I am having a terrible time with insomnia. And to make it worse, I get a ton of anxiety and just can't get comfortable. It's almost like a panic attack. To top it off, in week 4, I started experience post-surgery nausea and vomiting. I wake up each more and dry heave and even vomit as soon as I get to the kitchen in the morning. This has lasted 2 weeks. (I did get an anti-nausea medication). Has anyone else had these issues? Some nights I'm still up at 3 am, trying to get comfortable. I have loaded myself up with Zzquil, Benedryl, and other over the counter meds to knock me out. I thought with the opioids I'm still on, it would do the trick. Nope. Am I alone?

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Try a firm body pillow to put your whole leg on. I have had 2 TKR and was able to get comfortable and sleep. Advil PM also helps. Love my knees.

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@debbraw

Hi @amytro – I agree with Justin @JustinMcClanahan – I would keep a close eye on the issue of nausea. Three weeks after my last TKR I started having nausea so severely that I had to go to the ER. I, too, had been sent home from the hospital with anti-nausea meds but they didn't touch it. It turns out I was having a reaction to the Celebrex they prescribed as an anti-inflammatory and it was causing internal bleeding. I think your body may be sending you messages that all is not well. To me, the nausea and digestive issues sounds like the issues of greatest concern. If you don't have a doctor's appointment coming us very soon, could you message your doctor through the portal or call?

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Hi @amytro
Like you, I'm 5 weeks post 2nd knee replacement and suffering from insomnia, extreme fatigue, weight loss and nausea. I had none of these 3 years ago when I had my first knee replaced. I was on Xarelto for 30 days to prevent blood clots forming and stopped my opiod pain meds 12 days after surgery. I couldn't handle the constipation and weird feelings. I do feel depressed because I wish I had more strength. Anxiety used to be a problem but years of therapy helped with that. 5 years ago I was diagnosed with bladder cancer and had chemo followed by bladder removal and have been doing well.. All my CT scans have been negative and I felt great except for my knee. Not a fan of doing it the second time but I figured I survived the cancer surgery and first knee a year later without major difficulty. Now, I'm struggling with my PT exercises because I'm so tired. Surgeon said he doesn't prescribe for insomnia. My PCP was reluctant to prescribe but gave me a small script of Trazadone to try. It hasn't done much, nor the melatonin I'm taking. Food doesn't interest me like it did before and strong smells and tastes can make me nauseous. My surgeon's PA thinks I will turn the corner around 6 weeks post surgery when most of the pain passes. We'll see as that's only a week away. 1-2 hours sleep per night is all I can manage. Sleep is needed to heal properly and have energy to exercise. So, yes, I'm fatigued and somewhat depressed. Hopefully it will improve soon. Trazadone is also an anti-depressant so maybe I haven't given it enough time to build up in my system yet?

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@cmar

Hi @amytro
Like you, I'm 5 weeks post 2nd knee replacement and suffering from insomnia, extreme fatigue, weight loss and nausea. I had none of these 3 years ago when I had my first knee replaced. I was on Xarelto for 30 days to prevent blood clots forming and stopped my opiod pain meds 12 days after surgery. I couldn't handle the constipation and weird feelings. I do feel depressed because I wish I had more strength. Anxiety used to be a problem but years of therapy helped with that. 5 years ago I was diagnosed with bladder cancer and had chemo followed by bladder removal and have been doing well.. All my CT scans have been negative and I felt great except for my knee. Not a fan of doing it the second time but I figured I survived the cancer surgery and first knee a year later without major difficulty. Now, I'm struggling with my PT exercises because I'm so tired. Surgeon said he doesn't prescribe for insomnia. My PCP was reluctant to prescribe but gave me a small script of Trazadone to try. It hasn't done much, nor the melatonin I'm taking. Food doesn't interest me like it did before and strong smells and tastes can make me nauseous. My surgeon's PA thinks I will turn the corner around 6 weeks post surgery when most of the pain passes. We'll see as that's only a week away. 1-2 hours sleep per night is all I can manage. Sleep is needed to heal properly and have energy to exercise. So, yes, I'm fatigued and somewhat depressed. Hopefully it will improve soon. Trazadone is also an anti-depressant so maybe I haven't given it enough time to build up in my system yet?

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Hello @cmar, welcome to Connect. I am glad you found the post by @amytro to be helpful given your similar experiences. I wonder if you might have seen an earlier comment on this discussion by @jellycats who offered some additional suggestions for dealing with insomnia post TKR? You mentioned being too tired for your PT, so if you’re comfortable sharing, how are things progressing with your therapy in light of your lack of sleep?

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