Difficulty sleeping is common after surgery, which unfortunately can slow down postoperative recovery 1. Fortunately, postoperative insomnia doesn’t last as long and has a faster remission period than non-postoperative insomnia on average 2.
Different patients experience different types of sleep challenges following a surgical procedure. Sleep disturbances tend to disproportionately affect intensive care unit patients. In addition, major surgery tends to result in significantly more difficulty sleeping than more minor procedures.
A number of factors have been associated with postoperative sleep difficulties. These include old age, the presence of a preoperative comorbidity, the type of anesthesia, the severity of surgical trauma, postoperative pain, and environment stressors, among others 1.
Sleep disturbances negatively affect postoperative patients, resulting in a higher risk of delirium, increased sensitivity to pain, a higher frequency of cardiovascular events, and a delayed, compromised recovery period.
Pain is the most common reason people experience sleep disruptions after surgery 3. Second, major surgeries may sometimes spark a more extensive inflammation cascade that affects the whole body. This may further contribute to sleep disturbances. Third, some medications used during or after surgery can contribute to difficulty sleeping. Some data have suggested that people, and older adults in particular, are susceptible to sleep disruptions as a result of general anesthesia. However, several other types of medications, such as certain antibiotics, steroids, sedatives, and some respiratory medications, can also compromise sleep. Patients using beta blockers or opioids for pain relief may also have more difficulty sleeping.
Fourth, anxiety about surgical procedures may result in sleep disturbances pre- and postoperatively, intensifying patients’ perception of pain. Finally, people who need to spend one or more nights in the hospital following surgery often need to face a number of environmental disturbances, such as the bright lights and ambient noise of an in-patient hospital setting, making it particularly difficult to fall and stay asleep.
To boost postoperative sleep, health care providers may attempt to address the different root factors. First and foremost, it is important to manage a patient’s pain. Prior to a procedure, patients must be informed of the expected recovery period and discuss ways to manage their pain with their clinicians. In addition, it is important to manage patient anxiety. Providers may suggest treatments, including cognitive behavioral therapy, psychotherapy, or medications, in order to relieve symptoms of anxiety.
Furthermore, it is important to minimize any environmental disruptions, such as excess noise or light during an inpatient stay. Simple tools such as earplugs or eye masks may help to this end.
Electroacupuncture technology has also been suggested as a sleeping aid. It has been demonstrated to be safe and effective at reducing the risk factors of postoperative sleep disturbances, notably by relieving anxiety through its analgesic and sedative effects 4.
Finally, pharmacological measures can also improve postoperative sleep 1. These include zolpidiem (a short-acting non-benzodiazepine that increases the activity of gamma-aminobutyric acid), melatonin (a natural hormone secreted by the pineal gland to regulate circadian rhythms), and dexmedetomidine (a selective α2-adrenoceptor agonist with both sedative and analgesic properties). However, additional data is required in order to confirm and specify the benefits of such drugs on the quality and quantity of sleep in hospitalized patients 5.
For individuals who regularly struggle to get a good night’s sleep, it is critical to address pre-existing sleep issues as much as possible. For example, obstructive sleep apnea 6, chronic insomnia, or restless legs syndrome 7 are common sleep disorders in patients who have been hospitalized. Additional research is warranted in the future focusing on best defining the causes and remedies for difficulty sleeping after surgery.
References
1. Su, X. & Wang, D. X. Improve postoperative sleep: What can we do? Current Opinion in Anaesthesiology (2018). doi:10.1097/ACO.0000000000000538
2. Lin, W. C. et al. The risk of insomnia after surgical operation: A longitudinal, population-based, case-crossover study. J. Chin. Med. Assoc. 85, 519–524 (2022). doi: 10.1097/JCMA.0000000000000688.
3. Insomnia After Surgery: Causes and Tips for Relief | Sleep Foundation. Available at: https://www.sleepfoundation.org/insomnia/insomnia-after-surgery. (Accessed: 27th December 2022)
4. Luo, M., Song, B. & Zhu, J. Sleep Disturbances After General Anesthesia: Current Perspectives. Frontiers in Neurology (2020). doi:10.3389/fneur.2020.00629
5. Kanji, S. et al. Pharmacological interventions to improve sleep in hospitalised adults: A systematic review. BMJ Open (2016). doi:10.1136/bmjopen-2016-012108
6. Obstructive Sleep Apnea: Symptoms, Causes, and Treatments | Sleep Foundation. Available at: https://www.sleepfoundation.org/sleep-apnea/obstructive-sleep-apnea. (Accessed: 27th December 2022)
7. Restless Legs Syndrome: Symptoms and Causes | Sleep Foundation. Available at: https://www.sleepfoundation.org/restless-legs-syndrome. (Accessed: 27th December 2022)
