What is the best way to sleep after a total knee replacement?

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Sleeping after knee replacement wasn’t an easy. In fact, it was downright difficult because of the wound, the swelling, and some pain.

Today I’ll share with you how I managed to sleep after my knee replacement surgery and if side sleeping helped.

Certain positions worked for me while others didn’t work. At times I was unable to sleep.  I’ll begin with day 1 in the hospital and continue through day 28 of my recovery.

During the first 4 weeks, I never slept through the night without waking up and readjusting my position. It’s hard to get comfortable and early on I could only sleep in one position.

Later in my recovery, I could sleep in two positions and during the 3rd week I spent a short amount of time on my stomach. Early on I found that daily naps were useful on my recliner, however, they likely impacted my quality of sleep at night.

Rest and sleep speed up the healing process so it’s important to get a good nights rest. I hope my article gives you a few ideas to make sleeping easier for you.

If you’d like additional resources the Mayo Clinic also provides general tips for sleeping better.

What is the Best Way To Sleep After Total Knee Replacement

Needless-to-say, sleeping won’t be easy in the first few days after knee replacement. Here are a few reasons why:

• You’ll be on medication which can affect sleep
• You’ll be in some pain which will definitely affect sleep
• You’ll be worried about the wound leaking on the bed or splitting open
• You’ll be limited on the positions in which you can sleep

Ideally, you’ll want to sleep on your back. It’s the easiest position to sleep given you have stitches in your knee and a swollen leg.

If you sleep on your stomach there’s a chance the wound leaks or the bed could rub against the wound. Sleeping on your stomach will also put pressure on the top of the knee where it’s most sensitive.

Sleeping on your side is an option but ideally, you’ll want to sleep with the surgically repaired knee facing up (closest to ceiling).

If you can sleep on your back, great. You’ll want to prop up your leg so it’s slightly elevated.

As you recover, elevation while sleeping will become less important.  Some doctors believe you don’t need to elevate while sleeping at night.

I used a wedge pillow after knee replacement (pictured) and it worked great.  It was perfect for elevating the leg and also for sleeping.

Make sure it’s flat under the entire leg, not just the knee as it causes the leg to bend. When elevated, the leg should be supported from the hip to the foot.

Arrange your pillows or leg wedge pillow in a way that supports the whole leg, not just a part of the leg.

If sleeping on your back in bed is challenging, you can also try a recliner. A recliner is more of a seated position but it can be comfortable to sleep that way at night, especially early on.

In a recliner, you can still place a wedge pillow under your leg for elevation.

Don’t hesitate to take naps during the day. Naps are perfect when icing and elevating during the day. While you’re recovering, you’ll need a lot of sleep in between therapy sessions to regain your energy levels.

Don’t fall asleep too long if you’re icing! Use a timer.

How Soon After Knee Replacement Can I Sleep On My Side

As you’ll read below, sleeping on your side isn’t likely for the first 5 days.  Early on, your leg will be very swollen and it’s important to protect the wound and give it time to heal.

By the end of the first week, you should be able to rest and sleep on your side for short periods of time.

By the 3rd week, your staples will be out, the wound will be mostly healed, and the swelling subsides so sleeping on your side will be easier and more comfortable on your knee.

If you’re like me, you’ll discover that sleeping on your side with your new knee on the bottom is easier than it being on top. In the section below I’ll share more of my experience sleeping on my side.

No. 1 Prepare the Bed

When deciding which bed you’ll sleep in make sure it’s close to a bathroom and that you’re sleeping on the side nearest the bathroom.

Bedding should be clean from the get-go. Even though your incision is covered, the first few days the wound is still healing and cleanliness is important. On my 6th day home, my physical therapist removed the bandage for good and replaced it with Steri Strips (they gave the wound lateral support).

Have several pillows available to allow you to sit up in bed.  The extra pillows will also allow you to prop up your leg if needed.

Use thin blankets because you’ll be sleeping on your back and any weight on your incision will be uncomfortable. I always slept in my underwear and a T-shirt because pajamas rubbed on the incision and made sleeping more difficult (my article about what to wear after knee replacement).

The first 10 days I frequently woke up sweating profusely (this may have been due to the medication). I had to keep an extra T-shirt nearby to change into.

Because of the sweating and the inability to shower the first 12 days, we changed the sheets almost every day during the first two weeks.

No. 2 Keep Items Nearby

During the first week, make sure your walker is placed in easy reaching distance from the bed. Also, make sure you can reach a lamp from your sleeping position.

You can also read my article titled “A Walker, Cane, or Walking Poles After Knee Replacement“.

There are several things that you should keep near the bed.

• As I’ve mentioned in earlier articles I was always thirsty. I used the 64-ounce bottle with a built-in straw that I brought home from the hospital. For me, cold water quenched my thirst so I made sure I added fresh ice to my water before going to bed. I also was taking my pain medication every 4 hours or so and I needed water to swallow the pill.
• I had my pain medication on my nightstand within easy reach. I also began taking 2 or 3 pills out of the container so that they were easier to find and take during the night (also read asprin and the best medicines after knee replacement).
• After trying to get up and use the walker to go to the bathroom the first night I opted to leave the hospital furnished urine bottle on my nightstand and to stand up with the aid of my walker and urinate bedside. I soon learned that I needed a second bottle as I frequently filled the first bottle during the night.
• If you wear glasses I suggest you have a pair of glasses on your nightstand as well.
• I made sure I had a box of tissues and lip balm in close range.

Extra pillows are essential. I had two or three within easy reach. I used them to elevate my leg several times throughout the night and I used them to prop myself up in a sitting position.

During the first few days, I could only sleep on my back. I often sat up and was able to sleep in a sitting position for an hour or so.

No. 3 Get Comfortable (After Knee Replacement Can I Sleep On My Side? Best Sleeping Position)

Getting in and out of bed is important and the height of your bed can make a difference.

My bed is higher than most and at times it was challenging to get in bed but easier to get out of bed. I always tucked my good leg under the surgically repaired leg to support moving it on to and out of the bed.

I relied on the walker early on to stand up once I swung my legs down to the floor.

The first 5 nights my leg was extremely swollen and the only positions I could sleep in were flat on my back or in a sitting position propped up with pillows. The medication helped with pain and helped with sleep.

I woke up frequently to urinate and to drink. I usually slept for 2-hour intervals before waking up.

I did not have a restful nights sleep during this time but I did sleep a lot in my recliner during the day.

After the 5th day I was able to sleep on my right side for short periods of time (my right knee was my surgical knee). I could move my good knee in front or behind the surgical knee, however never on top of the surgical knee.

It was nice to get off of my back even for short periods of time.

After day 12 I began to lie on my stomach for short periods of time (10 minutes). I started out doing this during the day then gradually tried it at night.

I made sure my toes dangled over the edge of the bed so my knee was able to straighten out.

At this time I was no longer using the walker.  Instead, I used my hiking poles that are adjustable according to comfort. 

Sometimes I used both poles and other times I used one to support my healing leg.  Hiking poles are valuable to use after knee replacement and will be useful for many years down the road (check out my article on the best hiking poles after knee replacement).

At the end of the second week, I was sleeping on my stomach for 30 minutes to an hour each night. By the end of the 3rd week after surgery I was able to sleep for short periods of time on my left side if I supported the surgical knee (right) with a pillow.

I had a hard time keeping the sheet and blanket on the surgical knee. I had my surgery in May so I did not need much bedding.

If you live in a cold climate and have your surgery in the winter it may be uncomfortable to keep heavy bedding on your knee while sleeping on your back.

Having surgery during warm weather also allows you to wear shorts. Your wound won’t rub on your pants and doing therapy will be easier.

No. 4 Use Pillows

I started out not using pillows under my knee while sleeping. I believe I was able to do so because I was heavily medicated.

As I transitioned to Tylenol I began using 1 or 2 pillows to elevate my leg during the night. The wedge pillow worked well as did one or two conventional pillows under my leg.

While sleeping in my recliner I always used the wedge pillow, a throw pillow under my thigh, and a folded bed pillow under my ankle.

No. 5 Consider Sleeping In A Recliner

I considered sleeping in the recliner at night when I was having trouble sleeping in bed. I never did sleep in the recliner at night.

I did, however, sleep a lot in the recliner during the day so the change of location to the bed was welcome.  The Homall recliner pictured (right) is similar to the one I use at home.

It’s affordable and I prefer leather because it’s easier to clean.

>>check out Homall price and reviews on Amazon  

The first few nights my wife slept in the spare bedroom. On the third night she came back to our bed and her being on her half of the bed never made me uncomfortable.

If anything, I interrupted her sleep tossing and turning and getting up frequently to urinate.

When I did sleep in the recliner during the day I always elevated the knee with the pillows. The recliner does make it easier to get up to a standing position using the walker or the hiking poles.

No. 6 Keep Your Mind Busy During The Day

Do your best to keep your mind active during the day. The therapy workouts help but you’ll need to keep your mind busy too.

I read but for only short periods of time early on.

I did short-term activities like crossword puzzles and Sudoku. I tried to walk a lot in the house especially before going to bed.

When the therapist began taking me for walks outside I felt worn out at the end of the day. Focus on your workouts and do your best not to skip them or cheat.

I spaced my 3 workouts 3 hours apart and tried to make sure I was able to eat lunch on time. As I mentioned before, the early workouts including the walks were tough physically and mentally.

I did my best to be conscientious and stay on a routine.

Each day at the end of the 3rd workout I was relieved and worn out. The more activity that you do during the day, the chances for a better nights sleep will improve.

Unable To Sleep After Knee Replacement Surgery

The first thing I’ll say is don’t be surprised if you’re having trouble.  You’re not alone.  In the first week, it’s tough for everyone to sleep, even though you’ll be exhausted.

After arriving home from the hospital, I was extremely tired from the stress of surgery and the procedure.  I’d fall asleep quickly when I laid down but because I needed pain medication and couldn’t stay in a comfortable position, I woke up constantly.

As a result, my sleep suffered.

Related: Best Ice Pack After Knee Replacement

In addition to the tips above to make sleeping easier, consider taking melatonin (talk to your doctor about potential side effects or chemical reactions with other medicine).

The best way to fall asleep after knee replacement was working hard during physical therapy until I was exhausted.

I also did my best to limit my naps during the day so I was extra tired at night.

I can assure you that after the 1st week it gets easier.  Don’t panic if you’re struggling to fall asleep after TKR surgery.

Conclusion

Sleeping will not always be easy after TKR. You’ll feel tired and sleepy initially when you are taking pain medication.

Once I began to wean off the pain medication I found it harder to sleep for sustained periods of time.

To begin with, plan on sleeping on your back or in a sitting position. As days go by and the swelling and pain decrease you’ll be able to experiment with different sleeping positions.

The wedge pillow and bed pillows will offer much-needed support and elevation. Once I was able to lie on my stomach I felt like I had reached a milestone.

Constantly sleeping on my back was uncomfortable. Through trial and error, I found some new sleeping positions even if it was for short periods of time.

I hope this article helps you sleep better after your TKR surgery. You’ll have to experiment as time goes by.

I encourage you to try various sleeping positions that are comfortable for you.

I am looking forward to sleeping through the night in the future and hope you do as well!