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Sleep Concerns After A TKR

It has been almost one year since my total knee replacement and a good night’s sleep is still nonexistent. I take that back. There was one night in which I slept the entire night. This was after eating a nice two-cup sized bowl of smoked salmon chowder. Maybe there is something special in the salmon, but it sure made for a memorable, and pleasurable, night’s sleep. It also was an unusual event.

Usually I wake up with extreme pain along the outside part of my bionic knee. As I have mentioned in other blog posts, I have excessive nerve damage caused by a former bone spur. There are different ways that I try to ease the pain, but it initially tells me that it’s there.

Prior to my total knee replacement, the damaged nerve pain was so bad that I needed crutches to walk. Now, it is not so lingering. The damaged nerve does, however, cause my foot to tingle at times. Very strange. I have read about others having the same concern, though.

Maybe this will help explain why I burst out into laughter over the strangest things. I’ll blame it on sleep deprivation, anyways.

Memories of sleep….lovely, sleep. 😕


18 Responses

  1. I developed insomnia after about 4 weeks post TKR,
    and just concluded my 4th month recovery(Oct. was my OP)For 3 months have not had a “night’s sleep”. Awake everyhour throughout the night. My then, family physician,wouldn’t prescribe sleep medication. I tried every herbal and naturopathic remedies I could find. None could help give me a full night’s sleep. Recently after the second instance of being sleepless until 4AM I went to a new doctor who is willing to help with advice and medication. One bit of advice, was no
    computer 2 hours before bedtime. I would sit at the
    computer trying to avoid going to bed. Probably the same advice for TV, which I don’t have. I try to do all
    computer stuff early evening, then read or something
    quieting.I go to bed at what used to be my usual time .I get up at same time every morning, no matter how sleep-deprived I feel. If I nap, it’s supposed to be early afternoon.
    I think the insomnia developed because of the
    extreme discomfort, and sometimes pains ,in my leg.
    I couldn’t find a pain medication that worked for me
    with the dosages that are recommended, even with extra-strenghth Ibuprofen, it’s effects last a short
    period. The pains are diminished but are enough to
    wake me.
    Everybody of course will have their own issues to cope with, but I can truthfully say, it has not been a
    positive experience for me, this operation. I am
    grateful for the eventual positive outcome and keep
    telling myself, “keep your eyes on the Prize!”
    Time will tell how the sleep problem will resolve itself.
    It’s fortunate that we are able to communicate
    among ourselves through cyberspace, obtaining
    information which was not offered to us pre-op. and
    even post-op. Even after 4 months, I am still learning.

  2. I’ve had both knees totally replaced, the first 12 months ago and the second 3 months ago. I have problems sleeping because of muscle spasms still in my quads. The Dr. says normal side-effect, has anyone else experienced this?

  3. Joan…I still have sleep concerns a year after my tkr. There is nerve pain every night. It’s still better than before surgery, tho.

    Yes, I have non-painful muscle spasms – even a year after my tkr. The spasms can be alongside my knee, in my shin, or my foot. I just straighten my leg and massage, then elevate it. And…ice. 🙂

    Good luck to you both!

  4. Okay, I have had TWO bad nights in a row…..I had a good day at work Wed., no pain pill at all, was off Thursday, didn’t do much that day, but couldn’t sleep that night…..had to get up early Friday, was in pain so took pill and went off to work. After work Friday, I made sure I didn’t take a nap, so I’d sleep good last night. Hahahaha……went to bed at 9, no TV…..still restless and in pain (rode bike for 10 minutes one hour before) had ice pack on knee……finally at 3AM, took a pain pill, then had to get up at 5 to get ready for work. Worked till 11:15……leg was killing me, took ANOTHER pill about 9AM……..

    Iced my knee when I got home, and took an hour nap….felt better……drove to “the city” to buy some new work shoes….

    And now, just sitting around, leg still hurts, knee is swollen….about to grab ice pack, skipping bike tonight. Off work tomorrow……but have to go to a meeting on Monday where I have to climb a steep set of stairs…..it will take me awhile to get up them, I’m sure!

    Geeze, I really need some sleep and some time without pain! PLEASE!!!!!!

    okay, done complaining now!!!!! Thankful I have a job…..and I roof over my head…but I’d still like to sleep….!

  5. wow, after reading some of the blogs about not sleeping, i feel guilty to say that so far that has not been one of my problems. knock on wood! however i remember early after the surgery, while still on hydrocodone, i had some issues. once i got off that stuff, i felt better overall. and i have mentioned this in another blog about what i swear by for inflammation which in itself causes pain as we know, is FISH OIL!. I take the high potency liquid with epa and dha , only 1 tsp a day. its a brand called prn neutriceuticals with lemon zest. they have a website by name. if you can take this it is wonderful. and is great for so many other things as you know. my os put me on it years ago when i had one of my 5 knee surgeries. i never take any form of pain meds since, for anything. and i have saphenous nerve damge from all the surgeries and i don’t have to ice anymore even after excercies. i don’t really swell much anymore. it really works.! and no i don’t work for the company. just a thought for all you nonsleepers. take care. and goodnight.

  6. I have no clue how this works, but I’m a new tkr and really struggling. I am 57, own a business, and am single. I’ve had problems w/ my knee since 1975 due to a gymnastics accident. I finally, after many people have pushed, decided to have this stupid surgery. I’m really wondering now if I made the right decision. I had my surgery on Jan 12. It’s been just shy of a month and I have barely made the 90degree bend. I don’t sleep well yet. It’s like I just take lots of naps during the night. I guess in the past few days that’s improved a little.

    My PT pushes me to sobbing most sessions. I’ve begun outpatient PT and it’s like going to a torture chamber. I do exercises at home…have an exercise bike I work on alot although I can’t make a full rotation yet. I do other exercises as well pretty religiously.

    I feel like I was so unprepared for this. THe pain, the poor sleeping, such slow progress. I am really taken “aback” by it all and am trying to keep my spirits up, but between being uncomfortable so much of the time and poor sleep, it’s becoming a challenge.

    I could us some good news! Any out there?


    • Take heart. I had bilateral partial knees replaced the beginning of October. At three months I am beginning to have more good days than bad ones. I saw my doc on Friday and he will see me again in 9 months. He says it takes up to a full year to see the full benefit of the surgery. My sleep is also fractured but my g/p agreed to Ambien CR which is helping. I have also been fortunate to change jobs which does not require as much getting in and out of the car, stairs, etc. ( I was a visiting nurse). This is a long convalescence and I think most surgeons do not present it as such. That being said, I’m glad I had the surgery done. Once I’m on my feet and moving I’m practically pain free.

  7. Susan…….you sound just like me a few weeks ago! I was so depressed around the 3rd and 4th week……wondering what the heck was I thinking??? Cried like a baby, apologized to my husband for causing all the problems….lol……he just patted me on the head and said, go back to sleep, it’s okay!

    I did say before that the doctor did NOT tell me how long or how hard the rehab would be, so I felt like I was failing at rehab until I stumbled upon this blog. I felt so much better knowing it wasn’t just me!

    I also cried at PT sessions……but my PT’s were great…..they would cheer me up and cheer me on, for every little gain I made.

    So, it DOES get better…….measure your progress by weeks, not days…..that helps.


  8. Susan,

    I had tkr on Dec. 16th and I am just now beginning to see the light at the end of the tunnel. Two weeks after my surgery I broke down crying wondering if I had made the right decision to have this surgery. I am 45 years old and had my first surgery at 15. Many more have followed to this point. I injured mine running track in High school.
    I too thought of Physical therapy as something I hated to endure but now know it is the only way to progress positively. I spent the first five weeks rocking on the bike because I couldn’t make a full round because of scar tissue. After a manupiulation to break up the scar tissue, I finally made my first round on the bike. That was a day of celebration. Take them one at a time and celebrate even the little ones because it is progress. Although I am just a few days shy of two months post op, I am finally beginning to feel like my old self again. I am walking unassisted. It isn’t great but I am walking on my own. I am cleaning my house, cooking, grocery shopping and walking my neighborhood again, riding my stationary bike several times a day and still doing my PT everyday. For us we will have to incorporate PT for the rest of our lives, which isn’t necessarily a bad thing for me.
    I wish for you some peace but most of all much progress. It will come and I agree with Debi count the weeks not the days because you will change from week to week as your body heals. I certainly wasn’t prepared either for the rehab and recuperation dificulties. I have never been down long so I thought I would bounce back from this one too. WRONG!! I soon learned I had to be patient and just follow the professionals to get better. Take care and I am sending you best wishes for your recovery.

  9. Hi Susan…….you sound a lot like me! I was totally depressed around the 2nd-3rd week, wondering what the heck I had done…and crying almost daily……But now you’ve seen the light at the end of the tunnel, and it’s NOT a train!!!!

    Good for you for seeing the end of the road and realizing it is going to take time….lots of time!

    Finding this blog has saved my sanity and given me hope!

    My main problem now is the pain I’m enduring being back at work and on my feet so much….I am home for lunch now with an ice pack on my knee…also took a pain pill…..this will get me through the last 3 hours of my day!


  10. Hello Susan and Everyone else,

    This is a great site that has really helped me to learn about my TKR rehab during and after the fact. I had my surgery on 12/29 and can say that everyday since then has been filled with a lot of hard work, pain, and questioning the validity of my surgery decision. PT also brings tears to my eyes during most sessions, and I have use the exact same description for outpatient PT as a torture chamber although my PT’s have all been wonderful, very knowledgeable, and caring persons. I am hoping that last week on Friday I turned the corner so to speak as my flexion increased from 89 to 94, so keep your fingers crossed for me, as I will for all of you. This is indeed an intense journey that I was not prepared for as far as realizing the extensive rehab and pain involved, but this site and a few others have helped me to know that I am also not alone. I am working really hard to avoid manipulation, and my target is 110 to 115. Would love to hear from those of you who have had manipulation or from those who opted not to have it. I only take pain meds on PT days along with an antiinflammatory that has a gazillion side effects. It does seem to be helping a little, but not much. In fact I now take oxicoton only on PT days, but not a lot of relief. The last thing I want to do at PT is bend, but of course we do that evey session, and so much of it! I do my exercises 4 times a day with a few more thrown in hoping that at some point I will contine to improve my flexion.

  11. Hello Jackie,

    I had Manipulation three weeks ago and it worked for me. My range before manipulation was around 66. During the procedure he got 120. I am now at 110. I had a lot of scar tissue that was seriously disrupting my rom and knew I didn’t have much choice given I could not stand my pt trying to do it while I was awake. I was terrified to have it done because I thought I would be taking a step backwards but it felt wonderful after to have broken through that brick wall I was experiencing. My mucles were sore (quads mostly) for about a week then it began to subside. My os prescribed a mild muscle relaxant to help me with muscle stiffness and then my ROM improved even more. You still have to go to pt with gusto to retain your new range and I didn’t seem to mind so much after because it wasn’t so painful.
    I will tell you there are mixed feelings about this procedure so I can only confirm my own experience. It was sucessful for me and I am now eight weeks post op and improving every week. I wish you the best of luck.

  12. I’m 7 weeks post op and having trouble with sleep as well. At first I thought it was because of withdrawal symptoms from my oxycodone. I really felt I was going to jump out of my skin as I tried to settle down for sleep. I felt SO restless.
    Now that I am about 2 weeks off of the narcotic, I am a bit better but the restless is still an issue for about an hour after I go to bed. I’m already on trazadone at night for sleep, which i have taken for many years.
    I am hoping that once I get into the pool next week and get some real aerobic activity going on, my sleep might come back. By nature, I am a very active woman – I’ve got a physically demanding job and I’m an avid cyclist. Yet, this recoop time has taken away all of my physical outlets to deal with stress.
    Fortunately, I’ve got a wonderfully supportive spouse, good friends, and a supportive therapist to remind me of the facts – this was a big surgery, it’s going to take time to heal, and things could be so much worse. A cheering sections helps to remind me that working at recovering from the TKR everyday IS my job now (can’t return to work until August) and I better find a hobby to fill up my days.
    Being out of work with no salary until my long term disability kicks in is stressful. It’s a humbling experience and I’m sure doesn’t help my sleep either. “Take one day at a time” , I am learning, is a hard mantra to practice – but like working those quad muscles and stretching the hamstrings – it takes practice and it’s painful at times.

  13. I had a partial knee replacement in September 2009 and had nothing but trouble it wasnt until I got a second opinion from another surgeon that was told it had been fitted wrongly !! It is now August 2010 and am 3 weeks post op after revision total knee replacement and the pain is unbearable and sleep is non existant, I jus wish I coud havea break from the pain. I dread physio becos it hurts so much

  14. Hi Tracy,
    Like you I was looking for answers about 19months ago. If you scroll up, you will see one or two of my posts. You are three weeks post op. I don’t know why but the 3rd and 4th week were the hardest for me. I thought I had ruined my body forever at only 45. I promise you that the pain and rehab will get easier over time. I now do not regret the surgery and have even considered it for my right knee.
    Take a deep breath and know it will get better. The key, rehab, rehab, rehab…I know that isn’t what you wanted to hear but that is it in a nut shell. I cried at every rehab session and especially after as I was getting more depressed each day but one day, I made a full round on the bike at PT and my world changed. Read my post above.
    I never had any problems sleeping or with muscle spasms or nerve pain so I can not relate to that but I know others in these posts have and it is quite common. In a years time, you too will counsel others and being their cheerleader as others did for me. I guess I am paying it forward.
    Make rehab your full time job and rehab not only at PT b ut at home too several times a day. It will pay off. You may want to mention manipulation to your doc if your range of movement doesn’t improve soon. It is not effective if you wait to long. I had mine at around five weeks and that was my turn around at rehab. Once the scar tissue was broken, I made great strides.
    There are good medications for nerve pain. They are much different from pain pills so don’t expect that they will make you lightheaded like pain meds. They target nerve pain. You may want to discuss that also.
    Repost if you have anything else you need addressed. Those of us that have traveled this road will help you!! Take care and I do wish you all the best..

  15. Hi Alisa

    Thankyou for your reply, I think I will see about manipulation as I had this with my partial knee and it did bend better, but the pain and nerve pain are agonising at the moment and sleep is virtually non-existant . No amount of pain killers seem to help I am at a lost end . I cant even bear the sheets touching my knee .

  16. Tracy, speak to you Doc about all your concerns. The sheets, pain, nerves etc. He can’t fix what he doesn’t know is broken so to speak so always be honest about your progress and symptoms. Keep us posted about your progress as you have friends here. Wishing you pain free days and progress!!

    • Thank you for your good advice, Alisa. And, Tracy…I definitely feel for you. Bless you for hanging in there and keeping us posted about what’s happening.

      Kudos to you both. 🙂

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