Trouble Sleeping After Hip Replacement: Is It Normal?

Since most people who need hip surgery already have sleep problems, most find that their sleep quality goes up after surgery, but not always immediately.

Most of the time, this is a short-term side effect, and their sleep quality either returns to “normal” or surpasses it over time. This effect is seen with other surgeries that impact sleep like knee replacements.

Let’s take a quick look at how common these problems are, and how someone can try to manage sleep issues after a hip replacement.

How Common Are Sleep Problems After a Hip Replacement?

One study had 48 patients regularly complete a sleep questionnaire in the time leading up to hip surgery, and following it (1).

The first big finding was that:

75% of participants reported that their sleep was never or rarely disturbed by hip pain after surgery.

In other words, about 25% of subjects had their sleep disturbed after surgery.

The chart below shows the primary reason that subjects woke up during the night before and after the surgery:

Hip pain was a very common issue before the surgery, but not after. Instead, “other pain” and “other reasons” became more common after surgery, which refers to a variety of reasons including general discomfort in the hip area (but not the hip itself).

One other study also looked at sleep quality following total joint replacement (hip or knee) (2).

They found that:

In the early postoperative period (4-5 weeks), patients reported significant increases in sleep disturbance as denoted by increased length of time to fall asleep and mean nightly awakenings compared with the preoperative baseline. 

It makes sense that it’s tougher to get to sleep after a joint surgery as there are fewer comfortable positions that are possible.

But there was also good news found in that study:

At late postoperative follow-up (40 weeks), patients' sleep quality subsequently improved above the preoperative baseline

So while there were reports of sleep problems after the surgery, those were temporary and eventually the joint replacement led to overall better sleep and quality of life.

SummaryWhile not everyone who gets a hip replacement has sleep issues afterwards, many do. However, these sleep issues are temporary in most cases and sleep quality tends to improve in the medium-long term.

What Causes Sleep Trouble After a Hip Replacement?

As was noted in the studies we went over above, pain after a surgery is the main cause for concern when it comes to sleep problems.

One study looked specifically at this and found that there was a correlation between severity of pain and sleep quality after surgery (3). Not exactly surprising, but it shows that it’s the main factor and not something else.

But there are a few other potential causes of sleep problems during this period:

• Medication side effects - Many pain medications that are prescribed after a surgery can worsen sleep quality. Patients are typically weaned off these starting after a few weeks, and that may also help improve sleep quality.
• Depression or anxiety - Both depression and anxiety are risk factors for insomnia, and are possible after a significant surgery like a hip replacement.

Potential Solutions to Sleep Trouble After Hip Surgery

The biggest thing that you have control over after surgery is sleeping posture.

A study found that 81% of postoperative hip surgery patients were able to comply after being asked to sleep on their back (4). This is typically the ideal position for this type of recovery, as there’s almost no stress on the hip.

In general, to avoid stressing the recovering hip joint:

• Sleep on your back with legs stretched straight out
• Put a pillow between knees (to prevent your leg from bending together)

It can help to try to avoid:

• Rotating the leg in any way
• Crossing legs
• Sleeping on your side or stomach

What to Do If Sleep Problems Are Severe or Are Getting Worse?

As we’ve seen, research shows that sleep trouble after a hip replacement gradually gets better over time in most cases. Aside from natural healing, physiotherapy helps strengthen the muscles around the joint.

And while some sleep problems can be expected, severe ones are not and can impact the recovery process. In that case, be very clear about these issues to your doctor.

They will be able to see if anything is going wrong with your recovery, change your medication, or find other potential causes of sleep problems.

References

1. An assessment of sleep disturbance in patients before and after total hip arthroplasty
2. Prospective Assessment of Sleep Quality Before and After Primary Total Joint Replacement
3. Sleep quality and nocturnal pain in patients with hip osteoarthritis
4. Patient compliance with postoperative precautions in an unrestricted and a supine sleeping position following posterolateral total hip arthroplasty