Sleeping After ACL Surgery: What to Expect and How to Cope
Sleep after ACL surgery can be surprisingly difficult. Many patients say the lack of sleep rivals the pain and swelling in terms of discomfort. The main issue isn’t always pain. It’s often the challenge of positioning, especially during the early recovery period.
Why It’s Hard to Sleep
There are several factors working against restful sleep:
- Back Sleeping: Most people are advised to sleep on their back with the leg elevated, either on a standard pillow or a specialized wedge. If you’re a side sleeper, this position alone can be uncomfortable.
- Brace Discomfort: The knee brace, often locked at 0 degrees, can feel bulky and restrictive, especially when trying to fall asleep.
- Cold Therapy Devices: If you’re using a cold therapy machine, even the quiet models produce some hum that might disrupt light sleepers.
- Restricted Movement: Natural nighttime shifts in position are limited by the brace and the need to avoid twisting or rolling.
- Pain Medication: While some pain medications may have sedative effects, it’s also possible for them to wear off in the middle of the night causing waking from pain spikes. Also, restlessness, vivid dreams, interference with REM sleep and perhaps other issues may negatively impact sleep.
Tips for Better Sleep
Here’s an image of a “recovery room.” You might not have a spare guest room, but if you can get things set up just for yourself, consider a wedge pillow as you see here which can be vertical for daytime sitting/work, or horizontal for evening. You can see the leg elevation pillow and a Therm-X cold and compression machine. You can see a small adjustable tilt work or dining table, and other accessories within easy reach.
While there’s no magic fix, these suggestions might help ease discomfort:
- Simulate Side Sleeping: Try placing a wedge pillow or firm cushion behind your back, and stuff rolled-up blankets or sweatshirts along one side of your torso. This won’t let you truly sleep on your side, but it can trick your body into feeling slightly angled, which can be more comfortable than lying flat.
- Loosen the Brace (with Caution): Ask your doctor if it’s okay to loosen the straps slightly at night. This may reduce pressure points without compromising leg alignment. However, fully removing the brace is usually discouraged until cleared by your surgeon.
- Adjust Ice Machine Placement: Cold therapy sleeves can go under or over the brace, depending on your comfort and your doctor’s advice. You might experiment with timing the machine’s cycles so it doesn’t run continuously through the night.
- Elevate Strategically: In addition to a leg wedge, consider using a slight incline behind your back. This helps with both circulation and breathing, and can ease pressure on your lower back.
- Use a Pillow Between the Legs (Later Stage): Once cleared to sleep without the brace, placing a pillow between your legs—especially with the injured leg on top—can help maintain knee alignment and comfort.
Here’s an example of an adjustable leg elevation pillow. There are many models. This one, for example, has three levels of foam inside it so the height is adjustable. This may be useful both initially and over time as your need for elevation may change. E.g., perhaps high to start, but lower over time for comfort. You can see how the channel keeps the leg and brace in place and there’s plenty of room for an ice machine cooling sleeve. (You may find it useful to put a small washcloth under the cooling sleeve tube connectors if those are too cold on your lower leg or upper leg, depending on how yours connects.)
To my left is an adjustable tilt/table for eating, and also for laptop or iPad. The yoga strap to the left can be used for stretching, but also for hooking on to the foot of the bag leg to swing it on or off bed. For some people, when the nerve block is still active, you can’t feel or move your leg. So a strap can help, though you can also just carefully lift up on the brace straps. Fortunately, this usually passes in a day or two, though full control for some may take weeks or more.
Final Thought
Be mentally prepared: the first several days and possibly weeks may involve poor sleep. Knowing this in advance can help you plan rest periods during the day and reduce frustration. Sleep will return gradually as pain subsides and movement becomes less restricted.