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Following back or spinal surgery, your treating physician and nursing staff will provide you with written instructions following your discharge in addition to pain medication to help ease your transition from hospital to home. However, you may find yourself dealing with sleeping difficulties following surgeries such as lumbar spine surgery, disc replacement, spinal fusion, laminectomy, or discectomy.
Surgery is a type of trauma from which the body needs time to heal. You may find yourself having trouble getting comfortable in bed due to persisting pain or a sore incision, or you may wake up throughout the night as your pain meds wear off. It is imperative that you get enough sleep, particularly deep sleep obtained through continuous periods of uninterrupted sleep. A good night’s sleep helps your body to heal faster and gets you back to your normal routine again more quickly.
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Following spinal surgery, you should avoid sleeping on your stomach. The Orthopaedic Surgery Division of John Hopkins Medicine recommends sleeping on your side or back to relieve the pressure on your spinal discs. “The best sleeping position to reduce your pain after surgery is either on your back with your knees bent and a pillow under your knees or on your side with your knees bent and a pillow between your legs,” according to the John Hopkins Spine Service.
When sleeping on your side, the recommended position is to bend your knees, placing them on top of each other with the uppermost one lying slightly in front of the lower one. Tuck a pillow behind you to prevent you from slipping on your back, and avoid putting your top knee on the mattress or sleeping with your arms under your neck or head.
When sleeping on your back, sleep with your arms beside you or on your stomach. Try not to sleep with your arms raised above your head, as this places unnecessary stress on your shoulders and neck. You may, however, find it painful to sleep on your back, particularly if your incision location is at the midline.
When changing positions or getting out of bed, it’s best to use the log roll. In a log roll, you keep your body straight and rigid then roll from side to side or onto your back without twisting your body.
There are a variety of other conditions associated with the spine and back which can be painful and cause sleep difficulties. You can improve your sleep, and often reduce pain, by following these tips:
Bursitis: Choosing the wrong mattress can irritate the inflammation of the bursa over your hips. A firm mattress can aggravate this condition, particularly if you tend to sleep on your side. Instead, choose a softer mattress or purchase a mattress topper to add a layer of thick padding to your current bed.
Degenerative Disc Disease: You should sleep on your stomach in order to relieve the pressure on the disc space. Choose a firm mattress for added support and place a small, flat pillow under your stomach and hips to reduce stress on your lower back. If you find sleeping on your stomach difficult, then you can use a wedge pillow to slightly elevate your upper body and sleep on your back. Be sure to support your knees by keeping them slightly bent.
Herniated Lumbar Disc: When a herniated disc is located in the lumbar portion of the spine (lower back), the pain can vary depending on which disc is affected. The most common condition is paracentral disc herniation, which is when the center of the disc protrudes from its position, pressing against the rings of the spinal column, creating a bulge. This condition causes pain in the neck and back and is best relieved by sleeping flat on the stomach. For a foraminal herniated disc, which is located lower in the spine and associated with intense leg pain, it is recommended that you sleep in a fetal position to ease the pressure and pain.
Isthmic Spondylolisthesis: Raising the upper back, neck, and head through the use of an adjustable bed or a pillow wedge can support the body in such a position as to relieve pain associated with this condition.
Osteoarthritis: It is recommended that you sleep in a fetal position, which is on your side with your knees bent. This will open up the facet joints in your spine, relieving pressure. Another option is to sleep in a recliner or adjustable bed, elevating your head and knees. This will also open up the facet joints and relieve pressure associated with osteoarthritis.
Spinal Stenosis: Try to sleep on your side in a fetal position, curling your legs into your body, in order to relieve the pressure that rests on the nerve root. You can also sleep on your back if you elevate your upper body and head as well as your knees to relieve the nerve pain.
When you return home after back surgery, be sure that you have support from your family and friends or a nursing aide, if necessary. Pain management is an important component of your recovery. Your doctor will most likely prescribe narcotic pain pills, anti-inflammatory medications, and acetaminophen. A nerve pain-blocking medication may also be prescribed. NSAIDs (non-steroidal anti-inflammatory drugs) should be avoided by patients who have had fusion surgery, as they inhibit the formation of bone, which is necessary for healing in this type of operation.
Dress comfortably and apply ice to the incision to aid in pain management. Applying heat can relieve tension and muscle pain, but may cause an increase in swelling, so it should be alternated with ice applications. Try not to stay in one position too long, but instead, frequently change your position or take short walks to improve stiffness and pain.
When returning home after back surgery, a good night’s sleep is an important step in healing your body. You may find that you are more fatigued than usual and sleepy throughout the day, but try to limit daytime napping. Too much daytime sleep can affect your ability to sleep at night and may disturb your normal sleeping patterns.
When sleeping at night, elevate your upper back, shoulders, and head, using a wedge or pillows and place a medium-firm pillow under your knees. Your mattress itself should not be too soft. A firm or medium-firm mattress is best after back surgery, as it offers more support for your spine. Try not to sleep on your stomach, as this increases the pressure on your spine and the spaces between your vertebrae, causing pain. When getting in or out of bed, tighten your stomach muscles and use a log roll technique to keep your spine straight as you move.
While initially, you may experience pain that prevents you from sleeping through the night, after a few days, that should lessen. You may also require assistance getting in and out of bed at first. Implementing the above practical tips should help you to improve both the quality and quantity of your sleep as you return back to your normal lifestyle following back surgery.
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