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How to Sleep Better After ACL Surgery (6 Ways)

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  • This article has been medically reviewed by Darshan Shingala (M.D, MPH) – a qualified and practicing medical doctor – for maximum factual accuracy and reliability.

I have personally experienced two operations on my right knee from meniscus surgery so I know first-hand just how difficult it can be to sleep after surgery.

So how do you get better sleep after you’ve had ACL (anterior cruciate ligament) surgery?

To get to sleep after ACL surgery: consult with a doctor to find out if OTC (over-the-counter) or prescription pain medications are required; apply the RICE (rest, ice, compression, elevation) principle; use a compression stocking, and sleep on your back with your leg elevated slightly above the heart.

The rest of this article explains in more detail how to get better sleep after ACL surgery.

Although this article has been written by a qualified and practicing medical doctor to ensure maximum factual accuracy, it’s no substitute for the personalized medical advice that you should primarily seek from your own doctor/surgeon.

Related: 12 relaxation techniques to help you fall asleep faster.

6 Ways to Sleep Better After ACL Surgery

The Best Ways to Sleep After Your ACL Surgery!

After ACL surgery you may struggle to fall asleep and sleep through the night without waking up due to pain and discomfort.

However, it is absolutely essential that you obtain a restful and good night’s sleep while you recover from your surgery.

This is because most of the repair process in our bodies take place while we are sleeping.

The importance of practicing a good post-operative care routine cannot be stressed enough.

A good and restful sleep at night can relieve your body of extrinsic and intrinsic stressors, ease muscle tension, facilitate the repair mechanisms in the body, reduce inflammation, and calm the mind.

In order to achieve a good and restful sleep after ACL surgery, you can try the following six effective tips in your routine, in addition to following the post-surgery care protocol provided by your doctor:

1: Manage Pain With OTC or Doctor Prescribed Medications

One of the most effective ways to sleep better after ACL surgery is to take OTC (over-the-counter) or doctor-prescribed pain medications to help reduce discomfort, inflammation, and swelling.

Pain and inflammation are the main reasons why getting to sleep after ACL surgery is so challenging.

Hence, it is imperative that you strictly adhere to the post-operative care instructions provided by your doctor to control the swelling and pain in your wound.

Also, please make sure that you notify your healthcare provider of any known medicinal allergies in advance.

If you take your medications regularly in a timely manner, you can manage the pain, inflammation, and swelling in your injured leg better.

This will significantly help you in obtaining a good night’s sleep and achieving a speedy recovery.

OTC Medications are the Safest Option for Many Patients

It is likely that your doctor will prescribe you a list of analgesics and anti-inflammatory medications such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin IB), or naproxen sodium (Aleve).

These medications are available over-the-counter and are non-steroidal.

Prescription Medications Can Have Serious Side Effects

Depending on your individual case, your doctor may also prescribe you some stronger pain relievers, such as opioids.

Opioids like meloxicam (Mobic), tramadol (Ultram, Qdolo, ConZip), or oxycodone (OxyContin, Roxicodone) are prescription-only medications and they must be consumed strictly as advised by your doctor because they have addictive properties and can have serious side effects.

2: Apply a Compression Stocking to Prevent Blood Clots

In order to prevent the formation of blood clots postoperatively, it is recommended that you wrap your leg in a compression stocking or a large ace wrap.

A compression stocking may also help to reduce pain and inflammation – thus helping you to sleep better.

It is necessary that you continue this practice for at least seven to ten days after your surgery as compression stockings have been shown to significantly help in the reduction of swelling and the formation of blood clots after operations.

You can comfortably sleep with the compression stocking or an ace wrap at least until the sutures are removed.

It would be best to wrap your leg in the stocking most of the time and only remove it while you shower or change the bandage.

You should consult with your doctor before discontinuing the use of the compression stocking.

In most cases, after the removal of the sutures on your surgical wound – or after ten days postoperatively – your doctor will typically allow you to discontinue wearing the stocking.

3: Apply Ice to Reduce Pain and Swelling

It has been evidenced that applying ice can significantly reduce the symptoms of inflammation such as pain and edema – thus potentially allowing you to fall asleep faster and not wake up during the night because you’re in pain.

It is highly recommended that you frequently ice your wound during the day and also prior to going to bed.

Using an ice wrap would be a better choice than applying ice directly to the wound.

You can re-freeze the wrap in your home freezer as and when necessary.

It would be best that you consistently apply ice to your wound at least for the first two to three days for maximal reduction of pain and swelling.

Wearing an ice wrap for at least fifteen minutes prior to going to bed can substantially soothe the pain and reduce the swelling in your injured leg, which can help you to fall asleep quickly.

4: Sleep On Your Back With Your Leg Slightly Elevated

The most comfortable sleeping position for many patients after ACL surgery is on their back with the affected leg raised up slightly above the line of the heart to reduce swelling – a pillow can be used to achieve the desired level of elevation.

After ACL surgery, sleep can be elusive because of the inability to find a suitable sleeping position.

It is natural to experience immense discomfort and pain while trying to sleep after your surgery, however, the discomfort may significantly exponentiate if you sleep in a position that applies undue pressure to your healing leg.

You may be required to deviate from your usual sleeping posture in order to adapt yourself to the long recovery process.

For instance, if you usually sleep on your side or on your stomach, you might want to reconsider your sleeping posture and try sleeping in a supine position, that is, sleeping on your back.

In general, sleeping on your back is considered to be the best sleeping position as it offers several health benefits, such as relief from headaches, improvement of body posture, the release of muscle tension, and good blood circulation while sleeping.

After ACL surgery, sleeping on your back may be the most comfortable position because this position would apply minimum pressure on your healing leg.

In order to optimize your comfort, you can use a pillow or soft cushion under your calf while you sleep on your back.

The slight elevation offered by the pillow under your leg would reduce the swelling and speed up the recovery process.

The video below explains in more detail the best sleeping positions after ACL surgery:

Best Sleeping Positions After Total Knee OR Hip Replacement Surgery

5: Keep the Bandages Clean and Dry to Avoid Infection

It is extremely important to make sure that you go to bed with a clean and fresh wound dressing.

The bandages covering your surgical wound must be clean, dry, and hygienic at all times to avoid the development of post-surgical infection.

If you go to bed with wet and unclean bandages, it is quite likely that the dirty dressings will serve as a breeding ground for bacteria and microbes during the long hours at night, thus prolonging the recovery time.

Also, unclean and wet bandages can become tacky and adhere to the wound and cause discomfort.

Hence, it is important that the surgically operated area is free of moisture, especially while sleeping.

To achieve this, it would be best that before going to sleep, you remove the old bandages carefully, clean the wound with an antiseptic solution, apply a healing ointment over your wound, and then wrap the wound with fresh and clean bandages.

It is also recommended that you avoid wearing tight-fitting clothes as they can be uncomfortable to wear over the dressing.

Instead, you may opt for loose-fitting nightwear made of breathable fabrics such as cotton or linen to optimize your comfort while sleeping.

6: Use R.I.C.E to Reduce Pain and Improve Recovery

It is well known that the R.I.C.E principle (rest, ice, compression, and elevation) can work wonders in your recovery period and offer you maximum pain relief and comfort.

The rationale behind the R.I.C.E principle is that while recovering from an injury, you need good blood circulation to the damaged area.

Hence, it is highly recommended that while you rest on the bed, you keep your healing leg elevated, perhaps with the help of a few cushions below your calf.

Make sure that your leg is slightly above the level of your heart and it is not too inclined or too low.

It would be a good idea to wrap the elevated leg in compression bandages, and also apply an ice pack to minimize the swelling, pain, and inflammation.

If you practice this technique for at least fifteen to twenty minutes prior to going to bed, it is likely that you will be able to obtain a more restful sleep at night.

The video below discusses how to use the RICE principle to recover from ACL surgery:

ACL Surgery Recovery – Why RICE is Essential for your ACL Surgery Recovery Diet

How ACL Surgery Can Affect Sleep

Below is a short guide that explains what an ACL injury is and how ACL surgery can affect sleep.

ACL Surgery Repairs the Anterior Cruciate Ligament

ACL surgery is the surgical repair of the damaged or torn anterior cruciate ligament (ACL) in the knee.

Anatomically, the knee joint is supported by two main groups of ligaments, namely, the collateral ligaments and the cruciate ligaments.

The collateral ligaments are responsible for controlling the sideways motions of the knee joint whereas the cruciate ligaments are responsible for controlling the forward and backward motions of the knee joint.

The anterior cruciate ligament (ACL) lies in the front of the knee joint and it crosses diagonally through the middle of the joint to form an “X” shape.

The ACL provides the majority of the restraining force in the knee joint and therefore, it is the most injured ligament of the four ligaments located in the knee.

ACL Tears Are Mainly Caused By Impact Injuries

The most common cause of a torn anterior cruciate ligament (ACL) is a physical injury during active sports like soccer, basketball, or volleyball that involve sudden changes in direction, shocking movements of the leg, and the back and forth motion of the knee joint.

Henceforth, athletes form the most common population group with ACL tears.

Pain, Swelling, and Popping Are Common Symptoms

The most common symptoms of a torn ACL may be the development of pain and swelling within twenty-four hours after the injury.

Patients often state that they hear a “popping” sound from the knee upon injury.

Due to the injured ACL, the patient may experience a loss of full range of motion in the knee joint along with significant discomfort while walking.

Tenderness, redness, and excruciating pain are also other common symptoms.

It is important to note that these symptoms must not be ignored as they demand immediate medical attention.

Sometimes, patients ignore these crucial symptoms because the pain and swelling tend to reduce with time, and patients attempt to return to sports which unstabilizes the knee joint and aggravates the injury; causing severe damage.

ACL Tears Are Graded 1-3

The severity of an ACL tear can be graded on a scale from 1 to 3, with grade 1 being a mildly damaged ACL and a grade 3 tear being a completely torn ligament.

The knee joint in a grade 3 tear becomes completely unstable because the ACL has been split into two pieces.

Not All ACL Tears Require Surgery

A grade 3 tear is serious and requires immediate surgical repair, but less severe tears may not require surgery.

Patients with an ACL tear can opt for either a non-operative repair or an operative treatment, as advised by their healthcare professional.

When opting for ACL surgical repair, one must bear in mind that it is a complex operation that is dependent on several factors such as the age of the patient, history of any previous knee injury, comorbidities, leg alignment, choice of graft, and the patient’s expectations to practice sports post-surgery.

The classical approach for surgical ACL reconstruction consists of multiple steps.

As the first preparatory step, the orthopedic surgeon will harvest and prepare the ACL tendon graft.

The graft can either be an allograft or an autograft, and the choice of graft depends on each individual case.

The next steps in the surgery include the creation of a tibial and femoral tunnel to pass the graft and finally, securing the graft from both femoral and tibial sides.

A Full Recovery From ACL Surgery Can Take 2-12 Months

The ACL surgery itself can be quite taxing for the patient, and it is absolutely necessary to practice adequate post-operative care as instructed by your surgeon or doctor.

The first few weeks after the ACL surgery, the knee is usually immobilized to promote healing.

If proper post-operative care is practiced, the recovery time period after ACL surgery can last anywhere from two to eight months.

However, it may take approximately nine to twelve months for the patient to resume their sports.

It is important to know that returning to sports might be quite challenging initially, however, with adequate physiotherapy and rehabilitation, patients tend to demonstrate an overall good functional strength and stability in the knee joint.

It is understandable that athletes are usually in a rush to resume their sports, however, they must bear in mind that returning to play must be evidenced on objective clinical criteria and not solely on the time spent in the recovery period.

This is because each patient responds differently to treatment and everyone has their own speed of recovery.

Hence, after the ACL surgery, individuals must be patient and wait to be cleared by their physicians prior to resuming their physical activities, such as work or sports.

Individuals must be mindful of their recovery process and continue to actively monitor their stability, strength, movement, and alignment in order to minimize the risk of serious complications or re-injuries.

Sleeping Comfortably After ACL Surgery Can Be Difficult

In addition to dealing with a long and painful recovery period, patients often experience sleep disturbances after an ACL surgery.

Patients often complain that they are unable to find a comfortable sleeping position due to their surgical wounds and joint immobilization.

Patients also find it difficult to fall asleep and stay asleep throughout the night due to severe pain and inflammation.

However, despite these difficulties, one must strive to achieve a good night’s sleep because an adequate and restful sleep can significantly quicken the recovery process by promoting the healing of the wound.

Conclusion: Follow Your Doctor’s Advice

If you are having problems sleeping after your ACL surgery, you should talk to your doctor to get the right advice for your individual situation.

They may recommend OTC or prescription medications, RICE, compression bandages, and lying on your back with your leg elevated to help you get to sleep after your ACL surgery.

Up next: 9 ways to sleep better with a fever.


Sources and References

[1] NCBI – Anterior Cruciate Ligament Reconstruction: Principles of Treatment (view). Accessed 16/4/21.

[2] PubMed – Effect of Graft Choice on the Outcome of Revision Anterior Cruciate Ligament Reconstruction in the Multicenter ACL Revision Study (MARS) Cohort (view). Accessed 16/4/21.

[3] PubMed – How Does a Combined Preoperative and Postoperative Rehabilitation Programme Influence the Outcome of ACL reconstruction 2 Years After Surgery? A Comparison Between Patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry (view). Accessed 16/4/21.

[4] NCBI – Management of Anterior Cruciate Ligament Injury: What’s In and What’s Out? (view). Accessed 16/4/21.

[5] NCBI – Predictors for Anterior Cruciate Ligament (ACL) Re-injury after Successful Primary ACL Reconstruction (ACLR) (view). Accessed 16/4/21.

[6] PubMed – Returning to Sport After Anterior Cruciate Ligament Reconstruction in Physically Active Individuals (view). Accessed 16/4/21.

[7] PubMed – Nausea, Vomiting, Sleep, and Restfulness Upon Discharge Home after Outpatient Anterior Cruciate Ligament Reconstruction with Regional Anesthesia and Multimodal Analgesia/antiemesis (view). Accessed 16/4/21.

[8] PubMed – An Assessment of Sleep Quality in Patients Undergoing Total Knee Arthroplasty Before and After Surgery (view). Accessed 16/4/21.

[9] PubMed – Effects of Perioperative Nonsteroidal Anti-inflammatory Drug Administration on Soft Tissue Healing: A Systematic Review of Clinical Outcomes After Sports Medicine Orthopaedic Surgery Procedures (view). Accessed 16/4/21.

[10] NCBI – Anterior Cruciate Ligament Knee Injuries (view). Accessed 16/4/21.

Medical Disclaimer

No part of this article or website offers medical advice – always consult with a qualified medical professional to get the best possible treatment for your needs.

Image Attribution and Licencing

Main image: ‘Main Suffering With Knee Pain’ by Wave Break Media (Getty Images) used with permission under the terms of Canva’s One Design Use License Agreement.

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