This article was written by Dr. Babar Naeem (MBBS, MRCPCH) – a licensed and practicing medical doctor – to ensure maximum factual accuracy and unique content.
Sleeping after knee replacement surgery can be very difficult.
The main reasons why sleeping after knee replacement surgery is so difficult is due to the pain caused by the trauma of having the tissues cut, the limited range of sleeping positions, and the added stress placed upon the body when rehabilitation therapy begins.
So how can you sleep better after knee replacement surgery?
The most effective ways to sleep better after knee replacement surgery is to take doctor-prescribed pain medications; sleep on your back with a pillow under the calf to keep the leg straight; and use cold therapy to reduce pain and swelling – only take sleep medications if advised by your doctor.
And what are some of the things that you should not do after knee replacement surgery?
After knee replacement surgery you should avoid sleeping on your stomach, bending the knee, putting a pillow under the knee so the leg is bent, crossing your legs, skipping medications, or taking medications not advised by your doctor.
In the rest of this article, I have used my knowledge and experience as a practicing medical doctor to give you 11 strategies for sleeping better after a knee replacement.
But of course, you should always seek medical guidance from your own doctor first for the best advice.
11 Ways to Sleep After Knee Replacement Surgery
Below are 11 ways to sleep better after a knee replacement:
1: Sleep On Your Back With the Affected Leg Elevated
The best and safest position to sleep in after a knee replacement is on your back.
The affected leg should be elevated and kept almost straight by placing a pillow under the calf or adjusting the bed – do NOT place a pillow directly under the affected knee as this can result in a permanently bent knee according to the NHS.
This position will prevent the harmful twisting of the surgically operated leg in the wrong direction.
Another precaution that should be kept in mind is to avoid bending the knee, as this slows healing.
Bending of the knee may seem acceptable, as less pain is experienced in that position, however, it can lead to the formation of contractures, and poor mobility of the joint.
An adjustable bed can be a great way to elevate your leg and help you get in and out of bed.
Sleep On the Unaffected Side
If you are a strict side sleeper and don’t like sleeping on your back, then an acceptable alternative is to sleep on the unaffected side with two soft pillows placed between the legs and feet for support.
The video above shows you how to sleep on your affected side – this may be a viable option as healing takes place and the pain reduces.
Do Not Sleep On Your Stomach
The worst position to sleep in after a knee replacement is on your stomach.
This position is painful and puts unnecessary stress on the healing knee.
There is also a high risk of damage to the wound and stitches in this position.
2: Use Pillows for Elevation and Stability
A very simple and cost-effective measure that can make a lot of difference is the use of soft and comfortable pillows to keep your affected leg in the ideal position for optimal recovery – placing one pillow under your calf when sleeping on your back is ideal.
I recommend that my patients also place a pillow on either side of the affected leg to prevent twisting.
Please remember that you should not place the pillow directly under the knee, as it will cause harmful bending of the leg.
3: Take Pain Medications Prescribed Only By Your Doctor
Pain medications are an essential component of the rehabilitation regimen, especially during the early postoperative period.
There are a variety of useful medications, and the only person who can decide what’s best for you is your doctor.
Some pain medications, such as ibuprofen, have an anti-inflammatory action, and some are sedatives.
There are various side effects associated with pain medications, such as gastric ulceration, kidney failure, hepatic impairment, bleeding tendencies, constipation, respiratory depression, and development of tolerance .
Therefore, a careful balance is required between optimum pain control and avoiding side effects.
I have prepared a list of recommendations that should be kept in mind while using pain medications:
- Never use pain medications without consulting your doctor.
- Pain medicine should be taken at bedtime so that you can have a pain-free night, ensuring good quality sleep.
- The dose and frequency of the medicines should be fully discussed, and understood by the patient.
- The WHO pain relief ladder should be followed: i.e. use non-opioids for mild pain, low-potency opioids for moderate pain, and strong opioids for severe and persistent pain. Adjuvant therapies should always be considered in order to minimize the use of pain medications.
- Beware the possible side effects of the painkillers, and discuss them with your doctor if you experience any.
- You should avoid driving if you are using any sedating pain medications, such as morphine, methadone, or diazepam.
- Selecting the right type of pain medication is important. If you experience fever and pain, acetaminophen and ibuprofen will be more helpful; opioids are more useful if you have a co-existing stomach or kidney disorder; and steroids may be helpful in more specific conditions.
- If pain cannot be controlled with a single medicine, a combination of two or more medications may be used, after in depth discussion with your physician.
- Pain medications should be discontinued as early as possible.
4: Use Cold Therapy to Reduce Pain and Swelling
Cold therapy provides many important benefits, especially in the early recovery period.
Cold therapy, also called cryotherapy, has been used for the management of pain since 1960.
Aside from easing pain, it also decreases swelling, inflammation, and prevents blood loss.
All of these factors will help you sleep better, especially if cold therapy is used just before sleep.
When applying cold therapy, remember the following points:
- Cold therapy should be applied at least three times per day.
- Initially apply a cold pack for only 10 minutes, and then gradually build the application time up to 20 min.
- Always keep a towel or a cloth between your skin and the ice.
- Do not leave the ice on the skin for a prolonged period of time, or during sleep.
- Ice packs, ice towels, or a pack of frozen vegetables can be used to apply cold therapy.
- Remove the ice immediately if you are feeling numbness or loss of sensation.
5: Avoid Alcohol to Reduce Recovery Time
Alcohol can harm your sleep and recovery process in many ways.
Studies have confirmed that alcohol intake significantly delays the onset of sleep, as well as total sleep for the night .
Alcohol also interacts with pain medications and increases the risk of experiencing side effects.
6: Only Take Sleep Medications Under Your Doctor’s Guidance
If your sleep is severely affected by your knee replacement surgery, then you should talk to your doctor about taking a short course of sleep medications until you are able to sleep normally again unaided.
Melatonin, zolpidem, and benzodiazepines are sleep medications commonly prescribed to post-operative patients.
I advise my patients to only use these drugs for a short period, and only if sleep is not improved by other measures.
Melatonin is a hormone that is produced naturally by the brain to control sleep and the circadian rhythm.
Surgery results in decreased levels of melatonin, and hence, poor quality sleep.
Studies have confirmed that melatonin use results in improved sleep quality, decreased pain and analgesic use, and reduced stress in the early postoperative period .
But melatonin use can also produce many undesirable side effects, such as nausea, headaches, dizziness, sedation, irritability, and daytime sleepiness.
Zolpidem belongs to the category of drugs called non-benzodiazepine, or Z-drugs.
It acts by increasing the activity of inhibitory neurotransmitters in the brain, and hence, improves sleep quality.
But like other sleep medications, it can also produce many side effects, such as agitation, nightmares, drowsiness, amnesia, and CNS depression .
Benzodiazepines are a group of medicines which includes alprazolam, midazolam, triazolam and temezepam.
These drugs have a rapid onset of action and are commonly prescribed for insomnia.
But please remember, these medications are known for their typical side effects, which are dependence, tolerance, and potential for abuse .
Never use these sleep medicines without discussing them with your doctor first.
7: Improve Your Sleeping Environment
A dark, cool, clean, and noise-free bedroom with a comfortable mattress is an ideal sleeping environment.
Although an ideal sleeping environment is different for different individuals, a few things are essential to make the space sleep-friendly.
Keep the Room Temperature at 18.3 Degrees Celsius (65 Degrees Fahrenheit)
Experts have recommended a temperature of 18.3 degrees Celsius, or 65 degrees Fahrenheit, as the ideal bedroom temperature .
Your body temperature starts declining at the start of sleep, and this helps with the release of the sleep hormone, melatonin.
If the surrounding air is cool, then the onset of sleep will be faster, while a higher temperature will keep a person alert.
Limit Ambient Light and Light from Electronic Devices
Ambient light should be kept as low as possible for good sleep.
Exposure to light disturbs the circadian rhythm, as well as melatonin release.
A less-discussed source of light is the glow from mobile phones and electronics.
This type of light has the same tendency to disrupt our sleep as regular artificial light.
Moreover, these devices produce noise, and stimulate the brain center, keeping us awake.
I always recommend that my patients minimize the use of electronics in the evenings.
Mobile phones should be put on silent mode and flipped over for the night.
Block Out Noise With Earplugs
Noise is another factor that inhibits our sleep.
A quiet room helps to induce sleep early, while loud noises will cause sleep disruption and fragmentation.
If it is not possible to sleep in a peaceful environment, you can try using earplugs to reduce the noise level.
Sleep On a Mattress That’s Suited to Your Sleeping Style
A comfortable bed is another essential component of a good sleeping environment.
The right mattress will depend on your dominant sleeping position, body weight, and body type.
Studies have demonstrated that newer mattresses promote sleep and relieve pain .
A mattress that is too soft will not provide the required support, and a very hard mattress will be too uncomfortable for most people.
Choose Soothing Colors in Your Bedroom
The color of the bedroom is very important, not only for good quality sleep but for the overall mood .
It has been demonstrated that blue, green, and yellow are good choices for bedrooms.
8: Reduce Stress to Improve Sleep Quality
Deep breathing, relaxation exercises, and cognitive behavioral therapy are some of the strategies used to reduce stress levels after surgery.
Stress is a normal response after surgery, due to multiple factors such as trauma, pain, a feeling of losing control, separation from family, and limited mobility.
However, stress has a negative impact on sleep, as well as on wound healing .
Moreover, lack of sleep worsens the stress, and a vicious cycle starts.
Therefore, to experience good quality sleep, it is essential to control your stress levels.
I have compiled a list of recommendations to help you with this:
- You should reassure yourself that stress is a normal response to an unusual situation, and everything will be back to normal in a short while.
- Discuss your worries and fears with your friends, family, or doctor. Do not keep them yourself.
- Listen to your favorite music.
- Practice relaxation exercises.
- Try deep breathing.
- Avoid tobacco, cigarettes, alcohol, and stimulant drugs.
- If stress cannot be controlled with these simple measures, speak to a therapist for medications.
9: Follow Sleep Hygiene Measures to Trigger Sleep
These simple and inexpensive measures can have a significant effect on improving the quality of your sleep.
I have always stressed the importance of sleep hygiene in conjunction with medications and other therapies.
The following is a list of recommendations that you should follow after knee surgery:
- Go to bed at a fixed time, and do not disturb this cycle, even on weekends.
- Go to the bedroom only when you are sleepy, and get out of your bed if you are unable to sleep after 30 minutes.
- Do not watch TV, eat, play games, or use your mobile devices in the bed.
- Do not exercise before going to bed.
- A dark and quiet room will stimulate sleep.
- Relax your mind.
- Don’t eat a heavy meal before sleep.
- Eat a healthy diet, and avoid chocolates, soda, coffee, and caffeine-bearing tea in the evenings.
- Do not take a nap during the day.
- Make sure that your mattress and pillows are comfortable.
- Do not go to bed if you are too full or too hungry.
- Take your pain medicine shortly before going to bed.
10: Use a Recliner or Adjustable Bed for Comfort
A comfortable recliner is considered a vital part of the recovery process after knee replacement surgery.
Joint replacement surgery limits sleeping positions, and a recliner may be a perfect additional option.
A recliner or adjustable bed is a good choice during the post-operative period because you can keep your leg elevated and adjust yourself into your most comfortable position.
A study was done in the United States that compared the recovery of the patients who used recliner chairs to those who used traditional hospital beds.
The results showed that patients who used recliners :
- Recovered faster.
- Experienced less nausea.
- Experienced less pain.
- Experienced greater comfort levels.
- Had fewer adverse symptoms.
Patients who have used recliner chairs after knee surgery describe feeling more comfortable while sleeping on a recliner than in a bed.
I always advise my patients to use a recliner with caution, however, as spending a lot of time on a recliner can have some adverse effects, such as decreased blood flow, leg pain, and development of contractures.
Adjustable beds can also help you to get in and out of bed more easily – plus they are a great long-term investment if you have chronic conditions like back pain, COPD, sleep apnea, arthritis, or snore a lot.
11: Make Adjustments for Different Knee Surgery Types
There are different types of knee replacement surgeries available for which the following adjustments can be made:
How to Sleep After a Bilateral Knee Replacement
A bilateral knee replacement is when both knees are replaced in a single operation under one anesthesia.
The benefit is that you require only a single hospitalization and a single recovery period.
However, your recovery period will be more difficult due to the incapacitation of both knees.
Lying on your side is not advised, so the only position left to sleep in is on your back.
Pain medications, sleep hygiene, and a comfortable sleeping environment will be even more vital to ensuring good quality sleep.
How to Sleep After a Total Knee Replacement
The knee has three compartments; inner, outer, and front.
When all three compartments are replaced during the surgery, this is known as total knee replacement.
Sleeping on the unaffected side and sleeping on your back are the only options.
Pain medications play a key role, together with sleep hygiene, as already explained.
How to Sleep After a Partial Knee Replacement:
Partial knee replacement refers to the replacement of only the affected compartment of the knee.
The advantages of this procedure are a fast recovery and fewer complications.
So this is an ideal option for older patients, the obese, and those who have a minimal deformity.
As this procedure is the least invasive, sleep problems are easier to overcome by following the tips suggested in this article.
Conclusion: Rest and Follow Your Doctor’s Advice
It takes around 12 weeks to recover from knee replacement surgery to the point where most regular daily activities can be resumed, and potentially up to 12 months or more to regain maximal strength.
It is crucial that you follow the advice of your doctor/surgeon and follow the rehabilitation program they advise.
You should also consult with them in regards to getting better sleep as you recover from your knee replacement surgery.
Sources and References
 D. Slater, S. Kunnathil, J. McBride, and R. Koppala, “Pharmacology of nonsteroidal antiinflammatory drugs and opioids,” Semin. Intervent. Radiol., vol. 27, no. 4, pp. 400–411, Dec. 2010, doi: 10.1055/s-0030-1267855.
 E. Kuyucu, M. Bülbül, A. Kara, F. Koçyiğit, and M. Erdil, “Is cold therapy really efficient after knee arthroplasty?,” Ann. Med. Surg., vol. 4, no. 4, pp. 475–478, Nov. 2015, doi: 10.1016/j.amsu.2015.10.019.
 I. O. Ebrahim, C. M. Shapiro, A. J. Williams, and P. B. Fenwick, “Alcohol and Sleep I: Effects on Normal Sleep,” Alcohol. Clin. Exp. Res., vol. 37, no. 4, pp. 539` – 549, Apr. 2013, doi: https://doi.org/10.1111/acer.12006.
 H. Borazan, S. Tuncer, N. Yalcin, A. Erol, and S. Otelcioglu, “Effects of preoperative oral melatonin medication on postoperative analgesia, sleep quality, and sedation in patients undergoing elective prostatectomy: a randomized clinical trial,” J. Anesth., vol. 24, no. 2, pp. 155–160, 2010, doi: 10.1007/s00540-010-0891-8.
 J. D. Lie, K. N. Tu, D. D. Shen, and B. M. Wong, “Pharmacological Treatment of Insomnia,” P T, vol. 40, no. 11, pp. 759–771, Nov. 2015, [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/26609210.
 E. C. Harding, N. P. Franks, and W. Wisden, “Sleep and thermoregulation,” Curr. Opin. Physiol., vol. 15, pp. 7–13, 2020, doi: https://doi.org/10.1016/j.cophys.2019.11.008.
 B. H. Jacobson, A. Boolani, and D. B. Smith, “Changes in back pain, sleep quality, and perceived stress after introduction of new bedding systems,” J. Chiropr. Med., vol. 8, no. 1, pp. 1–8, Mar. 2009, doi: 10.1016/j.jcm.2008.09.002.
 S. Kurt and K. K. Osueke, “The Effects of Color on the Moods of College Students,” SAGE Open, vol. 4, no. 1, p. 2158244014525423, Jan. 2014, doi: 10.1177/2158244014525423.
 D. A. Kalmbach, J. R. Anderson, and C. L. Drake, “The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders,” J. Sleep Res., vol. 27, no. 6, pp. e12710–e12710, Dec. 2018, doi: 10.1111/jsr.12710.
 S. E. Agodoa, M. A. Holder, and S. M. Fowler, “Effects of recliner-chair versus traditional hospital bed on postsurgical diagnostic laparoscopic recovery time,” J. PeriAnesthesia Nurs., vol. 17, no. 5, pp. 318–324, Oct. 2002, doi: 10.1053/jpan.2002.35366.
No part of this article offers medical advice – always consult with a qualified medical professional for the best guidance.
Image Attribution and Licencing
Main image: ‘Knee Pain’ by InkkStudios (Getty Images Signature) used with permission under the terms of Canva’s One Design Use License Agreement.
Dan is the founder and head content creator at Bedroom Style Reviews.
He has been working as a professional online product reviewer since 2015 and was inspired to start this website when he ended up sleeping on a memory foam mattress that was too soft and gave him backache.
Through in-depth research and analysis, Dan’s goal with this website is to help others avoid such pitfalls by creating the best online resource for helping you find your ideal mattress, bedding, and bedroom furniture.
Dan is a qualified NVQ Level 2 Fitness Instructor with 6 years’ experience helping clients improve their health through diet, exercise, and proper sleep hygiene.
He also holds several college and university-level qualifications in health sciences, psychology, mathematics, art, and digital media creation – which helps him to publish well researched and informative product reviews as well as articles on sleep, health, wellbeing, and home decor.
Dan also has direct personal experience with insomnia, anxiety, misophonia (hypersensitivity to sounds), and pain from both acute and long-standing sporting injuries – he enjoys writing insightful articles around these subjects to help fellow sufferers of such conditions.
Learn more about Dan here.