How to Sleep With a Cast On Your Broken Leg (Doc’s 9 Tips)

Dr-Babar-Naeem.
  • This article was written by Dr. Babar Naeem (MBBS, MRCPCH) – a licensed and practicing medical doctor – to ensure maximum factual accuracy and unique content.

Trying to sleep with a cast on your leg can be difficult due to the pain and limited mobility.

So how can you sleep more comfortably with a cast on your leg or foot?

The best way to sleep more comfortably with a cast on your leg or foot is to sleep on your back with your affected leg elevated to no more than 25 degrees by putting pillows under your knee (not under the foot since this can hyperextend the knee) or using an adjustable bed.

In the rest of this article, I explain how to do this in more detail, plus I’ve given you 9 ways in total to sleep better with a cast on your leg.

These are the same tips that I offer to my medical patients, but you should always check with your own doctor or surgeon before altering your treatment plan.

Related: how to sleep with a broken leg.

9 Ways to Sleep With a Cast On Your Broken Leg

How to prevent a pressure ulcer when you have a cast

A leg cast is an orthopedic device designed to support and protect injured bone.

It is usually made of plaster of paris or fiberglass and allows the bones to heal by keeping them in place [1].

Although a cast is essential for a speedy recovery, it can cause pain, itching, burning, and swelling of the limbs.

These problems, including the cast’s added weight, can make it very difficult to sleep at night.

Here are 9 ways that you can try to sleep more comfortably with a cast on your broken leg:

1: Sleep On Your Back With Pillows Under the Knee

The best sleeping position if you have a leg cast is on your back.

Sleep is essential for promoting wound healing – studies have shown that insufficient sleep reduces bone mineral density (BMD), and weakens the bone [2].

However, finding a comfortable sleeping position that works for you is very challenging for the first few days.

The best position that I recommend to my patients is to sleep on their back – with pillows placed under their knee.

You should avoid turning on to your side while sleeping – pillows can be placed as a barrier at each side of your hips and shoulders to prevent this.

It would be best if you slept on your back in the middle of the bed to avoid the risk of falling out – a mattress with good edge support (like the Nolah Evolution) can really help prevent the feeling of roll-off and make getting in and out of bed easier.

Side sleeping or sleeping on your stomach can put pressure on the injured limb and delay the wound healing.

When the pain and swelling settle down after a few weeks, you can lie on the unaffected side.

When you lie on your side, you should not place your legs on top of the other.

You can place a soft pillow between your legs for added comfort.

Sleeping on your stomach is not an option, as it will put pressure on the cast, and carries a risk of damaging the healing tissues.

Sleeping on the sofa is another option that you could attempt when trying to find the best sleeping position for your situation.

The arms of the sofa provide an easy solution for the elevation of the legs.

Find out if memory foam mattresses and toppers are good for your back here.

2: Elevate Your Leg to Decrease Swelling

Elevating the injured limb using pillows under the knee or by elevating the lower section of an adjustable bed while sleeping helps decrease the pain and swelling – resulting in improved quality of sleep.

48 to 72 hours after injury, the injured limb starts to swell, putting pressure on the surrounding tissues, and increasing pain intensity.

When we elevate our limbs above the level of the body, it encourages fluid drainage out of the leg.

This results in decreased swelling and pain, and reduces insomnia.

The risk of severe complications, like thromboembolism and venous ulcer formation, are also reduced by leg elevation [3].

Place Pillows Under the Knee – Not Under the Foot

You can elevate the leg by placing pillows or cushions under the knee.

Pillows should be positioned in a way that is safe and comfortable for your leg – under the knee is typically better than towards the end of the leg in order to stop hyperextension of the knee.

You should not elevate the leg beyond 25-30 degrees, as it can cause a stretch in the leg, and will become uncomfortable.

Chinese researchers discovered that leg elevation reduces the swelling of the legs due to increased venous drainage.

They also mentioned that subjects felt comfortable when the leg was elevated up to 30 degrees but complained of pain and numbness when leg elevation was extended to 90 degrees [4].

There are specialized leg elevator cushions available on the market, designed to keep the leg elevated.

An adjustable bed can also be used to raise the legs without pillows or cushions.

Click here to see the best adjustable beds for a broken leg and back pain.

3: Ice the Cast to Reduce Pain and Inflammation

Ice therapy, also known as cryotherapy, is an effective remedy for controlling inflammation, pain, and swelling.

Decreasing the temperature of the injured area limits pain, inflammation, muscle spasm, and metabolic demands [5].

Research conducted in 2006 studied the temperature lowering effect of ice packs when applied over a cast.

They found that ice packs have a significant temperature lowering effect, even when applied over bandages and casts [6].

Icing is more effective when applied throughout the length of the injured area.

Ice-cubes wrapped in a cloth, ice packs, or plastic bags filled with cold water can be placed loosely around the cast.

Ice therapy is especially useful for the first 24 to 48 hours, as the pain, swelling, and inflammation are at their maximum then.

The Johns Hopkins Institute of Medicine also recommends using cryotherapy to manage pain and swelling.

A study conducted in France demonstrated that cold therapy also stimulates the parasympathetic system that improves the quality of sleep, and is used for patients with insomnia [7].

Find out if sleeping in Apple Airpods can cause cancer here.

4: Begin Supervised Rehab Exercises When Appropriate

MUST Do Exercises with Injured Foot or Ankle- Faster Recovery

A good exercise program is an essential component of rehabilitation and should be started after discussing with a physiotherapist or a doctor.

A leg passes through various phases after a fracture, and an appropriate exercise should be selected for each stage.

I have given a brief overview of some of the exercises below:

Toe Exercises

A leg cast puts pressure on the leg – decreasing blood flow to the toes and the feet.

This can result in pain, numbness, swelling, and stiffness of your foot and ankle.

A very simple exercise that you can do is to wiggle your toes to increase blood flow:

  • The toes should be moved up and down for 60 seconds.
  • Take a rest for 30 seconds, and then repeat this process five more times.
  • Another simple exercise you can do while lying down is to keep the heel and the cast flat on the floor.
  • Curl your toes downward, hold for 10 seconds, and then release.
  • Now curl your toes upward, stretch for 10 seconds, and then release.
  • Repeat this process five more times.

Toe exercises are recommended during the initial phases of the recovery and should be done at least ten times a day.

Isometric Exercise

This is a type of exercise in which a muscle contracts, but no movement is observed around the joint.

Isometric exercises are also known as static exercises and are great for increasing the strength of the muscles without damaging the healing tissues.

  • You can perform this exercise while sitting in an upright chair, or lying down on the floor.
  • Apply gentle pressure on the floor with your foot for five seconds, and then release.
  • Then repeat this cycle five more times.

As a rule, you should always start an exercise with low intensity, and then increase it as your stamina builds.

For example, in this case, you can increase the pressure applied on the ground, or the length of time of the stretch, after a few days.

Leg Lift

This exercise is designed to strengthen the thigh muscles while using a cast.

  • You should lie down flat on the floor with the leg straight to perform this exercise.
  • Raise your affected leg about four inches off the floor, and hold for five seconds.
  • Now bring the leg back to the floor, and rest for 10 seconds.
  • Repeat this cycle five times a day.

If you experience severe pain in the leg, you should discontinue this exercise.

This exercise is not recommended for the initial few days of your recovery.

Another modification to this exercise is to stand up and support yourself with a chair.

Lift the injured leg out to the side, hold for 5 seconds, and then release.

Repeat five sets of this exercise, ten times a day.

Here are 10 ways to sleep better after exercise.

5: Get Your Doctor to Adjust the Cast if Required

If you experience worsening pain and insomnia due to increased swelling, the best solution is to loosen the cast slightly.

You should consult a medical professional to re-adjust the cast.

Please remember that you should not attempt to remove the cast yourself – you could damage the healing tissue, and that will delay your recovery.

Try these 12 ways to sleep better with a knee brace on.

6: Take Good Care of Your Cast

A cast is necessary to immobilize the broken bone so that it can properly heal.

The duration for which a cast needs to be applied varies but is usually around four to six weeks.

That’s why taking good care of your cast is essential to avoid damaging the cast and to enable a speedy recovery.

I have made a list of recommendations for you to follow: [1]

Keep the Cast Dry

Do not wet the cast, as water can cause irritation of the skin, and increase the chances of getting an infection.

The material of some types of casts – such as plaster of Paris – can dissolve in water and lose its strength.

So you should avoid going to the swimming pool, and opt for a sponge bath.

Plastic bags should be applied to protect the leg from any splashes.

If the cast gets wet, you can dry it out with a low-heat hairdryer.

But if you cannot dry it, you should immediately consult a doctor to replace the cast, or for other valuable advice.

A fiberglass cast is usually waterproof, but its conventional inside padding is not.

You can discuss with your doctor for a waterproof lining so that you can enjoy a bath, or go swimming.

But you should always trust your doctor regarding the type of cast that is best suited for your fracture.

Do Not Scratch the Affected Area

Do not put anything inside the cast to scratch an itch, or for any other purpose.

It can injure the skin, and increase the chances of getting an infection.

The itchiness is caused by the irritating effect of the cast on the skin and is usually settled on its own in a few days.

You can blow cool air on the irritated skin with the help of a hairdryer, or take an antihistamine.

Taking an antihistamine like cetrizine or loratadine induces sleep, so it is best to take it at night.

Keep the Cast Clean

You should keep the cast clean, and avoid making adjustments to the length of the cast on your own.

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7: Take Your Medication as Prescribed

A broken bone takes a lot of time to recover, and medications are usually required to make this journey as smooth as possible.

Infection of the wound site is one of the most common complications that can delay healing.

According to the American Academy of Orthopedic Surgeons (AAOS), the presence of an open wound, diabetes, and joint disease increases the risks of infection [8].

Antibiotics are usually prescribed to treat or prevent the infection of the wound site.

If you experience fever, increased pain, redness, and swelling of the wound site, you should immediately consult a doctor for the treatment of the surgical site infection.

This infection, if left untreated, can result in amputation of the leg.

One very important point that I always tell my patients is to complete the course of the antibiotics as prescribed.

Some patients discontinue antibiotics as they are feeling well, resulting in antibiotic resistance.

After a fracture, pain can persist for up to 6 weeks.

The presence of a cast puts pressure on the leg that can increase pain.

Painkillers are usually required to manage this pain.

Different types of pain killers are available, including acetaminophen, NSAIDs, opioids, etc.

Some of them are freely available on the market as over-the-counter (OTC) drugs, while others require a prescription.

You should always consult a doctor to select the most appropriate one for you.

Unlike antibiotics, these are usually taken on an on-demand basis.

I always recommend that my patients take a long-acting pain killer at night, to have a night of good quality sleep.

You should be aware of the possible side effects of prolonged administration of these medications, such as stomach upset, kidney disease, sedation, etc.

Try these 8 ways to sleep better without relying on benzos.

8: Keep Your Bones Healthy

Maintaining optimum calcium, phosphorous, and vitamin D levels is essential for keeping your bones healthy.

Calcium

Calcium is one of the major components of bone and is essential for maintaining the strength of the bone.

If there is a decreased calcium level in the body, specialized cells called osteoclasts break down the bone, and release calcium.

This process increases the calcium level but weakens the bones.

That’s why adequate calcium is required to prevent bone destruction.

Calcium plays a very important role in cognition and sleep.

Researchers at The Brain Institute in Rio Grande do Norte, Brazil, reviewed the latest literature on this topic, and argued that calcium has a sleep-promoting effect on the brain [9].

Calcium is found in abundance in milk, cheese, yogurt, almonds, and leafy vegetables.

Vitamin D

Vitamin D is another essential component of our bone health.

Its deficiency increases the risk of bone fractures.

A study that was conducted at the Department of Psychobiology, Brazil demonstrated that vitamin D supplementation has a therapeutic role in managing and preventing chronic pain.

This study also showed the beneficial effects of vitamin D on the sleep/wake cycle, which are helpful for sleep disorders [10].

An adequate level of Vitamin D is also required to absorb calcium from the gut.

It comes from two sources:

  • Dietary sources of vitamin D include fish, liver, egg yolk, and fortified foods.
  • Vitamin D is also synthesized in the body in the presence of sunlight.

Adequate exposure to the sun is essential for maintaining an adequate level of vitamin D.

Dark skin color, using sunblock, and spending more time indoors are associated with increased risks of vitamin D deficiency.

I always advise the importance of a balanced diet, as it is a good source of calcium, vitamin D, phosphorus, protein, and carbohydrates.

Calcium and vitamin D supplements are usually prescribed for patients with fractures, to help the bones heal better.

These are mainly required for people with inadequate sun exposure and poor eating habits.

Other essential factors that are required for healthy bones are smoking cessation, maintaining a healthy weight, decreased caffeine intake, and regular exercise.

There are some things that decrease the absorption of calcium from the gut or increase losses through the urine.

These things, known as anti-nutrients, include steroids, oxalates, increased salt intake, and alcohol [11].

It would be best if you always discussed the effects of your medications on calcium and vitamin D metabolism with your doctor.

Here’s how to sleep better with sunburn.

9: Wear Comfortable Clothing

Wearing loose-fitting, light, and comfortable nightclothes is necessary for getting a night of good quality sleep.

Wearing a leg cast can get really problematic during the summer, as it is very hot.

So sleeping in heavy attire can make you sweat or itch, and both of these can exacerbate the situation.

The presence of a cast also makes it very difficult to fit into pants.

So, the best idea is to select loose-fitting clothes with elastic bands for use during your recovery period.

It would be best if you choose clothing that, although appropriate for the occasion and season, is still comfortable.

Try these 31 ways to cool down a hot and stuffy bedroom.

Conclusion: Sleep On Your Back With Your Leg Elevated

A leg cast is crucial for the appropriate healing of the fractured leg but can cause pain, swelling, and sleep disturbance.

Sleeping on your back with the affected leg elevated is the most appropriate position for improving sleep quality.

Cold therapy, exercise programs, a balanced diet, loose clothes, and vitamin supplementation are helpful for a quick recovery and improved bone health.

Up next: 10 ways to sleep better after rotator cuff surgery.


Sources and References

[1] “How should I care for my plaster cast?,” NHS, 2021. https://www.nhs.uk/common-health-questions/accidents-first-aid-and-treatments/how-should-i-care-for-my-plaster-cast/ (accessed Dec. 30, 2021).

[2] K. Wang et al., “The associations of bedtime, nocturnal, and daytime sleep duration with bone mineral density in pre- and post-menopausal women,” Endocrine, vol. 49, no. 2, pp. 538–548, 2015, doi: 10.1007/s12020-014-0493-6.

[3] E. Meilman, “Leg elevation in prophylaxis of thromboembolism,” Lancet, 1994, doi: https://doi.org/10.1016/S0140-6736(94)91271-8.

[4] M. K. W. M Y Liaw, “[The effects of leg elevation to reduce leg edema resulting from prolonged standing],” [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/2794965/.

[5] G. A. Malanga, N. Yan, and J. Stark, “Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury,” Postgrad. Med., vol. 127, no. 1, pp. 57–65, Jan. 2015, doi: 10.1080/00325481.2015.992719.

[6] G. Okcu and H. S. Yercan, “Is it possible to decrease skin temperature with ice packs under casts and bandages?,” Arch. Orthop. Trauma Surg., vol. 126, no. 10, pp. 668–673, 2006, doi: 10.1007/s00402-006-0189-3.

[7] W. Douzi, O. Dupuy, M. Tanneau, G. Boucard, R. Bouzigon, and B. Dugué, “3-min whole body cryotherapy/cryostimulation after training in the evening improves sleep quality in physically active men,” Eur. J. Sport Sci., vol. 19, no. 6, pp. 860–867, Jul. 2019, doi: 10.1080/17461391.2018.1551937.

[8] “Infections After Fracture,” AAOS. https://orthoinfo.aaos.org/en/diseases–conditions/infections-after-fracture/ (accessed Jan. 01, 2022).

[9] S. Ribeiro, “Sleep and plasticity,” Pflugers Arch., vol. 463, no. 1, pp. 111–120, Jan. 2012, doi: 10.1007/s00424-011-1031-5.

[10] D. L. de Oliveira, C. Hirotsu, S. Tufik, and M. L. Andersen, “The interfaces between vitamin D, sleep and pain,” J. Endocrinol., vol. 234, no. 1, pp. R23–R36, 2017, doi: 10.1530/JOE-16-0514.

[11] “Calcium,” Harvard school of public health. https://www.hsph.harvard.edu/nutritionsource/calcium/ (accessed Jan. 01, 2022).

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Image Attribution and Licensing

Main image: ‘Broken leg in cast of unrecognizable little boy’ – by halfpoint (used with permission and commercially licensed through Envato Elements).