How to sleep after knee replacement - sleeping position

How To Sleep After Knee Replacement (6 Steps – Sleeping Position)

Sleeping after knee replacement wasn’t an easy endeavor. In fact, it was downright difficult because of the wound, the swelling, and some pain.

Today I’ll share with you how I managed to sleep after my knee replacement surgery.

Certain positions worked for me while others didn’t work. At times I was unable to sleep.  I’ll begin with day 1 in the hospital and continue through day 28 of my recovery.

During the first 4 weeks, I never slept through the night without waking up and readjusting my position. It’s hard to get comfortable and early on I could only sleep in one position.

Later in my recovery, I could sleep in two positions and during the 3rd week I spent a short amount of time on my stomach. Early on I found that daily naps were useful on my recliner, however, they likely impacted my quality of sleep at night.

Rest and sleep speed up the healing process so it’s important to get a good nights rest. I hope my article gives you a few ideas to make sleeping easier for you.

If you’d like additional resources the Mayo Clinic also provides general tips for sleeping better.

What is the Best Way To Sleep After Total Knee Replacement

Needless-to-say, sleeping won’t be easy in the first few days after knee replacement. Here are a few reasons why:

  • You’ll be on medication which can affect sleep
  • You’ll be in some pain which will definitely affect sleep
  • You’ll be worried about the wound leaking on the bed or splitting open
  • You’ll be limited on the positions in which you can sleep

Ideally, you’ll want to sleep on your back. It’s the easiest position to sleep given you have stitches in your knee and a swollen leg.

If you sleep on your stomach there’s a chance the wound leaks or the bed could rub against the wound. Sleeping on your stomach will also put pressure on the top of the knee where it’s most sensitive.

Sleeping on your side is an option but ideally, you’ll want to sleep with the surgically repaired knee facing up (closest to ceiling).

best sleeping position after knee replacement surgery

If you can sleep on your back, great. You’ll want to prop up your leg so it’s slightly elevated.

As you recover, elevation while sleeping will become less important.  Some doctors believe you don’t need to elevate while sleeping at night.

I used a wedge pillow after knee replacement (pictured right) and it worked great.  It was perfect for elevating the leg and also for sleeping.

Make sure it’s flat under the entire leg, not just the knee as it causes the leg to bend. When elevated, the leg should be supported from the hip to the foot.

Arrange your pillows or leg wedge pillow in a way that supports the whole leg, not just an area.

If sleeping on your back in bed is challenging, you can also try a recliner. A recliner is more of a seated position but it can be comfortable to sleep that way at night.

In a recliner, you can still place a wedge pillow under your leg for elevation.

Don’t hesitate to take naps during the day. Naps are perfect when icing and elevating during the day. While you’re recovering, you’ll need a lot of sleep in between therapy sessions to regain your energy levels.

Don’t fall asleep too long if you’re icing! Use a timer.

How Soon After Knee Replacement Can I Sleep On My Side

As you’ll read below, sleeping on your side won’t be possible for the first 5 days.  Early on, your leg will be very swollen and it’s important to protect the wound and give it time to heal.

By the end of the first week, you should be able to rest and sleep on your side for short periods of time.  By the 3rd week, your staples will be out, the wound will be mostly healed, and the swelling subsides so sleeping on your side will be easier and more comfortable on your knee.

If you’re like me, you’ll discover that sleeping on your side with your new knee on the bottom is easier than it being on top. In the section below I’ll share more of my experience sleeping on my side.

6 Steps To Sleep After Knee Replacement Surgery

No. 1 Prepare the Bed

When deciding which bed you’ll sleep in make sure it’s close to a bathroom and that you’re sleeping on the side nearest the bathroom.

Bedding should be clean from the get-go as your incision even though it’s covered the first few days, is still healing. On my 6th day home, my physical therapist removed the bandage for good and replaced it with Steri Strips (they gave the wound lateral support).

Make sure you have several pillows available to allow you to sit up in bed.  The extra pillows also allow you to prop up your leg if needed.

Use thin blankets because you’ll be sleeping on your back and any weight on your incision will be uncomfortable. I always slept in my underwear and a T-shirt because pajamas rubbed on the incision and made sleeping more difficult.

The first 10 days I frequently woke up sweating profusely (this may have been due to the medication). I had to keep an extra T-shirt nearby to change into.

Because of the sweating and the fact that I couldn’t shower the first 12 days we changed the sheets almost every day during the first two weeks.

No. 2 Keep Items Nearby

During the first week make sure your walker is placed in reaching distance from the bed. Also, make sure you can reach a lamp from your sleeping position.

You can also read my article titled “A Walker, Cane, or Walking Poles After Knee Replacement“.

There are several things that you should keep near the bed.

  • As I’ve mentioned in earlier articles I was always thirsty. I used the 64-ounce bottle with a built-in straw that I brought home from the hospital. For me, cold water quenched my thirst so I made sure I added fresh ice to my water before going to bed. I also was taking my pain medication every 4 hours or so and I needed water to swallow the pill.
  • I had my pain medication on my nightstand within easy reach. I also began taking 2 or 3 pills out of the container so that they were easier to find and take during the night. Also read Asprin and the best medicines after knee replacement.
  • After trying to get up and use the walker to go to the bathroom the first night I opted to leave the hospital furnished urine bottle on my nightstand and to stand up with the aid of my walker and urinate bedside. I soon learned that I needed a second bottle as I frequently filled the first bottle during the night.
  • If you wear glasses I suggest you have a pair of glasses on your nightstand as well.
  • I made sure I had a box of tissues and lip balm in close range.

Extra pillows are essential. I had two or three within easy reach. I used them to elevate my leg several times throughout the night and I used them to prop myself up in a sitting position.

During the first few days, I could only sleep on my back. I often sat up and was able to sleep in a sitting position for an hour or so.

No. 3 Get Comfortable (After Knee Replacement Can I Sleep On My Side? Best Sleeping Position)

Getting in and out of bed is important and the height of your bed can make a difference.

My bed is higher than most and at times it was challenging to get in bed but easier to get out of bed. I always tucked my good leg under the surgically repaired leg to support moving it on to and out of the bed.

I relied on the walker early on to stand up once I swung my legs down to the floor.

The first 5 nights my leg was extremely swollen and the only positions I could sleep in were flat on my back or in a sitting position propped up with pillows. The medication helped with pain and helped with sleep.

I woke up frequently to urinate and to drink. I usually slept for 2-hour intervals before waking up.

I did not have a restful nights sleep during this time but I did sleep a lot in my recliner during the day.

After the 5th day I was able to sleep on my right side for short periods of time (my right knee was my surgical knee). I could move my good knee in front or behind the surgical knee, however never on top of the surgical knee.

It was nice to get off of my back even for short periods of time.

After day 12 I began to lie on my stomach for short periods of time (10 minutes). I started out doing this during the day then gradually tried it at night.

I made sure my toes dangled over the edge of the bed so my knee was able to straighten out.

At this time I was no longer using the walker.  Instead, I used my walking poles that are adjustable according to comfort. 

Sometimes I used both poles and other times I used one to support my healing leg.  Walking poles are valuable to use after knee replacement and will be useful for many years down the road. Check out my article on the best walking poles after knee replacement.

At the end of the second week, I was sleeping on my stomach for 30 minutes to an hour each night. By the end of the 3rd week after surgery I was able to sleep for short periods of time on my left side if I supported the surgical knee with a pillow.

I had a hard time keeping the sheet and blanket on the surgical knee. I had my surgery in May so I did not need much bedding.

If you live in a cold climate and have your surgery in the winter it may be uncomfortable to keep heavy bedding on your knee while sleeping on your back.

Having surgery during warm weather also allows you to wear shorts. Your wound won’t rub on your pants and doing therapy will be easier.

No. 4 Use Pillows

I started out not using pillows under my knee while sleeping. I believe I could do so because I was heavily medicated.

As I transitioned to Tylenol I began using 1 or 2 pillows to elevate my leg during the night. The wedge pillow worked well and as did one or two conventional pillows under my leg.

While sleeping in my recliner I always used the wedge pillow, a throw pillow under my thigh, and a folded bed pillow under my ankle.

No. 5 Consider Sleeping In A Recliner

I considered sleeping in the recliner at night when I was having trouble sleeping in bed. I never did sleep in the recliner at night.

I did, however, sleep a lot in the recliner during the day so the change of location to the bed was welcome.  The Homall recliner pictured (right) is similar to the one I use at home.

It’s affordable and I prefer leather because it’s easier to clean.

>>check out Homall price and reviews on Amazon  

The first few nights my wife slept in the spare bedroom. On the third night she came back to our bed and her being on her half of the bed never made me uncomfortable.

If anything, I interrupted her sleep tossing and turning and getting up frequently to urinate.

When I did sleep in the recliner during the day I always elevated the knee with the pillows. The recliner does make it easier to get up to a standing position using the walker or the walking poles.

No. 6 Keep Your Mind Busy During The Day

Do your best to keep your mind active during the day. The therapy workouts help but you’ll need to keep your mind busy too.

I read but for only short periods of time early on.

I did short-term activities like crossword puzzles and Sudoku. I tried to walk a lot in the house especially before going to bed.

When the therapist began taking me for walks outside I felt worn out at the end of the day. Focus on your workouts and do your best not to skip them or cheat.

I spaced my 3 workouts 3 hours apart and tried to make sure I was able to eat lunch on time. As I mentioned before, the early workouts including the walks were tough physically and mentally.

I did my best to be conscientious and stay on a routine.

Each day at the end of the 3rd workout I was relieved and worn out. The more activity that you do during the day, the chances for a better nights sleep will improve.

Unable To Sleep After Knee Replacement Surgery

The first thing I’ll say is don’t be surprised if you’re having trouble.  You’re not alone.  In the first week, it’s tough for everyone to sleep, even though you’ll be exhausted.

After arriving home from the hospital, I was extremely tired from the stress of surgery and the procedure.  I’d fall asleep quickly when I laid down but because I needed pain medication and couldn’t stay in a comfortable position, I woke up constantly.

As a result, my sleep suffered.

Related: Best Ice Pack After Knee Replacement

In addition to the tips above to make sleeping easier, consider taking melatonin (talk to your doctor about potential side effects or chemical reactions with other medicine).  The best way to fall asleep after knee replacement was working hard during physical therapy until I was exhausted.

I also did my best to limit my naps during the day so I was extra tired at night.

I can assure you that after the 1st week it gets easier.  Don’t panic if you’re struggling to fall asleep after TKR surgery.

Conclusion

Sleeping will not always be easy after TKR. You’ll feel tired and sleepy initially when you are taking pain medication.

Once I began to wean off the pain medication I found it harder to sleep for sustained periods of time.

To begin with, plan on sleeping on your back or in a sitting position. As days go by and the swelling and pain decrease you’ll be able to experiment with different sleeping positions.

The wedge pillow and bed pillows will offer much-needed support and elevation. Once I was able to lie on my stomach I felt like I had reached a milestone.

Constantly sleeping on my back was uncomfortable. Through trial and error, I found some new sleeping positions even if it was for short periods of time.

I hope this article helps you sleep better after your TKR surgery. You’ll have to experiment as time goes by.

I encourage you to try various sleeping positions that are comfortable for you.

I am looking forward to sleeping through the night in the future and hope you do as well!

Comments

    1. Author

      Thanks Rudy, I’m sure it’s a challenging time for you so soon after surgery. In time I’m sure you’ll start sleeping better – it takes a while. Play the long game, and best wishes.

    2. Rudy thanks for the article very helpful. Having rt knee replaced 8/26. Lucky for me I became a back sleeper 2 yrs ago when I had shoulder replacement and learned the recliner was my best bet and will help with the knee. Wishing you the best!😁
      Pam T

  1. Thank you . It is helpful to hear other people’s experiences , especially when they mirror my own. I was so happy to sleep for two and a half hours last night but them woke up for another two hours where my leg was so stiff. That is still an hour and a half more than normal.

    1. Author

      Sleeping isn’t easy! I was surprised because I didn’t think about it beforehand. I was exhausted but still had trouble getting in a comfortable position. If the wedge pillow and bed don’t work, remember to try the couch or recliner. I found my sleep improved a lot after the first week. I hope you experience the same! Thanks for reading and for the comment.

    2. Just read your article. So glad that I did. Have been concerned about sleeping positions. Sleeping on my back was very uncomfortable for me and I was afraid to sleep on my side for fear of undoing the surgery. Had my surgery on April 23rd. Stayed in in-patient rehab for a week. That was a blessing in disguise. I am 80 years old. Home now and lots of decisions to make. The biggest of which is sleep positions and fear of doing something wrong. Have been sleeping on my side now for 4 days and thought it may be a mistake. Glad I read your article and realize that sleeping on side may not be wrong. See my doctor in 3 days. Was afraid to tell him. You put my mind at ease. Thank you!

      1. Author

        Double check with your doctor but sleeping on your side should be okay. Don’t forget to elevate the leg during the day, ice, and movement. After a few weeks, you’ll be sleeping better.

  2. Good to see I’m not alone not sleeping. Hoping to get out more when the weather improves. The pain is still much better than before surgery

  3. I’m on day 5 after surgery and all of these trials have been part of my recovery. I was soo glad to hear that sleeping was very difficult. Now I feel it’s okay to have these problems. I will work through them and know they are normal. thank you so much for your article.

  4. I am 13 days from having bilateral knee replacements how can I sleep on my side

  5. What a great article thank you for sharing. I had my second knee done four weeks ago and I am behind in my recovery from my first knee replacement on the other leg. The part that nobody tells you about, you’re the first one to ever mention it, is the mental issues. The mind is a powerful thing and it can take over in your recovery and make you feel defeated and human nature makes us compare with others and so I have been feeling like I am failing and falling behind . I have not been able to sleep in my bed yet except for three hours but I keep trying every day but it is so uncomfortable in every position. I have not tried the stomach so that is my goal for tonight. Again much thanks for sharing

    1. Author

      Thanks for the comment. I agree the mental side of recovery was a struggle and little things, like sleeping, weren’t something I considered before the surgery. Hopefully, you’ve found you can sleep on the couch or on a recliner. We’re all having TKR for slightly different reasons and we’re different ages. Some people will recover quickly and it might take other people longer. In my opinion, the key is to keep moving/trying especially in those first few months. Stay motivated!

      1. I had my second TKR JULY 23. I’m still not able to sleep in bed. I use a pillow between knees but after about 20 minutes my knee is aching regardless I’d moving it to find a comfortable position. I’m very frustrated at this point . My first TKR was Oct 9 so I feel like I’ve been dealing with pain, life adjustment, ,depression for quite sometime. If I could just get in bed and read and get a nights sleep I believe I could go on with all this rehab etc. Thanks for any suggestions!

  6. Hi, I’m 6six weeks after the operation. I’ve never tried sleeping on my stomach as was afraid of hurting. Thank you for the article. I enjoyed therapy except for cycling one as it exzousts me and make the knee to pain more.

    1. Author

      Yes, the cycling is tough at the beginning but I’d encourage you to continue at your doctor/physical therapist discretion. At six weeks I’d bet sleeping on your stomach is possible. As long as the wound is healed you should be okay. Thanks for the comment.

  7. What side of the bed works for right leg TKR? I am thinking the R as easier to get the bad leg off the bed. I am having 1st knee done in June and 2nd in Oct. Hopefully that is not too close together. Wish both could be done at the same time but Dr. says no. I am 67.

    1. Author

      I was on the right side of the bed and my right leg had surgery. I never thought if I should be on the other side of the bed, nor did I try. This is a great question…please check back and let us know which side worked best for you. I’m curious if I was on the wrong side!

    2. I had my first knee done Oct 25/18, and just had my second knee done on May 2/19. My doctor said no to both being done at the same time and I can totally understand why, it is better to focus on one at a time to get the movement etc going as quick as possible. I could have had it done earlier but wanted at least 6 months between to be sure the right one was healed up good and my mental state was okay. I have to say it is hard mentally going through it all again, doesn’t seem too long ago I was having the sleepless nights and trouble getting comfortable. Hoping in the end I will have two good knees. good luck with yours.

      1. Author

        Thanks for the message. 6 months apart seems like a good strategy, but I bet you weren’t looking forward to the 2nd round. At least you know what to expect and what to focus on. Best wishes to you and your recovery!

    3. Dee
      I had my left knee done in May, it is great used motorize cryocuff from Aircast for cooling ice(make 16oz, and 4oz plastic containers for ice) it last longer than ice cubes, this item was very helpful for me. Also, for my left knee I did sleep going to bed with my left knee first using my right knee to help raise. Now I’ll be going for my right knee and plan is going to bed with my right knee first. I did not use reclainer did use special bed rest pillow heavy one it has arm support which helps to get up from bed. Good luck with yours
      cryocuff is like small coolar, make sure you know what size cuff no returns

  8. I had bilateral total knee replacements on April 15, 2019. Sleeping well has been one of the bigger challenges. I tried bed when I first got home but it didn’t work because of pressure at incisions and I cannot sleep on my back. It’s been 2 weeks in the recliner. Haven’t had a good night yet. Tonight I am ready to try the bed again as I feel healed enough to sleep on my side which is my normal position. Sure praying and hoping that it works. Really need a good night’s sleep over here!!!

    1. Author

      Sleeping was so difficult early on. This is also the same time I was wondering if surgery was the correct decision. Give it another week or two and I bet you’ll be sleeping well. All the best and thanks for reading.

  9. It’s been 3 mths & 1 wk since I had my TKR. I’m still having swelling & stiffness. I’m still going to PT twice a week. I went back to work after 9 weeks off. But it’s hard to get comfortable at work. I sit in front of a computer & I try to get up & stretch every hour. I get frustrated because of the 24/7 swelling of my knee. My Orthopedic Surgeon & Physical Therapist said it would be up to 6 mths for the swelling to go away. I need to have left knee TKR. I’m thinking by October. Sleeping was very difficult for me because I’m a stomach sleeper. Even now I’m not able to completely sleep on my stomach. Thank you for your article. It was very interesting. It gives me a lot of insight on what to do when I have my left TKR. Right now my ROM in my right knee is 98% bend on my own & 104% bend with the help of the Physical Therapist. My Ortho Surg wants me at 111% bend by the end of this month (May). Eeek!! Thanks again for your wonderful article.

    1. Author

      Keep working hard to get that bend (range of motion). I think long periods of sitting for work might be tough on the knee/ciruculation. Hopefully, you are elevating and icing when you get home.

  10. Thank you so much for the advice. I had such a bad night until I found your article. I had a decent nights sleep . This is my fourth replacement . I am truly bionic. I will be 80 on the 22 my birthday gift. I could walk up all my stairs but the swelling and sleep were bad. My leg looks less swollen this morning. I get my staples out on Monday. That will help. Thanks again.

    1. Author

      No problem. And congrats on a 4th replacement. I’m sure you could provide much better advice and insight than I could. Stairs are tough so soon after surgery but glad to hear you’re improving. Wish you the best!

  11. Your website’s terrific! 2 questions (so far):
    Is the “wedge” pillow the triangle one or the semi-trapazoid one?
    and
    I have an adjustable bed. Any comments, pro or con?

    My TKR’s scheduled for mid-July. Thanks for all the prep suggestions.

    1. Author

      Not the triangle one, the semi-trap! Adjustable bed sounds like it would help with sitting up and getting out of bed. I’d image it’s a pro. Good to hear you’re getting ready well in advance, it’s worth it to prepare!

  12. Thank you. I found your article very helpful and easy to read.

    I’ve just been discharged home after bilateral TKR surgery. After the first night in my own bed (alone, as my wife has decided to sleep in the spare room), I was a bit concerned that I wasn’t lying in bed as I perhaps should. You may fall asleep on your back, but that’s not my natural position, so I was worried about crossing my legs and, potentially, causing blood clots. I certainly didn’t wake up in the same position I started out.

    As BTKR is a much less common operation, I have been struggling to find relevant advice. When you’ve had both legs done at the same time, “bad leg, good leg” rules go right out of the window.

    Thanks again

    1. Author

      Glad to hear you made it home safely. It sure beats having to stay in the hospital! You’re correct, I suppose my experience and tips with sleeping aren’t as helpful to those who have both done. Work hard in therapy, stay moving, and best wishes!

  13. I wish I had found this sooner! I am day 12 and was starting to think I was Looney regarding the exhaustion and difficulty sleeping. My TKR also involved extensive ligament work (on the ones that were not removed). At my 2 week follow up next Wednesday, my surgeon wants me at 105 flexion. As a result, I went way overboard in movement today and in pretty bad pain now. I just put a small pillow slanted under my leg and got a lot of relief while icing. Thank you so much for your valuable insights!

  14. I just read all the stories from people commenting and have an immense amount of relief from them. I am on day 6 after bilateral total knee replacements and felt like it was insane how little sleep I have found! So exhausted yet so challenging to find a comfortable position! Every day is a little easier but holy moly I can’t wait to be able to be in less pain! I was particularly weirded out by the feeling of the staples pressing against the bandages all night long and can’t wait until they are out! Thank you so much for sharing!

    1. Author

      Two weeks after the surgery you’ll be feeling a lot better than the first few days…be patient and work through the pain. Stay moving even though you’d rather rest/relax. Tough to sleep with those staples in! Thanks for reading.

  15. I am three weeks away from TKR. Have been doing prescribed exercises for a week. I began with the exercises as prescribed and have worked up to half again or double the reps. Can you suggest which of the knee exercises best prepare the knee for the surgery? It seems the hamstring stretch and raising the straight leg while lying on the opposite side have the most Impact—or I feel them the most. Thanks for sharing your experience.

    1. Author

      Glad my experience could help. I can’t recommend exercises for individuals because I think we’re all in slightly different situations for needing TKR in the first place. Good to hear you are stretching – I think that will really help. General leg strength from walking or swimming would be helpful if your bad knee allows it. Thanks for reading!

  16. Thanks for your advice I am 6 weeks post TKR & am still having problems sleeping. I have found some relief sleeping on my surgical side (right side) & resting my left knee on a body pillow That is placed along my right side. This ensures that there is no weight placed on my surgical knee but my left knee is also supported. Hope this may help others.

  17. I am so very nervous about my impending TKR surgery scheduled for Nov. 11, 2019. I get very sick and vomit a lot when I take Pain Meds…..I had a spinal fusion back on Jan. 3, 2017 and I was put on Tramadol for pain…I took only half of the prescribed amount. I did not vomit, but, I had a slight feeling of nausea each day….MY BIGGEST fear, though, is getting a blood clot. A month after my spinal fusion I got a PE and it was very painful and mostly VERY SCARY….To know that the blood clot had to travel through my heart and lodge in my lung is frightening as it could lodge in my heart and kill me. The day after my spinal fusion I was very sick from low sodium. I believe that is what caused my blood clot as I was not moving much at all….I was vomiting off and on when I even raised my head….SO, after reading that TKR surgery causes blood clots more than any other ortho surgeries, now my nervous level is very very high….Once one has had a blood clot, the chances of getting another one increase quite a bit…Anyone else in here get sick easily on Pain Killers..If so, what do you take? I was told that Tramadol is not the best at helping with pain….but, I think that is what my doc will put me on….So, I will be in pain and living in fear of getting a blood clot…I AM SCARED/////

    1. Author

      I was anxious as well. If you tell your medical staff about your concerns (meds and clots) I think they can come up with individualized preparation for you. Find a good surgeon and I bet you’ll be in good hands. It’s not something to look forward to, but I’m sure glad I had my surgery. Best wishes!

  18. Hi Ken,

    I am finding your blogs very informative. I’m having total left knee replacement Jan 7th, 2020 and trying to get ready and get as informed as I can. What do you think about having an adjustable bed for recovering? I’ve really enjoyed ready about your entire process and your suggestions for items needed and planning to be done ahead of time.

    Thank you so much for the information and support to everyone. 😊

    1. Author

      Adjustable bed would help with comfort and easy of getting in/out. If you already have one, great, but if you’re considering buying one I’d go with a more affordable option like a recliner (many people already have these). Early on, I spent as much time in my recliner as I did my bed because I had a hard time sleeping. An adjustable bed would help with finding a comfy position and with leg elevation. Thanks for reading/commenting, best wishes!

  19. I’m on my third tkr. My first two after 15 yrs came loose so I’m just had my right redone. It is very painful. But I do want to say thank you to everyone on this site for the advise. I was having terrible time sleeping. I tend to do what nurses say, which was not use pillows under the legs, so I read your ideas out pillows under my legs and got some sleep. Thankyou, thank you thankyou. After a nights sleep everything is better.

    1. Author

      Wow, three TKRs, that’s impressive! We should always listen to our nurses…but I hope you get some sleep. Thanks for the comment and wish you a speedy recovery.

Leave a Comment