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Thursday, June 20, 2013
Lack of sleep after general anesthesia
On 12/17/2007, I had surgery on my lower back for removal of spurs pressing on discs. The surgery relieved the pain that I was having in my left leg. However, I have been having a lot of trouble getting to sleep. How long will this last? My surgeon and others said it may last 2 to 3 months.
Thanks for your question.
Sleep disturbance after major surgery is common. The "surgical stress response", that is the body's response to the trauma of surgery, is quite profound and has an important effect on sleep. Many hormones and metabolites are released, fever is common, the sympathetic nervous system is activated (adrenaline). Pain, pain medications, starvation, psychological factors, age, and a person's usual sleep profile all affect sleep after surgery. Pain decreases sleep, and, conversely, inadequate sleep exacerbates pain. Environmental factors in the hospital (noise, observation and nursing procedures, temperature and light) can also limit the duration and quality of sleep. The bigger the surgery, the more severe the sleep disturbance.
After surgery, the amount of REM sleep (associated with dreaming) is decreased for 1 or 2 nights, then rebounds. Nightmares during the rebound period (around night 4) are common. So-called Slow Wave Sleep is also affected for the first few nights. By around 1 week most people's sleep patterns are restored to normal, but as many as a quarter of people still are not sleeping normally at this point after major surgery. I am not aware of any studies of sleep patterns that have gone beyond one week after surgery.
Interestingly enough, the form of anesthesia (general vs. regional) does not seem to affect sleep disturbance after surgery. This suggests that general anesthesia, often blamed for a wide range of ills and unusual symptoms after surgery, is not responsible for the problem you are experiencing. In fact, study volunteers who underwent 3 hours of general anesthesia without surgery showed only minimal sleep disturbance afterwards.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University