sleep disturbances frequently occur in patients after surgery, and its occurrence is harmful for postoperative recovery [1–5]. here we reviewed evidences regarding occurrence, risk factors, harmful effects, prevention, and management of sleep disturbances in patients after surgery. patients with preoperative obstructive sleep apnea (osa) are at increased risk of postoperative sleep disturbances. the impact of opioids on the development of postoperative sleep disturbances is also reported in other studies [2].
many postoperative factors are associated with the development of sleep disturbances. a meta-analysis showed that the use of ear plugs and eye mask is also helpful in promoting sleep among patients in icu [35]. in a small sample size study of patients undergoing prostatectomy, preoperative melatonin enhanced sleep quality, decreased pain scores and tramadol consumption, but produced sedation during the early postoperative period [42]. development of sleep disturbances produces harmful effects on postoperative patients, that is, higher risk of delirium, increased sensitivity to pain, more cardiovascular events, and poorer recovery.
general anesthesia changes the postoperative sleep structure especially in elderly patients after major surgery and results in a high incidence rate of sleep disturbances. the hypothalamus involved in sleep regulation may be the target of general anesthetics (10). postoperative sleep disturbances caused by general anesthesia might increase the incidence of postoperative complications such as postoperative fatigue, severe anxiety and depression, delirium (39, 40), and even severe stroke [(41); figure 1]. sleep can regulate the function of the immune system by inducing changes in the sympathetic nervous system and hypothalamus-pituitary-adrenal axis. and the treatment of sleep disturbances may improve sleep-related symptoms and benefit the long-term outcomes (56). the efficacy of electroacupuncture alone or combined with drugs in the treatment of sleep disturbances is better than that of drugs alone and more secure (78). in addition, melatonin may be considered an effective alternative for benzodiazepines in the management of postoperative sleep disturbances (92). the relationship between general anesthesia and postoperative sleep disturbances is still unclear. doi: 10.1212/con.0000000000000495 4. fadayomi ab, ibala r, bilotta f, westover mb, akeju o. a systematic review and meta-analysis examining the impact of sleep disturbance on postoperative delirium. overlapping neurobiological mechanisms of sleep and anesthesia. effect sites of anesthetics in the central nervous system network–looking into the mechanisms for natural sleep and anesthesia. doi: 10.1016/s0140-6736(00)02795-1 18. kärkelä j, vakkuri o, kaukinen s, huang wq, pasanen m. the influence of anaesthesia and surgery on the circadian rhythm of melatonin. quality differences in postoperative sleep between propofol-remifentanil and sevoflurane anesthesia in infants. the effects of tramadol and morphine on immune responses and pain after surgery in cancer patients.
effect of sevoflurane and halothane anesthesia on cognitive function and immune function in young rats. anesthesia with abdominal surgery leads to intense rem sleep during the first postoperative week. doi: 10.1055/s-0031-1296459 43. zisapel n. sleep and sleep disturbances: biological basis and clinical implications. sleep disturbances and cognitive decline in the northern manhattan study. sleep duration, insomnia and markers of systemic inflammation: results from the netherlands study of depression and anxiety(nesda). sleep complaints co-segregate with illness in older adults: clinical research by and informing epidemiological studies of sleep. doi: 10.1093/bja/76.4.552 68. yilmaz h, iskesen i. follow up with objective and subjective tests of the sleep characteristics of patients after cardiac surgery. 72. dolan r, huh j, tiwari n, sproat t, camilleri-brennan j. a prospective analysis of sleep deprivation and disturbance in surgical patients. randomized clinical trial of psychological support and sleep adjuvant measures for postoperative sleep disturbance in patients undergoing oesophagectomy. doi: 10.1097/gme.0000000000000779 80. chen y, zhang h, tang y, shu j. impact of bilateral st36 and pc6 electroacupuncture on the depth of sedation in general anesthesia. acupuncture and electroacupuncture for anxiety disorders: a systematic review of the clinical research. effect of melatonin on sleep in the perioperative period after breast cancer surgery: a randomized, double-blind, placebo-controlled trial. doi: 10.1056/nejmoa1904710 98. peng k, ji f-h, liu h-y, zhang j, chen q-c, jiang y-h. effects of perioperative dexmedetomidine on postoperative mortality and morbidity: a systematic review and meta-analysis. doi: 10.1056/nejm198610023151403 citation: luo m, song b and zhu j (2020) sleep disturbances after general anesthesia: current perspectives.
patients often develop significant sleep disturbances immediately after surgery, especially major postoperative sleep disturbances are featured by insomnia, hypersomnia and narcolepsy, there can be many reasons why you are unable to sleep after surgery. some of the most common include the following: poor airway control: poor, how long does insomnia last after surgery, trouble sleeping after abdominal surgery, trouble sleeping after abdominal surgery, talking in sleep after surgery, insomnia months after surgery.
postoperative sleep disturbance is a well-recognized phenomenon. factors that contribute include the surgical inflammatory response, severity of surgery, type of anesthesia, pain, anxiety, and environmental factors such as nocturnal noise and light. if you take pain medicine, schedule it around 30 minutes before bedtime, if possible, to help you get comfortable and catch some much-needed shut-eye. there are also medications that have proven effective in promoting sleep after surgery, including zolpidem, melatonin and dexmedetomidine. are characterized by a decrease in total sleep time, elimination of rapid eye move- ment (rem) sleep, a marked reduction in the amount of slow wave sleep (sws) this study result showed that adult surgical patients with ages between 25 and 54 years were 15.2 times more likely to develop postoperative sleep disturbance around 50% of patients hospitalized overnight after surgery have sleep disturbances [1]. unfortunately, poor post-operative sleep is related, trouble sleeping weeks after surgery, night terrors after surgery in adults.
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