Insomnia

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AZATADINE

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Aug 30, 2021
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I'm almost 8 weeks post AVR and I'm having pretty bad insomnia unfortunately. For the first few weeks, I'd get a couple of hours sleep, maybe wake for an hour and drift off for another couple of hours but for the last couple of weeks, I'm getting hardly any sleep at night. I dont sleep during the day either.

I'm walking around 10km per day (about 2 km or thereabouts per individual walk) and my body does feel tired at night but my damn mind is wide awake.

Is this normal for this stage of recovery? I have no intention of taking any sleeping tablets to help.

My medication is not the cause as far as I know. I'm on 1.25 mg Bisoprolol (which I take in the morning) but the other medication are routine enough (aspirin 75mg, warfarin 4 mg). The dose of Bisoprolol was cut back from 2.5mg to 1.25mg a couple of weeks ago.

I'm assuming this is some kind of phase and that it'll pass but just wondering if any of you have had similar experiences? I should probably add that my valve is tissue so it doesn't click (I know that could take getting used to at first but not an issue here).

Also, the pain is not bad at this stage. I might take a couple of paracetamol now and again but I don't have too much in the way of pain at night and can rest in any position in bed really.
 
Its a hard one alright, I had sleeping pills in those first few months and they do help.
Now days I’m out like a light watching tv but go to bed and its still sometimes hours of wide awake click click click.
Maybe try a radio on or tv or white noise machine, I love it when it rains and find listening to my leaky spouting dripping with the sound of the rain on the roof in the background very pleasant.
 
Hey, I did not sleep for months, I tried sleeping pills but found it was not a refreshing sleep pattern
so I came off them after a few days and let nature take its course.
I took plenty of daytime naps in the early days too.

good luck
 
Yeah, it becomes kind of self propagating after a while too. I half expect to not sleep....then get annoyed when I can't sleep....

One other thing is that I stopped taking paracetamol around the same time as it started as the pain was not too bad. Nevertheless, there can be some pain now and again. Wonder would it be worth taking some again in the evening/prior to bed? Maybe there's enough background pain in the bed to wake me?

How long do most people keep taking paracetamol for? Maybe I've come off them too early.

Funnily enough, even though my valve is tissue, by God, does it thump through my ears at night! Nice regular beating but loud. Probably doesn't help 😄.

It's good to know that others go through some similar experience and that it does settle.
 
When you say off all medication after 4 weeks, does that include beta blockers, aspirin and warfarin or just paracetamol?

I think I'll be on the aspirin forever, the beta blockers for a long time (I suppose 1.25mg is a tiny dose but I'd rather not take it long term to be honest) but hopefully off warfarin in the next month or so.

Yeah, I'm feeling a bit better knowing that I'm not alone having sleep issues after the op and that it'll settle. I guess there's possibly an element of my brain not getting tired enough compared to when I'm in work too.
 
@AZATADINE I have a mechanical valve so I take Warfarin.

I meant I was off all other medication ; Pain killers and low dose Beta Blockers (2.5mg)

I have never been prescribed Aspirin


You're certainly not alone with Post surgical sleep problems
 
Some find melatonin helpful in promoting sleep. Other things that help are to keep the bed for only sleep and sex. Stop reading, watching TV or surfing the net in bed. Your body should expect sleep when it goes to bed. A light snack before bed can help too. A glass of warm milk is tried and true.
 
My valve op was over 7 years ago now, and I forget exactly when I was able to sleep more normally but certainly experienced insomnia for a while. You might want to consider experimenting by taking the Bisoprolol at night, which is when I take my beta blocker, as a side-effect is to cause tiredness which might be helpful for a while. Having said that, your dose is very low, and advice is to normally take in the mornings: Bisoprolol: medicine to treat high blood pressure
 
It is very common to have sleep issues after valve surgery and it seems to last a long time for some.

I certainly had issues. In the hospital- really hard to sleep. Once home, still hard to sleep, but it was an energized type of insomnia for me, at least for the first 7-10 days home. It was like I was so thrilled to be home and by the fact that I felt much better than I expected, that I was just sort of energized. I remember being up reading at 2am-4am, wide awake, and thinking that this must be what it is like for people who cycle manic/depressive, during the manic phase.

I've always had a hard time sleeping on my back or even reclining. On overnight fligts, for example, I am always awake the entire time. So, not being able to sleep on my side for several weeks made sleep challenging. Once I was able to sleep on my side again, things were much better for me.

One thing that has really helped me sleep over the years is very low dose melatonin. I find the over the counter dosage of 2mg to 10mg is much too much for me, so I only take the 300mcg pills. They are typically not available in this small of a dose over the counter, but can be ordered on Amazon. 1000mcg= 1mg, so 300mcg is only 0.3mg.

There was a study done which found that the very small dose of .3mg was more effective than larger dosing.

"(0.3 mg) with a statistically significant improvement in sleep quality and without subsequent alterations in the normal circadian pattern of circulating melatonin levels. A supraphysiologic dose (3.0 mg) of melatonin was somewhat less efficacious"

Link to study:

http://web.mit.edu/dick/www/pdf/975.pdf
 
Hi Azatadine,
What helped me was meditation tapes - ( my valve was replaced almost 25 years ago). Now I just put on headphones and plug into my phone and listen to sleep meditation. There are lots of choices now. My favorites are Jason Stephenson or The Honest Guys. They have a lot of different choices and are free.
Sharon
 
I’m going on seven years post surgery (mechanical valve + aortic aneurysm repair) and I’m still in my 50’s. Sleep did escape me in the hospital and for a few months at home. It did concern me also. I took a low dose of a sleeping pill each night at first. I went off of that after six months. I now sleep with a fan at a low speed and I’ll take the smallest dose of an anti-anxiety for those nights when sleep just does not come. You will find your way, so try not to stress over it.

Once I turned 50 (pre-surgery), my sleep patterns changed and long, uninterrupted sleep was less frequent. My ability to nap also diminished, so I understand aging for me may also be a factor.

But please know this, life for me is good. I do not have health or diet restrictions. I go to the gym and lift regularly. I walk and bike daily, which is easy to do here in NYC. I started traveling five months after surgery and continue to do so, safely, several times a month and adjust well to time changes. And most importantly, I have a healthy valve, a terrific relationship with my cardiologist, and I found my way to being grateful for it all. I wish you the best of luck.
 
Apart from the beta blocker comment I made earlier, I do still get insomnia but have put this down to a combination of work stress and insufficient exercise whilst working from home, which I am trying to address, though who knows: maybe some meds are the cause. I have several techniques:

  1. If I wake at, say 4am, I know that it will not be easy to get back to sleep and so I get up and do something, whether it is washing up or something physical, or computer work, rather than lie in bed stressing about it. I find I can go back to bed an hour or so later and get to sleep quickly.
  2. Another option is to listen on my phone to a podcast that I enjoy. For this, I am in the fortunate position of being single and not having to worry about waking a partner!
  3. Finally, as others have said: white noise or certain sounds (eg waves gently crashing on a beach, or the sound of rain) can be helpful.
 
I understand how frustrating it can be to feel tired but unable to sleep. It's possible that your body is still adjusting to the changes from the surgery, and that could be causing some of the sleep difficulties. Have you tried any relaxation techniques before bed to help calm your mind? As for the most comfortable reclining chairs, I've heard that some people find them helpful for sleeping after surgery because they can adjust to a comfortable position. I hope you find some relief soon!
 
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OP here. I actually half dread talking about insomnia because it might come back.....but it's not as bad these days.

I certainly struggled badly for a period of months after the operation and although it can rear it's head now and again, it's not as bad as it was post op thankfully.
 
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