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What Can Be Done For Sleep Disturbances After A Bilateral Knee Replacement Surgery?

Posted on Thu, 3 Oct 2019

Question: Dear Sir,
My Mother Has undergone Bilateral Knee replacement on 30th March 2018 its 18 days over now.From past 6-7 days My mother is not able to Sleep due to Anxiety and stress.
My mother is diabetic from 10 years .She is taking Gemer P2 morning and night before food Does not have hypertension its under boarder range. No thyroid . Vegetarian diet . Before surgery she was sleeping perfectly without any issues but started getting sleep disturbance after surgery due to stress,pain and medications etc
.
She is currently taking following medication
TAB PREGABA 1-0-0 AFTER FOOD FOR PAIN
TAB PREGABA - NT 0-0-1 AFTER FOOD FOR PAIN
LIVOGEN -Z IRON TABLETS DAILY ONE TABLET
TAB GEMER P2 1-0-1 BEFOORE FOOD FOR SUGAR

Answered by Dr. Seikhoo Bishnoi (28 minutes later)

Brief Answer:
Low dose benzodiazepines can be added.

Detailed Answer:
Hello thanks for asking

I can understand your problem. It’s normal to develop slight anxiety or sleep disturbance after some major surgery. Pain and her age are other contributing factors for her symptoms.

If she is in anxiety and not able to sleep then for some time low dose benzodiazepines can be added. Clonazepam in 0.25-0.5 mg dose can be used for her sleep. The drug will not only reduce anxiety but will also help in good refreshing sleep. You can talk with her doctor to add this drug.

Thanks and take care

You are welcome to ask follow up doubts.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Seikhoo Bishnoi (50 minutes later)

Thanks for Quick Yesterday Night we had given ZOLFRESH Zolpidem (5mg) but still was not able to sleep.
Tablets which you have mentioned benzodiazepines or Clonazepam in 0.25-0.5 mg is for sleep i guess whether they are similar kind of drugs compare to ZOLFRESH Zolpidem (5mg).
Will Consult doctor and will tell to add those drugs but wanted to confirm if it causes any side effects and how many days it would should be taken and when it should be taken

Answered by Dr. Seikhoo Bishnoi (23 minutes later)

Brief Answer:
Zolfresh and Clonazepam are different drugs.

Detailed Answer:
Hello again

Zolfresh is a drug for sleep and has short lasting action while Clonazepam helps in sleep and also in anxiety. Zolfresh doesn’t help much in anxiety.

So in my opinion you can try Clonazepam for her. Use the drug for at least a week and then you can gradually reduce the dose and use on sos basis. You can talk with her doctor.

Thanks.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Seikhoo Bishnoi (49 minutes later)

Thanks for the information.Wanted to check if Clonazepam would have interactions with any other drugs which would cause Side Effects.
Whether Clonotril 0.25Mg tablet would be fine ?and when it should be taken before or after food?.What is recommended dosage?
Whether it would cause any addiction if we start giving that drug ?

Answered by Dr. Seikhoo Bishnoi (10 minutes later)

Brief Answer:
Clonazepam is safe to use.

Detailed Answer:
Hello again

Yes Clonotril is fine.

The drug has no serious side effects. It can be taken with most of commonly used pain killers and with drugs she is taking.

The drug should be taken after dinner around half hour before bed time. Caution should be there while use in elderly in high dose. It can cause sedation and this could result in accidental fall. But that is rare.

The drug can cause addiction if taken regularly for long without supervision of a doctor. Regular consultation of a qualified doctor is must.

The dose of 0.25-0.5 mg would be fine for her.

Thanks

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Seikhoo Bishnoi (3 days later)

Hi, I have provided some attachments. Please review them.

Answered by Dr. Seikhoo Bishnoi (5 hours later)

Brief Answer:
I hope her sleep is fine.

Detailed Answer:
Hello again,

I have gone through the attachments you have uploaded. The reports are more or less fine and there is no serious issue in her. The soft tissue edema on X-rays is seen normally after surgery. This will settle with time.

The lab reports are also fine. Though her RBS is in high range her HbA1c is normal so we can overlook this. Her cardiac, renal and hepatic functions are also normal. Slightly deranged lipoproteins levels are considered as normal. No need to get worried about that.

The ALKALINE PHOSPHATASE levels are altered most likely due to the bone issue. This is not a serious thing.

I hope her sleep has improved with medicines I suggested.

Thanks

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Seikhoo Bishnoi (34 hours later)

thanks for information. Still she is not able to sleep also we are not able to give prescription suggested by you since they are asking for valid prescription .im not able to visit doctor since still she cant walk comfortably. could you please let me know if there are any home remedies for inducing sleep

Answered by Dr. Seikhoo Bishnoi (10 hours later)

Brief Answer:
The dose of Zolfresh can be increased

Detailed Answer:
Hello again

Since she is elderly and has developed insomnia post surgery so I am afraid home remedies will work. But if you have prescription of Zolfresh then you can give 10 mg Zolfresh instead of 5 mg and this will surely help in inducing sleep.

Thanks

Please don't hesitate to ask again for more clarifications.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (13 hours later)

Sure Thanks.Will give Zolfresh 10mg as suggested by you Since i have prescription for that i can get that medicine without any issues.Wanted to confirm how many days this should be given.Does it develop dependency in case if it is stopped?

Answered by Dr. Seikhoo Bishnoi (12 hours later)

Brief Answer:
The drug is safe to use.

Detailed Answer:
Hello again

Try to use the drug at this dose for around a couple of weeks and then reduce the dose to 5 mg again for one more week and then the drug should be given on SOS basis.

Though the drug is very safe and has very low abuse and addiction potential even then elderly are prone to develop psychological dependence on this drug. So you can use the drug without worries but cautiously.

Thanks

Please let me know if you need more clarifications.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar