Recovery after open heart surgery requires time and attention to physical limitations, and restful sleep is a significant component of the healing process. Finding a comfortable position for sleep can be a challenge for patients, especially those who prefer to sleep on their side. The primary concern influencing post-operative sleeping positions is the healing of the breastbone, or sternum, which was divided during the procedure to access the heart. This bone must be given an opportunity to stabilize before a patient can safely return to their pre-surgery sleeping habits.
Protecting the Sternum: The Initial Back Sleeping Mandate
The initial post-operative period imposes mandatory sternal precautions to ensure the breastbone heals correctly. During surgery, the sternum is cut and then reconnected using stainless steel wires, which hold the bone fragments together while they fuse. These wires are permanent, but the bone itself needs several weeks to rebuild the structural integrity necessary to withstand external forces. Any twisting, pulling, or excessive pressure on the chest cavity can strain the healing sternum, risking a complication known as sternal non-union or instability.
For this reason, the initial recommendation is to strictly maintain a supine position. Sleeping on the back naturally aligns the head, neck, and spine, distributing body weight evenly and minimizing strain on the chest incision. Many patients find that sleeping slightly upright helps to ease pain and manage any fluid buildup in the lungs or around the heart, which can cause discomfort when lying completely flat. This can be achieved by using a wedge pillow or by sleeping in a recliner chair for the first few weeks following the operation.
The goal of this back-sleeping mandate is to provide maximum stability to the median sternotomy incision, allowing the bone to knit without interruption. It is important to avoid using the arms to push or pull oneself up when getting out of bed, as this can directly pull on the sternum. Instead, patients should use their legs and core muscles to move, following the specific mobility instructions provided by their surgical team.
Criteria for Safely Transitioning to Side Sleeping
The question of when a patient can safely transition to side sleeping depends entirely on the progression of sternal healing and medical clearance. While many patients feel a strong urge to return to their preferred position, the general healing timeline for the sternum is approximately six to eight weeks. Attempting to sleep on the side before this period carries the risk of putting lateral pressure on the chest, which can interfere with the bone fusion process.
Medical clearance from the surgeon or cardiologist is a necessary step before attempting any change in sleeping posture. This professional confirmation indicates that the sternum has reached an acceptable level of stability, and the patient’s recovery is on track. Beyond a specific timeline, a significant physical criterion for readiness is the absence of pain when attempting small movements or turns. If a patient experiences sharp, localized pain in the chest wall while gently shifting their weight, it is a clear indication that the sternum is not yet stable enough for side sleeping.
The transition, once cleared, should be gradual, rather than a sudden shift to a full side-sleeping position. Some patients begin by using a small incline or a series of pillows to achieve a semi-side position, which is a compromise between the supine and lateral positions. Managing pain with over-the-counter medication and feeling deep, internal stability in the chest are reliable indicators of increasing readiness.
Practical Steps for Supporting the Chest While Side Sleeping
Once a physician has given clearance, the practical application of side sleeping involves specific techniques to maintain sternal support and prevent accidental over-rotation. To safely get into a side-lying position, patients should utilize the “log rolling” technique, which involves moving the body as a single unit without twisting the torso. Starting from the back, the patient bends their knees and rolls their entire body—shoulders, torso, and hips—simultaneously to one side. This method minimizes the shearing forces that could strain the healing sternum.
A central technique for maintaining comfort and stability is the use of a supportive pillow to hug against the chest. This pillow, sometimes a specially designed sternal pillow, acts as a brace that stabilizes the incision and prevents the top arm from pulling down on the chest wall. Keeping the arms wrapped around this pillow offers a form of external support, particularly when coughing or taking a deep breath.
Proper pillow placement prevents the body from rotating too far onto the stomach or twisting the spine. A pillow should be placed between the knees to keep the hips and pelvis aligned, which in turn helps keep the upper body stable. Another pillow can be positioned behind the back to act as a physical barrier, preventing the patient from rolling onto the supine position and potentially straining the chest while asleep. If any position, even with full pillow support, causes new or increased pain, it is a signal to stop and return to the back-sleeping position until the sternum has had more time to heal.