Coronary Artery Bypass Graft (CABG) surgery is a major intervention that requires a careful and structured recovery to ensure the best outcome. Achieving comfortable and restorative sleep often becomes a significant challenge during the initial post-operative period. Following specific instructions regarding activity and body positioning is paramount for proper healing and minimizing the risk of complications. Understanding these guidelines is the first step toward a successful recovery.
Understanding Sternal Precautions
The primary concern immediately following CABG surgery relates to the healing of the sternum (breastbone). During the procedure, the surgeon performs a median sternotomy, cutting the sternum lengthwise to access the heart. The bone halves are then wired back together to allow them to fuse, a process known as sternal healing.
This healing process is delicate, and the sternum is vulnerable to excessive force or movement. Sternal precautions are guidelines designed to protect the incision and the bone repair. Side sleeping is restricted because it introduces a twisting or shear force across the sternum. This lateral pressure can jeopardize the integrity of the repair, potentially leading to sternal instability or non-union.
Recommended Safe Sleeping Positions
Since side sleeping is discouraged in the early recovery phase, the supine position (sleeping on the back) is the recommended position. Lying flat on the back distributes body weight evenly, minimizing strain and pressure on the healing sternum. Using pillows to slightly elevate the upper body, typically to a 30- to 45-degree angle, can enhance comfort.
This elevation is also beneficial for patients who experience shortness of breath or acid reflux. A small, firm pillow or a folded blanket should be placed across the chest incision to act as a splint. This support is helpful when coughing, sneezing, or taking a deep breath, as it helps to stabilize the chest wall. Many patients find sleeping in a recliner chair for the first few weeks provides the ideal elevated and supported posture.
Timeline for Resuming Normal Sleep
The duration for adhering to sternal precautions, including restrictions on side sleeping, is tied to the rate of sternal healing. The sternum requires six to eight weeks to achieve significant fusion and regain approximately 80% of its strength. Complete maturation of the bone tissue can take several months, sometimes up to six months.
Patients should not resume side sleeping without clearance from their cardiac surgeon or rehabilitation team. Once cleared, the transition should be gradual. Many find it helpful to use a large body pillow placed in front of or behind them to prevent rolling completely onto the side. This provides partial support and allows the body to slowly adjust to the pressure distribution on the healing chest.
Practical Tips for Improving Sleep Quality
Fragmented or poor sleep is common after major surgery due to discomfort, pain, and the unfamiliar sleeping position. To maximize rest, establish a consistent sleep schedule and ensure the sleeping environment is dark and cool. Managing pain effectively is important, so timing pain medication to provide relief an hour before bedtime can help facilitate sleep onset.
To safely get in and out of bed without straining the sternum, patients should use the “log rolling” technique. This method involves moving the entire body as one unit, avoiding any twisting of the trunk. To rise, roll onto the side, lower the legs off the bed, and then use the elbow of the lower arm to push the torso up to a seated position, minimizing strain on the chest muscles. Always avoid using the arms to push or pull yourself up from a lying or seated position.