Sleep is important; you know that. You are not the best version of yourself when you haven’t slept well. However, there are points in life, where it may be particularly crucial, and there is good evidence that the times before and after an operation are among them. Getting the right support to sleep well at these points will set you up for a better outcome and a smoother recovery from your surgery.
The Effect of Sleep
Sleep disturbance before and after surgery is understandable; it is a stressful time. Nevertheless, getting good sleep before a procedure has been shown to be associated with less pain, and less confusion. In 2024, a review of 29 scientific papers, which considered evidence from over 16 thousand people, found that those with very disturbed sleep before surgery were more than twice as likely to suffer from moderate to severe pain the day after1. Two separate studies have found that poor sleep before surgery can also increase the chances of confusion, with one showing an almost threefold increase 2,3.
Sleeping well after surgery is also important and has been linked to better wound healing. When 110 people who had emergency abdominal surgery were followed up, there was an association between better sleep and better healing from day three onwards4. As unlikely as it sounds, one group of scientists have even experimented directly in this area: test subjects were split into two groups, one was sleep-deprived and the other left alone, then all of them were given minor suction-blister wounds. Those who had slept better, healed better5.
So, the links to better pain control, less confusion and better wound healing are apparent, but what of more significant complications? Here, things are a little less clear; nevertheless, some clinicians are finding connections. In 2025, a group from Chicago followed 96 people undergoing gynaecological surgery, finding that those who slept better after their procedures had fewer complications. Furthermore, there appeared to be a ‘dose-dependent’ link: the better the sleep, the better the recovery. Dose-dependence is often used as evidence for causation, something that the authors do in this case, arguing that if we could improve sleep, then we might be able to improve recovery and outcomes.6
Putting this all together, better sleep is associated with faster recovery. It was noticed that when almost 1,000 people undergoing joint replacement were followed, better sleep before the operation was associated with not only less pain and improved mobility after it, but also a shorter hospital stay.7
Why Does This Happen?
You may have heard of the ‘runners’ high,’ that state of euphoria attained by those stoic souls who push through pain on exercise. This frame of mind is aptly named, as it is brought about by a group of molecules your body produces itself, known as endorphins, which are closely related to opioid drugs like morphine and heroin. Endorphins are part of your pain regulation system, a system which appears to tip away from pain control, and towards pain perception if you sleep poorly.8
Furthermore, sleep effects your immune system and how it responds to surgery. The immune system steps in whenever the body is disrupted, whether that disruption is accidental (as in the case of injury or infection), or purposeful (as in the case of surgery). Inflammation, characterised by increased blood flow, swelling and the recruitment of white blood cells, is one of the first steps of an immune response. Sleep loss has been shown to alter your inflammatory response in both the body and brain 6,9 with implications for wound healing, pain, and confusion.
The Recovery Loop
Better sleep helps synergistically with other areas that can support your recovery. As such, good sleep, good mobility, and good nutrition can be seen as a self-reinforcing loop, rather than three independent variables.
Getting moving is particularly important after many procedures, encouraging blood flow, healing, and reducing the chance of certain complications such as blood clots. Better sleep helps you move in several ways. You have seen how sleeping better is linked to better pain control, but it also promotes mobility through greater energy levels and motivation. Good nutrition has been linked to successful mobilization after hip fracture, and an improved metabolic environment for physical therapy 10, 11 . But nutrition does not simply help movement, it also, independently improves surgical outcomes like wound healing12, as well as sleep13.
A 2025 trial, involving 290 people with colon cancer, compared a combined sleep and nutritional boosting regimen to standard care, finding it improved pain, mood, and quality of life.14
Getting the Sleep You Need
Sleeping well can be challenging around an operation, with stress before it and the hospital environment after, providing difficult barriers. Nevertheless, consciously prioritising it can help. You are the most important person in your clinical journey, so make sure to air any concerns you might have about sleep with those supporting you through your preparations, hospital stay and recovery.
Before surgery avoid any significant changes to your bedtime routine if possible, and consider how your environment could support normal sleep, avoiding extremes of temperature and minimising disturbances. After your procedure, the noise and lights of the ward can often be countered with a comfortable set of ear plugs and an eye mask, whilst a sensible discussion with your surgeon might lead to a safe reduction in the amount of disturbing monitoring you experience.
Another point to discuss with your clinical team is post-operative pain control, as a GP I have often consulted with people who have run low on pain-relieving medication shortly after their surgery, something which can be avoided if an appropriate supply is provided on discharge.
A Final Thought
So, is sleep really a panacea, a golden bullet for a guaranteed and graceful recovery? While it does weave its threads through the tapestry of a healthy life, good sleep is only part of the picture. Many of the studies that provide evidence for its importance show association, not causation, meaning that there may well be other factors that contribute to both good sleep and a good recovery independently. Nevertheless, as we have seen, sleep is inextricably linked to other areas of life that, if nurtured appropriately, have wide ranging benefits for our health. As such, while there is certainly evidence that good sleep causes better outcomes in certain cases, in others, sleep is acting like a barometer for general wellbeing. Creating and fostering a situation in which good quality sleep comes to you, will be of great benefit, whether it is the sleep itself that causes it or not. People who sleep better, do better.
Author: Dr Jonathan Tham
Dr Jonathan Tham is a General Practitioner and Sleep Specialist at Wessex Private General Practice
Dr Jonathan Tham | Sleep Specialist | Wessex Private GP
Sources
- Niklasson et al. 2024
- Fadayomi et al. 2018
- Leung et al. 2023
- Das et al. 2024
- Wilson et al. 2017
- Debbiche et al. 2025
- Luo et all. 2019
- Liu et al. 2026
- Ni et al. 2019
- Rodriguez-Bocanegra et al. 2020
- Alreshidi et al. 2024
- Braga et al. 2002
- Tan et al. 2016
- Wang and Pan 2025
