Coronary Artery Bypass Graft (CABG) surgery restores blood flow to the heart. Following this open-heart operation, patients often struggle to find a comfortable and safe sleeping position. Quality sleep is a major factor in recovery, helping to conserve energy and promote tissue repair. The need to protect the surgical site from undue pressure or strain often hampers the patient’s ability to rest well.
The Reason for Positional Restrictions
The primary reason for temporary restrictions on sleeping positions stems from the sternotomy, the surgical incision made down the center of the breastbone, or sternum. To access the heart, the surgeon divides the sternum, which is then rejoined using strong stainless steel wires. This reconnected bone requires a period of immobilization and rest to fuse back together securely.
The guidelines protecting this healing bone are known as Sternal Precautions. These precautions advise against activities that could stress the sternum, including pushing, pulling, or lifting more than a very light weight for several weeks. Side sleeping, especially without proper support, creates a rotational or twisting force on the chest wall. This uneven pressure can compromise the stability of the healing sternum or the wires holding it together, potentially leading to sternal non-union or instability.
Safe Sleeping Positions and Support Techniques
During the initial recovery phase, which typically lasts the first four to six weeks, the supine, or back-sleeping, position is the safest and most recommended choice. This position distributes the body’s weight evenly, minimizing strain and rotational forces on the healing sternum. Many patients find that elevating the upper body slightly, using a wedge pillow or by sleeping in a recliner chair, helps reduce swelling and makes breathing easier.
A common technique to manage pain and provide stability is sternal splinting, which involves holding a firm pillow firmly against the chest incision. Patients should use this pillow to brace the chest when coughing, sneezing, or taking deep breaths to absorb the internal pressure and prevent excessive sternal movement. For maximum comfort while lying on the back, placing small pillows under the arms can relieve shoulder tension, while a pillow under the knees can reduce lower back strain.
Getting in and out of bed must be done carefully to avoid using the arm and chest muscles to push up. Patients are taught the “log roll” technique, which keeps the body in one straight line without twisting the trunk. To execute this, the patient rolls the entire body as a single unit to the side of the bed, then uses the elbow and leg strength to lower the feet to the floor while simultaneously raising the torso to a seated position. This coordinated movement minimizes the shear forces placed on the sternum.
When and How to Safely Resume Side Sleeping
The return to side sleeping is generally considered safe only after the sternum has demonstrated adequate healing, which is typically around six to eight weeks post-surgery. This timeline is an estimate, and a patient should always receive clearance from their surgeon before attempting to sleep on their side. The bone needs this time to regain enough structural integrity to withstand the concentrated pressure of lateral positioning.
When cleared to try side sleeping, the transition should be gradual and heavily supported. The safest method involves using a large body pillow or multiple standard pillows placed strategically to maintain spinal and sternal alignment. The pillow should be hugged firmly against the chest to provide external support for the sternal incision and prevent the torso from collapsing forward.
Another pillow should be placed between the knees to keep the hips and pelvis aligned, preventing the upper body from twisting and straining the chest. Patients should test the position for short periods and be alert for warning signs that the sternum is not ready. These signs include a sharp, localized pain, a feeling of movement or instability in the chest, or an audible clicking or grinding sensation. If any of these occur, the patient should immediately return to a supported back-sleeping position and consult their medical team.