Open-heart surgery, such as a Coronary Artery Bypass Graft (CABG) or valve repair, requires a sternotomy—a vertical incision through the breastbone—to access the heart. Managing the healing of this sternal incision is a focused part of the initial recovery. Sleep position is a significant concern because improper movement can place undue stress on the mending bone.
Sternal Precautions and Healing Timeline
A sternotomy requires the breastbone to be cut lengthwise. The two halves are secured back together, typically with stainless steel wires, to facilitate bone fusion. Patients must follow Sternal Precautions to protect this delicate repair. These guidelines minimize movement that could pull the two sides of the breastbone apart.
Side sleeping is restricted because it introduces rotational or shearing forces across the healing sternum, which can compromise the repair. Any movement involving pushing, pulling, or twisting the chest should be avoided. The standard duration for the bone to achieve significant fusion and regain strength is approximately six to eight weeks.
The six to eight week period is the general timeline for the initial sternal healing phase. During this time, the bone is actively fusing and vulnerable to separation under strain. Full bone maturation and complete strength recovery can take several months, sometimes up to six months. Adherence to these precautions prevents complications like sternal instability or a non-union, where the bone fails to fuse properly.
Guidance on Reintroducing Side Sleeping
The six to eight week timeline is a general guideline. Patients must receive direct clearance from their cardiac surgeon or rehabilitation team before attempting to resume side sleeping. Once medically cleared, the transition should be gradual and supported. The goal is to move the body as a single unit to avoid twisting the torso and stressing the sternal incision.
To get into or out of bed, patients are taught the “log roll” technique. This technique prevents the chest and abdomen from moving independently. The patient first bends both knees while lying on their back, keeping the arms folded across the chest or holding a supportive pillow.
The patient then rolls their head, shoulders, torso, and legs simultaneously, shifting the entire body to one side without twisting the spine. This movement prevents arm muscles from pulling on the chest and ensures sternum stability. Once on the side, the patient gently swings their legs off the edge of the bed, using the opposite elbow close to the body to push up to a seated position.
When starting to side sleep, many patients find partial side-lying more comfortable than a full side position. This involves placing a supportive body pillow or a stack of regular pillows directly behind the back. This barrier prevents the body from rolling completely flat onto the side, which can put excessive pressure on the chest.
Practical Strategies for Post-Surgery Sleep Comfort
During the initial recovery, when full side sleeping is not permitted, the recommended position is supine, or on the back. Lying flat distributes body weight evenly, minimizing localized pressure on the healing sternum. Many find it helpful to sleep with the upper body slightly elevated, often at a 30- to 45-degree angle.
Elevation can be achieved using a foam wedge pillow, a stack of pillows, or an adjustable bed. This slightly upright position often improves breathing and reduces discomfort from fluid shifts or acid reflux. Using a small, firm pillow or a folded blanket to “splint” the chest is also recommended.
Holding this supportive object firmly against the chest incision is beneficial when performing actions that increase internal pressure, such as coughing, sneezing, or deep breathing. This external support helps stabilize the chest wall and reduces sharp pain associated with sudden movements. Many individuals find that sleeping in a comfortable recliner chair is the most tolerable option during the first few weeks home.
To prevent accidental turning onto the side during sleep, patients can use positioning aids. A large body pillow or multiple pillows placed alongside the torso can act as a physical barrier. Placing one pillow between the knees can also help align the spine and increase overall comfort.
Recognizing Potential Complications
While following precautions, patients should remain vigilant for signs indicating a complication with sternal healing. Persistent or worsening pain at the incision site should be reported to the medical team. Mechanical symptoms related to the breastbone itself are of specific concern.
The patient might notice an audible or palpable clicking, popping, or grinding sensation, known as crepitus, when moving or breathing deeply. This sound may signal sternal instability, where the bone halves are separating or shifting.
Any new or excessive redness, swelling, or drainage from the incision site could indicate an infection. Signs of infection, such as fever, warmth around the wound, or pus-like discharge, require immediate medical consultation. Promptly reporting these symptoms ensures a timely assessment and intervention.