A sprained ankle is the most common ankle injury, but that doesn’t mean it can’t cause severe pain and interfere with every day life. A sprained ankle involves sudden injury to the ligaments that support the ankle joint, and as such, this can be quite painful, both in terms of when the injury happened and during the early stages of recovery.
Why can’t I sleep with a sprained ankle?
Sleeping with a sprained ankle can be challenging, especially in more severe ankle sprains, as inflammation is prominent in the initial stages of healing for any injured structure.
Inflammation is a normal part of healing as long as it isn’t too severe or prolonged, and as such, you can expect some ankle pain and discomfort during the first 1-2 weeks following an ankle sprain. Many people describe a throbbing pain at night following an ankle sprain (Petersen et al, 2013).
Increased swelling in the ankle is another reason it can be difficult to fall asleep and stay asleep following an ankle sprain. Swelling typically increases throughout the day as gravity will make it more difficult for the body to take up the swelling, and the healing tissues may be under stress if you are on your feet throughout the day.
The last major reason that it can be difficult to sleep with a sprained ankle is due to poor foot and ankle positioning in bed. Depending on what ligament is injured, it is important to not keep that injured ligament on stretch while it is healing, otherwise the ligament will heal in a more lengthened position and won’t provide the best achievable support for the ankle joint once healed.
We will discuss how to prevent these causes of ankle pain while sleeping in the section below.
How to Sleep With a Sprained Ankle
Elevation is a key component to early recovery from a sprained ankle, both in the day and at night. Elevating the ankle above heart height will allow gravity to reduce swelling and alleviate pain.
The simplest way to elevate your sprained ankle at night is to lie on your back and place a stack of pillows under your ankle. This way, with the ankle propped on pillows, gravity will provide enough assistance to reduce swelling and manage pain, but it won’t be too uncomfortable on other joints like the hip and knee.
For the most comfortable position, create a stack of pillows that is just higher than your chest (chest height when lying down), but to be more effective, elevating the sprained ankle approximately 60 degrees appears to be more effective (Herrington and Al-Shammari, 2006).
It is possible to elevate your ankle while lying on your side, but it’s a bit more awkward and ill-advised if you haven’t discussed this with a physical therapist in person, just in case the awkward positioning may create further problems.
Ice Your Ankle Before Bed
Icing your sprained ankle can also assist in the reduction of swelling and inflammation in the early stages of injury, and will also help prevent secondary tissue damage from prolonged or excessive swelling.
Icing your ankle just before bed is preferred, as you this will help in the reduction of pain, swelling, and inflammation, which can make it easier to fall asleep. Given you will be in a horizontal position while sleeping, and especially if you keep the ankle elevated, the reduction in swelling may actually be maintained throughout the night, offering a more comfortable sleep.
Some people do find it beneficial to keep some ice on their ankle as they fall asleep, but we do not recommend this for a couple reasons.
First, if left on for too long, ice can create skin damage by severely altering blood flow, sometimes even as severe as frostbite. Second, it’s another item to be monitoring while you sleep, and if you’re moving around in your sleep, it might actually become less comfortable.
It’s highly advised to seek physical therapy guidance involving icing your sprained ankle if you have any questions and to ensure safe and proper application.
Compression can be an effective strategy to reduce swelling and alleviate pain from an ankle sprain. This is best done throughout the day when you are on your feet or in a dependent position (leg hanging in a sitting position), as it will help minimize the accumulation of excessive swelling (Hansrani et al, 2015). Going to bed with less ankle swelling can lead to less pain and a better night’s sleep.
Compression can be applied at night as well, but may not have the same effect as during the day since you are already in a horizontal position that minimizes the accumulation of swelling in the ankle, especially if you are also elevating the ankle.
The most common forms of compression include graded compression socks or stockings, as well as tensor bandages.
Graded compression socks help provide pressure on the ankle, with more pressure on the foot and gradually reducing up the leg, which can help “squeeze” existing swelling up the leg and prevent pooling of swelling in the ankle. 20-30 mmHg is the most common strength of compression sock, but you can also start lighter, for example 15 to 20 mmHg.
A tensor bandage, also known as an elastic bandage or compression bandage, offers more customization in terms of amount of compression, but this must be applied on your own and can be a little bit cumbersome. The compression may also not be as uniform throughout the foot and ankle, but can still have good results for preventing excessive swelling and pain throughout the day or night.
For a compression bandage, the main thing is to ensure that you don’t restrict blood flow to your foot, so keep an eye on the color of your toes and make sure you monitor the sensation in your foot and toes after applying the tensor bandage. For more guidance on preventing interruption to the blood flow to your foot or ankle, please consult with a physical therapist.
Avoid Blankets or Sheets on the Injured Ankle
We recommend avoiding having blankets or sheets on your feet while sleeping with a sprained ankle, especially if you are sleeping on your back, as this may put pressure on your ankle towards a position that stresses the injured ligaments, particularly with lateral ankle sprains.
Even a light constant pressure can increase pain in the injured area. This doesn’t mean you can’t use blankets or sheets at all, just don’t have them draped over the injured ankle if possible.
Given the first phase of healing for a sprained ankle involves substantial inflammation, it may be beneficial to reduce this inflammation slightly through the use of oral or topical anti inflammatories taken throughout the day, before bed, or throughout the night.
Advising on medications is typically out of the scope of practice for physical therapists, and as such, it is highly recommended to speak with a doctor or pharmacist prior to taking anti inflammatories for your sprained ankle, even over the counter anti inflammatories.
Anti inflammatories can have some adverse effects. For example, some may cause gut problems. Anti inflammatories can also interact with other medications or conditions, particularly heart medications and conditions, and this is also a reason why it’s highly recommended to speak with a doctor or pharmacist prior to taking anti inflammatories for your ankle sprain.
Other Pain Medications
Other pain medications that do not have direct anti inflammatory properties may also be beneficial, especially if a doctor or pharmacists deems it unsafe for you to take anti inflammatories. In this case, Tylenol is probably the most common over the counter pain medication. The generic name for Tylenol is acetaminophen.
Like any other medication, acetaminophen also has potential adverse affects, namely liver damage. It can also interact with other medications as well. Therefore, it is highly recommended to speak with your doctor or pharmacist first to ensure it is safe for you to take.
If it is deemed safe, it is often recommended to take Tylenol or acetaminophen before bed to get on top of the pain, and may be required at some point in the night. However, an in-person consultation about the dosing of medication is recommended to ensure optimal results and safety.
For more detailed information on the potential benefits, risks, and comparisons of different medications for ankle sprains, please refer to Tiemstra, 2012.
Pacing and Planning for Sleep
All of the strategies mentioned above can be incorporated into the daytime as well. For example, staying on top of ice and elevation throughout the day can reduce the amount of ankle pain during sleeping.
Additionally, pacing your activities throughout the day to avoid too much stress on the ankle can be a wise strategy, as this may leave you with less pain to begin with by the time you go to bed.
Specifically, resting in the few hours before bed while also incorporating ice and elevation can be an effective strategy to help you fall asleep after a recent ankle sprain.
While there is no one best way to improve your sleep with a sprained ankle, the strategies mentioned above have proven effective for many people and are typically safe options to explore, particularly with the guidance of a healthcare professional, such as a doctor, physical therapist, or pharmacist.
Hansrani, V., Khanbhai, M., Bhandari, S., Pillai, A., & McCollum, C. N. (2015). The role of compression in the management of soft tissue ankle injuries: a systematic review. European Journal of Orthopaedic Surgery & Traumatology, 25, 987-995.
Herrington, L., & Al-Shammari, R. A. (2006). The effect of three degrees of elevation on swelling in acute inversion ankle sprains. Physical Therapy in Sport, 7(4), 175.
Petersen, W., Rembitzki, I. V., Koppenburg, A. G., Ellermann, A., Liebau, C., Brüggemann, G. P., & Best, R. (2013). Treatment of acute ankle ligament injuries: a systematic review. Archives of orthopaedic and trauma surgery, 133, 1129-1141.
Tiemstra, J. D. (2012). Update on acute ankle sprains. American family physician, 85(12), 1170-1176.
The content here is designed for information & education purposes only and is not intended for medical advice.