Written by the Nuvirox Research Team
Short answer: trouble sleeping the week before surgery is extremely common, it isn't just nerves, and it's worth mentioning to your care team rather than managing quietly on your own. If you have a procedure coming up and you're finding it harder to fall asleep, waking more during the night, or lying awake running through scenarios, you're describing one of the most well-documented experiences in perioperative research.
Key Points
- Preoperative anxiety is common — studies report it affects roughly a quarter to over three-quarters of surgical patients — and it's directly linked to worse sleep in the days leading up to surgery.
- This isn't just an unpleasant few nights: research shows higher preoperative anxiety predicts worse sleep quality after surgery too, and poor perioperative sleep is linked to slower recovery and more pain.
- Because anesthesia, surgery timing, and some medications can interact with sleep supplements, this is a case where your surgical team needs to be in the loop before you add anything new.
How common is preoperative sleep disruption, really?
A study by Ruis and colleagues, cited in a 2023 narrative overview in Anesthesiology and Perioperative Science, found that anxiety related to surgery and anesthesia affects an estimated 25% to 80% of surgical patients — a wide range that reflects real variation by procedure type and individual factors, but underscores just how common this is. A separate study measuring insomnia specifically in the days before surgery found that older adults awaiting surgery had sleep disturbance rates of nearly 60%, compared to 29% to 48% in the general population — a meaningful jump tied directly to the surgical context.
A prospective cohort study of 330 patients undergoing laparoscopic gynecological surgery found that patients with higher preoperative anxiety scores had significantly higher insomnia scores not just the night before surgery, but for at least three days afterward as well — suggesting this isn't a one-night problem that resolves once the procedure is behind you.
Why does anxiety about surgery specifically disrupt sleep?
Anticipatory anxiety activates the same physiological arousal systems as other forms of stress — elevated cortisol, heightened vigilance, and a mind that has trouble disengaging from planning and worry, similar to what happens the night before a high-stakes exam. But surgery adds specific features that can intensify this: uncertainty about outcomes, unfamiliar hospital environments, fear of anesthesia itself, and often genuine physical discomfort from the underlying condition requiring surgery in the first place.
Research published in the Journal of Clinical Medicine on preoperative anxiety and sleep quality found that patients with higher anxiety scores had significantly worse scores on the Athens Insomnia Scale measured the night before surgery — and importantly, this elevated pattern continued through postoperative day three, suggesting the anxiety-sleep relationship doesn't simply resolve once the procedure starts.
Does this actually matter for recovery, or is it just an unpleasant few nights?
It appears to matter beyond comfort. The same body of research links preoperative sleep disturbance to worse postoperative outcomes — including higher pain scores, and in some studies, an association with perioperative neurocognitive disorders in older adults undergoing major non-cardiac surgery. A systematic review and meta-analysis on preoperative sleep disturbance and acute postoperative pain control concluded that because insomnia is a potentially modifiable risk factor, targeting sleep before surgery may be a genuine lever for improving pain control afterward — though the authors note the certainty of this evidence is still building.
Honest limitation: most of this research is observational, showing association between preoperative anxiety, sleep, and outcomes rather than proving that fixing sleep alone improves recovery. It's a genuinely promising area, not a settled one.
Why your surgical team needs to be part of this conversation
Before adding any supplement
Always tell your surgical or anesthesia team about anything you're taking or considering before a scheduled procedure — including over-the-counter sleep aids, melatonin, and herbal ingredients. Some sleep-supporting ingredients can interact with anesthesia, blood pressure medications, or blood-clotting processes, and pre-surgical guidance commonly asks patients to stop certain supplements for a period before their procedure.
This is genuinely one of the more important "check with a professional first" moments in sleep health — not because any specific ingredient is known to be dangerous, but because the stakes and interaction risks around a scheduled surgery are meaningfully higher than an ordinary night's sleep.
What's worth raising with your care team
- Name the anxiety specifically — surgical teams are used to this and often have resources (from simple reassurance to formal anxiety-reduction protocols) that can help, and the same general anxiety-reduction approaches covered in anxiety keeping you awake at night can be a useful starting point for framing the conversation.
- Ask what's safe to take, and when to stop it — this includes anything from melatonin to herbal teas, especially in the 24–48 hours before your procedure.
- Ask about the actual procedure details — research suggests uncertainty itself is a major driver of preoperative anxiety, and clear, concrete information can measurably reduce it.
Frequently Asked Questions
Is it normal to not sleep well for more than one night before surgery?
Yes — research shows elevated anxiety and insomnia scores can persist for days both before and after a procedure, not just the single night before.
Can poor sleep before surgery actually affect how the surgery goes?
The clearest evidence connects preoperative sleep disturbance to postoperative outcomes like pain and, in older adults, cognitive recovery — rather than to the procedure itself. This is still an active area of research.
Is it okay to take melatonin the night before surgery?
This depends entirely on your specific procedure, anesthesia plan, and other medications — ask your surgical or anesthesia team directly rather than deciding on your own.
Why does anxiety before surgery sometimes get worse rather than better as the date approaches?
Anticipatory anxiety often intensifies as an event gets closer and more concrete — this is a well-documented pattern in anxiety research generally, not unique to surgery, and reflects increasing salience and reduced ability to distract from the upcoming event.
Are certain types of surgery associated with more preoperative sleep disruption than others?
Research suggests procedure type, perceived risk, and personal relevance all play a role — for example, studies have found meaningfully high anxiety and insomnia rates in populations undergoing cancer-related surgery specifically, likely reflecting both the medical stakes and the emotional weight of the underlying diagnosis.
What happens if preoperative anxiety and sleep problems go unaddressed
Beyond the sleep-quality data itself, it's worth understanding why surgical teams increasingly treat preoperative anxiety as something worth actively screening for, not just an expected inconvenience. Research specifically measuring the relationship between preoperative anxiety, sleep, and postoperative course has found that higher preoperative anxiety is associated with higher visual analog pain scores in the 48 hours after surgery, and separate research links preoperative sleep disturbance to a heightened risk of perioperative neurocognitive disorders in older adults, mediated in part through neuroinflammation and impaired metabolic waste clearance during sleep. This is part of why some surgical centers have begun incorporating brief anxiety and sleep screening into preoperative assessments — not to add another hurdle, but because addressing this ahead of time is increasingly understood as a genuine, modifiable lever for a smoother recovery.
FROM NUVIROX
Why we formulated Sleep+ Restore
Sleep+ Restore combines 10 mg of melatonin with a 905 mg proprietary blend that includes L-tryptophan, L-theanine, chamomile, passionflower, ashwagandha, GABA, and 5-HTP — ingredients studied, individually and in combination, for their role in sleep onset and sleep quality support.
We back it with a 60-day money-back guarantee — long enough to actually evaluate it the way the research says you should.
Always tell your surgical or anesthesia team about any supplement you're taking or considering — including melatonin and herbal sleep ingredients — before a scheduled procedure, since some can interact with anesthesia or blood-clotting medications.
Learn more about Sleep+ Restore →The bottom line: preoperative sleep disruption is common, measurable, and tied to a real physiological anxiety response — not a personal failing. It's also genuinely worth flagging to your surgical team, both because they may have resources to help and because anything you consider adding to your routine beforehand needs their sign-off.
References
- Zhang X, et al. Effects of preoperative anxiety on postoperative outcomes and sleep quality in patients undergoing laparoscopic gynecological surgery. Journal of Clinical Medicine. 2023;12(5):1835. PMC10003609.
- Preoperative anxiety and postoperative adverse events: a narrative overview. Anesthesiology and Perioperative Science. 2023;1:19.
- Impact of preoperative sleep disturbance on perioperative neurocognitive disorders in older adults undergoing major non-cardiac surgery: A multicenter prospective cohort study. Journal of Clinical Anesthesia. 2026.