Is pre-surgery anxiety keeping you awake? Read about the fear of not waking from anaesthesia, questions for your doctors and practical steps to prepare.
The date of your operation has been set, and since then every time you look at the calendar your chest tightens. When you lie down in bed at night your mind keeps going back to the same scene: you are laid on the operating table, they bring the mask towards your face, and then darkness. "What if I never wake up?" When this thought comes, your heart races and sleep escapes you. During the day your colleagues say, "It's a simple operation, there's nothing to be afraid of"; you nod, but the voice inside does not go quiet. Perhaps you are thinking about your children, or wondering whether you should write down your computer passwords for your partner. Pre-surgery anxiety is a natural reaction that many people experience regardless of the size of the operation. In this article we explain why this anxiety can be so intense, the most common fears, the questions you can ask your doctors and the steps that can help you spend the days leading up to surgery more calmly.
Why Is Pre-Surgery Anxiety So Intense?
Surgery is one of the experiences in which a person hands control over to others the most. Knowing that your body will be operated on while you are unconscious unsettles even the calmest person. Several factors increase the intensity of this anxiety:
- Loss of control: Being unable to see or hear what is happening during anaesthesia, being unable to have any say in anything.
- Uncertainty: Not fully knowing the answers to questions such as how long the operation will take, what the outcome will be and how recovery will go.
- Previous experiences: Having been through a difficult operation in the past, or losing a loved one during or after surgery.
- Stories you have heard: Accounts from people around you such as "they never woke up from the anaesthetic" or "they heard everything during the operation", and extreme cases read online.
- Long waits and postponements: Waiting weeks for a surgery date, last-minute postponements or having to travel to a hospital in another city and stay there keep the anxiety alive for a long time. Each postponement means having to prepare yourself all over again.
- Worry that life will be disrupted: For someone running their own business, how many days they will be unable to work; for someone caring for an elderly parent or with young children, who they will be left with. These are layers of anxiety that are separate from the operation but intertwined with it.
- The reason for the operation: When the operation is carried out to make a diagnosis or to treat a serious illness, the anxiety becomes about the outcome as well as the procedure.
A certain amount of anxiety is functional: it leads you to prepare, ask questions and pay attention to your doctor's instructions. The problem is when the anxiety becomes intense enough to disrupt sleep, appetite and daily functioning.
The Most Common Fears
Fear of not waking up from anaesthesia
This is the fear most often voiced before surgery. Many people imagine anaesthesia as "a sleep similar to death". In fact, general anaesthesia is a state that the anaesthetist continuously monitors and controls throughout the operation. Heart rhythm, blood pressure, oxygen level and breathing are tracked at every moment. Your anaesthetist assesses your medical history and makes a plan that suits you. If you carry this fear, raising it openly in the anaesthetic assessment allows your doctor to explain the process to you in detail.
Fear of waking up during the operation
"What if I wake up in the middle of the operation, feel everything but can't speak?" This fear is also common. It is known that such an experience is rare and that anaesthetic teams use various monitoring methods to prevent it. Asking your anaesthetist about your concern lets you learn about the precautions specific to you.
Fear of pain
How much pain there will be after the operation is an important source of anxiety. Managing post-operative pain is a planned part of treatment. Telling your nurse and doctor about your pain without hesitation ensures that the necessary adjustments are made.
Fear of the outcome and diagnosis
In some operations the real anxiety is the pathology result that will come after surgery. This wait can be more challenging than the operation itself. We discuss suggestions for anxiety while waiting for results in our article on anxiety while waiting for test results.
Embarrassment and privacy
Wearing a hospital gown, having your body seen by others and procedures such as a urinary catheter create serious worries about embarrassment for some people. These feelings are real and legitimate too; voicing them to the healthcare team can lead to more care being taken over your privacy.
Rather than trying to get rid of anxiety, turning it into questions is the way to replace uncertainty with information and helplessness with preparation.
Signs of Pre-Surgery Anxiety
This anxiety tends to increase as the date of the operation approaches and can appear in the following ways:
- Difficulty falling asleep, waking often at night, nightmares
- Loss of appetite or, conversely, constant snacking
- Nausea, palpitations, shortness of breath, muscle tension
- Being unable to concentrate, absent-mindedness at work or at home
- Spending hours researching the operation online
- Constant "What if something bad happens" thoughts and scenarios of saying goodbye
- An urge to postpone or cancel the operation
- Irritability towards those around you, bouts of crying
Thoughts of cancelling or postponing the operation should be taken seriously. Putting off a necessary operation because of anxiety can pose a health risk. If such thoughts are crossing your mind, it is important to talk with both your surgeon and a mental health professional rather than making the decision alone. If worries about your health come up frequently in general, our article on health anxiety may also be helpful.
Questions You Can Ask Your Doctors
Uncertainty is the strongest fuel for anxiety. Getting information reduces this uncertainty. You can write the following questions on a piece of paper and take them to your pre-operative appointments:
For your surgeon:
- How exactly will the operation be done, and how long will it take?
- How many days will I stay in hospital?
- What will the recovery process be like, and when can I return to work and daily life?
- Which symptoms after the operation are normal, and which should I report straight away?
For your anaesthetist:
- What type of anaesthesia will I be given?
- Who will monitor me during the operation, and how?
- How, and how quickly, will I wake up from the anaesthetic?
- If my anxiety is very intense, is there anything that can be done about it before the operation?
Doctors' time may be limited, so writing your questions down in advance and taking notes of the answers makes things easier. Having someone close to you with you also helps you remember what you heard later.
Practical Suggestions for the Days Leading Up to Surgery
Deal with practical matters early
Do not leave tasks such as packing your hospital bag, notifying your workplace of your leave, sharing out responsibilities at home and settling who will stay with you in hospital until the last day. As practical uncertainties decrease, the mind relaxes too.
Limit visitors and phone calls
In Turkey, news of an operation spreads quickly. Relatives, neighbours and former colleagues call; each tells their own surgery story or an incident they have heard about. Well-meant remarks such as "The neighbour's daughter had the same operation, it was really hard" can increase anxiety. Appointing someone close to you as your "spokesperson" and limiting visits in the days before surgery is a legitimate way of protecting yourself.
Set limits on internet research
Get reliable information about your operation from your doctor. Individual experiences read on forums and social media are usually the most extreme examples and do not reflect your situation. If you want to do some research, allow yourself a short time once a day.
Calm your body
Do slow breathing exercises twice a day for five minutes at a time: breathe in for four seconds and out for six. Before going to bed, tense and relax your muscles in turn. A gentle walk can help reduce anxiety unless your doctor advises otherwise.
Set a worry time
If anxious thoughts keep coming throughout the day, set aside a twenty-minute "worry time" for them in the late afternoon. During this time, write down your worries; postpone thoughts that come during the day by saying, "I'll think about this in the evening."
Imagine life after recovery
If your mind keeps going to the operating table, direct your attention to the days after the operation. What will you do when you get home? Who will be with you in the first week? What is the first thing you want to do when you have recovered? A concrete plan for the future is a strong counterweight to the mind's "I won't wake up" scenario.
Make a plan for the morning of the operation
Decide in advance what you will do that morning: which music you will listen to, who you will talk to, which breathing exercise you will do while being taken to theatre. A specific plan prevents the hours of waiting from feeling like an uncontrollable void.
Let us imagine a teacher and mother of two who is due to have gallbladder surgery and lies awake every night in the week before the operation. The same question keeps turning in her mind: "If I don't wake up, who will take the children to school?" She talks about this with her sister, and together they plan the children's school routine for the week of the operation. In the anaesthetic assessment she openly voices her fear; the anaesthetist explains to her, one by one, how she will be monitored throughout the operation. Her anxiety does not completely go away; but she can now think far enough ahead to plan a film night with her children for the Sunday after the operation.
Brief Notes for Family Members
Pre-surgery anxiety does not belong to the patient alone. Partners, parents and adult children waiting for hours at the door of the operating theatre also experience intense anxiety. The things that will help your loved one most during this time are:
- Not belittling their fear: saying "It makes complete sense that you're scared, I'm here with you" instead of "Don't be silly, nothing will happen".
- Not placing your own anxiety on them; talking about your own worries with someone else close to you.
- Giving concrete support with practical matters: looking after the children, dealing with paperwork, managing visitors.
- Not neglecting your own eating and rest on the day of the operation.
For parents whose child is having an operation, managing their own anxiety is especially important, because children draw strength from their parents' calmness.
When Should You Seek Professional Support?
It may be helpful to get support from a mental health professional in the following situations:
- Because of anxiety you are postponing a necessary operation or thinking of cancelling it.
- Weeks before the operation date, your sleep, appetite and functioning have been noticeably disrupted.
- You are having panic attacks.
- A difficult operation in the past, or the loss of a loved one, is feeding your current anxiety.
- The operation is related to a serious illness and the diagnostic process is shaking you deeply.
Whether medication is needed for anxiety should be assessed by your doctors, also taking into account any interaction with the surgery. Do not start taking medication on your own.
How Is Pre-Surgery Anxiety Addressed in Therapy?
The period before surgery is usually a limited window of time, so in therapy the work proceeds in a focused and practical way. The following elements can be used within a cognitive behavioural approach:
- Clarifying the content of the anxiety: Is the feared thing the anaesthetic, pain, the outcome or those left behind? As the focus becomes clearer, the work also becomes more concrete.
- Reducing uncertainty with information: Preparing the questions to ask the doctors and evaluating the information obtained together.
- Testing catastrophic thoughts: What evidence thoughts such as "I won't wake up" are based on, and how the person weighs up the probabilities, are examined.
- Body-focused skills: Breathing, muscle relaxation and attention-directing techniques are practised in sessions.
- The post-operative period: Emotional ups and downs that may arise during recovery, coping with pain and returning to daily life are planned.
During the periods before and after surgery when mobility is limited, sessions can also continue from home through online therapy. You do not have to carry your anxiety alone.
Frequently Asked Questions
Is it normal to be afraid before an operation?
Yes. Feeling anxious before an operation is a very common and natural reaction, regardless of the size of the operation. Anxiety also helps you prepare and be careful. The problem is when anxiety seriously disrupts sleep and daily functioning or leads to a necessary operation being postponed.
Will being anxious affect the outcome of the operation?
The surgical team knows that the great majority of patients are anxious to some degree and takes this into account. Intense anxiety can affect the perception of post-operative pain and comfort during recovery, so trying to manage the anxiety is worthwhile. Sharing your anxiety with your anaesthetist allows suitable precautions to be taken for you.
Is it a bad sign to have thoughts about wills or saying goodbye before an operation?
These thoughts are a natural reflection of coming face to face with the possibility of death and are not a sign of a bad outcome. For some people, sorting out important documents or expressing their feelings to loved ones can be comforting. If the thoughts constantly occupy you and disturb your sleep, it is helpful to talk about them with a professional.
What should I do if I feel anxious or low after the operation as well?
Tiredness, emotional ups and downs and sadness are common in the first days after an operation. These feelings usually lessen as recovery progresses. If they continue or intensify even after weeks have passed, it is important to contact both your doctor and a mental health professional.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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