Shoulder pain can be a big bummer when you’re trying to catch a good night’s sleep. Quite often, it’s hard to pin down what’s causing the pain and if there’s anything you can do about it without immediately running to a doctor. There are several causes of shoulder pain that we will further explore in this article, along with some sleeping positions to keep in mind to ensure a good night’s sleep despite the pain.
- There are several causes that contribute to shoulder pain, like bursitis, rotator cuff injury, frozen shoulder, shoulder impingement syndrome and osteoarthritis of the shoulder, amongst other things,
- Shoulder pain can cause those affected by it to change their preferred sleeping positions, leading them to fall asleep in difficult positions, experiencing poor sleep and even neck pain and other discomforts while trying to fall asleep,
- There are guidelines you can follow to ensure stable sleep with shoulder pain, some of which are using a soft mattress or body pillow, sleeping on the affected shoulder while placing a pillow between mid-hip and back, and placing a pillow at the back to prevent rolling over to another position, sleeping on the painful shoulder elevated and sleeping on your back, which is, by far, considered the most effective.
What are the causes of shoulder pain?
Some sleeping positions—such as sleeping on your side—for extended periods of time can put extra stress on your shoulder. When you sleep on your side, your shoulder ends up bearing a lot of your torso weight. A study found that of the people seeking medical attention for shoulder pain, 67% slept on their side.
While one’s sleeping position can definitely contribute to shoulder pain, it’s not the only cause. Several other conditions can cause pain when one’s trying to sleep. With each of these conditions, sleeping while leaning on the affected shoulder can exacerbate the pain.
Some of the other causes are
Rotator cuff injury
The rotator cuff is a collection of tendons surrounding the shoulder joint. It helps attach the end of the upper arm bone to the shoulder blade, securing it in its socket.
These injuries happen when the tendons of the rotator cuff become irritated, inflamed (often known as tendinitis) or partially or completely torn. There are several reasons why this can happen, such as an injury incurred while lifting something heavy; falling with an arm extended out; participating extensively in sports like rowing, tennis or baseball that frequently use the shoulder joint; and performing activities that require lifting or overhead use of the arm, like painting or construction. The symptoms of a rotator cuff injury include a deep pain or dull ache in the shoulder that worsens with movements like reaching behind your back, throwing or lifting; loss of range of motion; stiffness; and disrupted sleep if one rolls onto the affected shoulder.
Initial treatment only includes resting and icing the affected shoulder. You can relieve the pain with over-the-counter (OTC) anti-inflammatories such as aspirin or ibuprofen.
In some cases, working with a physical therapist is also recommended. A therapist will prescribe exercises to improve the range of motion and strength in the shoulder and ease the pain.
In case of a lot of pain, doctors may administer a corticosteroid injection that helps with inflammation and pain. Some injuries may be severe and may require surgery. Consulting a doctor is highly recommended.
Bursae are small, fluid-filled sacs that help cushion the tissues that envelop the joints. They can be found all over the body. Bursitis is a condition that happens when the bursa becomes inflamed; the shoulder is a common location for bursitis to occur. Common causes for shoulder bursitis are an injury that affects the shoulder or continuous repetitive actions that can over-exert the shoulder joint.
The symptoms of shoulder bursitis can vary between individuals, but some common ones include tenderness or localised aches in the affected shoulder; swelling and redness, stiffness in the affected shoulder; pain that worsens with movement of the affected shoulder; and pain when pressure is applied to the area, such as when you’re lying down. Initially, treatment usually includes resting the shoulder, doing physical therapy exercises and taking OTC anti-inflammatories for pain and inflammation.
In cases that don’t respond to this treatment, corticosteroid injections can afford some relief. If these treatments don’t work, one may need surgery to drain or remove the affected bursa.
Shoulder impingement syndrome
This syndrome occurs when the soft tissues around the rotator cuff catch or rub on nearby tissue or bone as one moves their arm. This rubbing or catching of the soft tissue can result from tendinitis (swelling of the surrounding tendons); bursitis (inflammation of the surrounding bursa); a bone in the shoulder joint—called the acromion—that’s curved or hooked instead of being flat; or the presence of bone spurs, which can develop as one age.
The symptoms of shoulder impingement can include pain that becomes worse on the top or outer part of your shoulder; pain that becomes worse when lifting your arm, particularly if you’re lifting it above your head; a feeling of weakness in the affected arm or shoulder; and pain that becomes worse at night and affect sleep, particularly if you put weight on the affected shoulder. Initial treatment involves rest, pain relief with OTC anti-inflammatories and minimal shoulder exercises. Corticosteroid injections may be used for inflammation and pain and surgery to widen the area around the rotator cuff might be necessary.
Osteoarthritis of the shoulder
This can happen when cartilage, which usually provides cushioning between the bones, begins to break down. It can affect various joints in the body, including the shoulder.
This can naturally occur with age and can also happen due to previous injuries such as a dislocated shoulder or a rotator cuff tear. The symptoms can include stiffness or loss of range of motion; grinding or clicking sounds when you move your shoulder; or pain that only happens initially while moving the shoulder but can also happen while at rest or asleep. Treatment can vary from oral or topical pain relievers and specific physical therapy exercises.
A frozen shoulder can happen when the connective tissue in the shoulder joint thickens and impairs movement. What exactly is the culprit here is unknown, but the risk increases when the shoulder has been immobilised for a long time as a result of recovery from injury or surgery, for instance. Underlying conditions like diabetes can also add to the risk of getting this condition. The symptoms occur in three stages: freezing, characterised by pain with movement and decreased range of motion; frozen, when the pain lessens but the shoulder becomes stiff and movement is difficult; and thawing, when the range of motion gradually improves. This pain may be worse in the evenings which can disrupt sleep.
Treatment is centred on relieving pain and promoting a range of motion. This can be done via physical therapy and pain relievers. Consistent pain may require corticosteroid injections, shoulder manipulation (this is when a patient is brought into the operating room and under general anaesthetic—when their muscles are paralysed—the shoulder is taken through a range of motion; in the course of doing so, and the shoulder reaching a full range of motion, popping sounds can often be heard inside the joint, signifying a tearing of the adhesions) or surgery.
The effects of shoulder pain on sleep
Shoulder pain can cause those affected by it to change their preferred sleeping positions, leading them to fall asleep in difficult positions, experiencing poor sleep and even neck pain and other discomforts while trying to fall asleep. Shoulder injuries including fractures, dislocations and shoulder operations can also affect sleep.
How can one sleep with shoulder pain at night?
If you’re somebody who’s struggling with pain when you sleep on your shoulder, these tips will help you sleep better:
- Avoid sleeping on the affected shoulder at all costs. Adjusting one’s sleeping position to the other side or on the stomach or back helps take the pressure off a sore shoulder.
- Avoid activities that over-exert you in the day that could further irritate the shoulder.
- Make use of a pillow; if you’re concerned about rolling onto your sore shoulder while asleep, try placing a pillow in a manner that will prevent you from doing so.
- Staying active and regular exercise helps blood flow and circulation, which, in turn, helps the muscles and tendons in the shoulder heal faster. Gentle shoulder exercises and stretches also help reduce shoulder pain.
- Practising good sleep habits like keeping a regular sleep schedule, turning off computers, phones, TVs or other screens shortly before bed, and avoiding nicotine, alcohol and caffeine in the evening helps too.
Seven best sleeping positions for shoulder pain and bursitis
Sleeping on your back
Sleeping on the back is one of the most effective positions for relief from shoulder pain since it allows for a neutral, even distribution of weight. This position can support the neck, head and spine and allows the body to rest in a stress-free posture. When one sleeps on their back, the shoulders are relaxed rather than being compressed in different directions. Despite the obvious benefits, only 8% of sleepers are back sleepers.
If you’re already sleeping on your back and are still experiencing shoulder pain, try placing a pillow under your armpit area. This prevents you from leaning on your shoulders at night. Having the right thickness of the pillow while asleep is also important. The neck shouldn’t be bending up to the ceiling, nor should the chin be tucked inwards. The human neck and head have interconnected muscles, which means that if those areas suffer from imbalance or pressure, the shoulders will be affected.
Sleeping on the painful shoulder, elevated
For this particular sleeping position, you need to put a pillow on top of your stomach, then add another pillow under the armpit area to push up, support and restrict pressure on the affected shoulder. Ensure that your hands and elbows aren’t resting too high as this can prevent the proper flow of blood and cause numbness in the arm. Placing another pillow between the legs on your upper hip is also useful as it helps release stress from the pelvis, keeping the body in a neutral position while sleeping. This position helps the spine, shoulders and pelvis straighten up in addition to alleviating shoulder pain so you can sleep well.
Sleeping on the affected shoulder
Sometimes, it can help to sleep on the sore shoulder as it helps alleviate the pain. This is handy for people who find it difficult to sleep on their backs. The way to sleep on your sore shoulder is to turn to your side and place a pillow beneath the mid-hips and back. For people with a pelvis wider than the shoulders, placing an extra pillow will help balance the position of the body and support restful sleep. The head will need an extra pillow since it’s lifted which can provide comfort and relief as well as align the spine correctly.
Sleeping with the hands under or beside the pillow or prone position
If you can place your hands carefully beside the pillow, this will help you avoid stretching the arm and shoulder muscles and will allow you to keep your arms in a neutral position with your elbows bent at 90 degrees. Shoulders should generally not be stretched excessively. If you experience pain and tension in the shoulders or weakness and tingling in the hands in this position, shift to one of the other positions mentioned here.
Sleeping on the other slide
If you sleep on the non-painful side, hug a pillow in front of you. This prevents the shoulders from slumping forward too much and compressing the structures in the shoulder. It helps stabilize the shoulder joint.
Placing a pillow at the back
Place a pillow or rolled towel underneath you to prevent you from rolling onto a position which may be a lot more uncomfortable for the shoulder while you’re deeply asleep and which you may not feel immediately.
Use a soft mattress or a body pillow
If you have bursitis, use a soft mattress and body pillow that provides optimal support and pressure relief.
Shoulder pain can be debilitating and there are several causes that contribute to it. Some of them are bursitis, rotator cuff injury, frozen shoulder, shoulder impingement syndrome and osteoarthritis of the shoulder, amongst other things. Recovery involves varying treatments from ice packs to physical therapy to OTC pain-relievers, depending on the case. There are guidelines you can follow to ensure stable sleep with shoulder pain, some of which are using a soft mattress or body pillow, sleeping on the affected shoulder while placing a pillow between mid-hip and back, and placing a pillow at the back to prevent rolling over to another position, sleeping on the painful shoulder elevated and sleeping on your back, which is, by far, considered the most effective.
Disclaimer: The contents of this article are for general information and educational purposes only. It neither provides any medical advice nor intends to substitute professional medical opinion on the treatment, diagnosis, prevention or alleviation of any disease, disorder or disability. Always consult with your doctor or qualified healthcare professional about your health condition and/or concerns before undertaking a new health care regimen including making any dietary or lifestyle changes.
- Association between the side of unilateral shoulder pain and preferred sleeping position: a cross-sectional study of 83 Danish patients
- Why Does Your Shoulder Hurt When You Sleep, and What Helps?
- The Best Sleeping Position For Shoulder Pain
- What can you do if you can’t sleep from shoulder pain? And, why is shoulder pain worse at night