Let’s face it: Shoulder pain and sleep aren’t a great mix.
People in pain often struggle to fall asleep, wake up frequently throughout the night, or fail to enter restorative deep sleep stages once they do manage to get a few Zzz’s. This is something I hear about a lot from my patients—especially patients who come to see me with a stiff painful shoulder.
The thing is, I’m not surprised shoulder pain is so effective (unfortunately) at keeping people awake. As the most mobile joint in your body, the healthy shoulder requires the coordinated action of dozens of muscles, tendons, ligaments, and bones in order to function properly. This increased mobility can increase the margin for error, meaning our shoulders are often at risk of injury.
The problem, of course, is that losing sleep over your painful shoulder can actually worsen your pain and delay healing, not to mention cause other problems associated with sleep deprivation like low mood, memory problems, and an increased risk of other health conditions. Not getting enough sleep has even been associated with reduced vaccine effectiveness, which has huge implications for anyone preparing to get a COVID-19 vaccine.
I encourage anyone with persistent shoulder pain to see a physical therapist who can help them find relief. In the meantime, let’s take some time to better understand this common phenomenon and what you can do about it.
Why Your Shoulder Hurts (And Especially at Night)
Repetitive overhead movement, advancing age, accidents, and poor posture are primary risk factors for shoulder problems like tendonitis, osteoarthritis, frozen shoulder, impingement syndrome, and rotator cuff tears. These conditions are associated with tissue damage, inflammation, swelling, stiffness, and pain that can interrupt daily activities ranging from getting dressed to throwing a tennis ball to your dog.
Many people notice their shoulder pain gets even worse at night. This could be for a number of reasons, including:
- Your sleeping position: many prefer to sleep on their side, but laying directly on the affected shoulder feels too uncomfortable. This forces them to toss and turn until they find an acceptable position. This may cause them to wake up with a yelp if they roll onto their affected side in their sleep.
- Being still: laying down in bed changes the relative position of your shoulder, diminishes the effect of gravity in the joint, and allows the muscles and tissues to relax. Together, these changes can slow blood flow in the area and contribute to stiffness and worsening inflammation. If you struggle with issues like hyper-mobility or instability, you may even find your upper arm bone resting out of place when your body is in a horizontal position. Ouch!
- Your mattress and pillow: super thick pillows, as well as very firm mattresses, can strain many tissues of the neck and shoulder.
- Cognitive and neuro-chemical changes: emotionally and mentally, many of us simply perceive pain differently at night. Without other activities to keep us busy, we may perseverate about how uncomfortable we feel and how little sleep we’re getting, which can lead to a vicious spiral of worry and stress.
Anecdotally, I’ve even noticed that nighttime breathing patterns can influence a person’s shoulder pain. Most breathe through their mouths while asleep, which strains tissues in the neck/shoulder area and jaw. Nasal breathing helps reduce pain and calm the nervous system, going eight hours without it may prevent natural relief.
When You Can’t Sleep Because of Shoulder Pain
I mentioned that consulting with a physical therapist is one of the most effective solutions for nighttime shoulder pain. Once we diagnose your underlying condition and identify its contributing factors, we can implement a personalized treatment plan. Your treatment plan will directly address your symptoms and help your shoulder heal. In the meantime, consider these strategies for managing your pain and getting better sleep:
- Use supportive pillows. For example, sleep on your non-affected side and place a pillow between your knees and under your affected arm. Try sleeping on your back with a pillow under your knees and another pillow tucked under the affected arm.
- Perform gentle range of motion exercises at the neck and shoulder before and after bed.
- Practice good sleep hygiene overall. Go to bed at the same time every night, have a relaxing nighttime routine. Dim the lights in the evening, avoid eating too close to bed, minimize alcohol and caffeine intake. And last, make your bedroom dark and cool.