Shoulder pain at night? You're not alone!

Key takeaways

• More than 80% of people who have been experiencing shoulder pain for more than three months also have sleep problems.
• The pain often worsens when lying down: the position, pressure on the joint, and biological factors specific to nighttime all combine to exacerbate the pain.
• Changing your sleeping position—with or without a support pillow—is one of the best-documented measures.
• Lack of sleep itself increases sensitivity to pain: the relationship works both ways.
• After shoulder surgery, it usually takes several months for sleep to return to normal, but there is a definite improvement.

Why are shoulder pain and sleep so often linked?

Shoulder pain at night is common: it often worsens when lying down, as the pressure on the joint changes, and nighttime biological processes can also make the pain more noticeable. If you have trouble sleeping because of shoulder pain or if you wake up in the middle of the night and can’t fall back asleep, you’re not alone. In adults, these nighttime awakenings are often related to activities that strained the shoulder during the day, whether it was prolonged sitting in front of a screen, unusual physical exertion, or an uncomfortable resting position.

People with tendinitis, a rotator cuff tear, subacromial impingement, or frozen shoulder very frequently experience associated sleep disturbances: waking up during the night, insomnia, and non-restorative sleep. More than 80% of people who have had shoulder pain for more than three months also report sleep disturbances (Cho et al., 2013), and poor-quality sleep can increase the sensation of pain over the course of the night, directly impacting daily well-being. Here you’ll find clear guidance to better understand the link between shoulder pain and sleep, the factors that worsen pain at night, the effect of sleep position on comfort, the influence of sleep deprivation on pain, the aftermath of shoulder surgery, as well as practical, natural, and ergonomic tips for better sleep.

Why does the pain get worse when I lie down?

When you lie down, the pressure in the shoulder joint increases, especially in certain positions. This can compress the tendons or the subacromial bursa into a smaller space, which intensifies the pain you feel.

At night, biological factors—such as increased production of inflammatory substances—exacerbate inflammation and irritation, making shoulder pain more pronounced. The drop in the natural hormone cortisol during the latter part of the night further increases pain sensitivity. For people with adhesive capsulitis, nighttime pain is often one of the very first symptoms, sometimes even before marked stiffness sets in during the day.

Does your sleeping position really make a difference?

Sleeping on your side, with direct pressure on the painful shoulder, increases pressure on the joint and perpetuates the pain. Certain sleeping positions can also reduce the space under the acromion, which alters how weight is distributed around the shoulder at night. A study specifically examining the link between sleep position and shoulder pain confirms this association (Zenian, 2010), and another study has shown a link between sleep position and rotator cuff tendinopathy (Holdaway et al., 2018).

Changing your sleeping position—to your back or the opposite side—usually helps improve comfort at night. The French National Health Insurance system also recommends using a support pillow to reduce shoulder pain at night, while keeping the neck properly aligned during sleep. It is precisely with this in mind that the Shooldy ergonomic shoulder pillow was designed: it allows you to follow these recommendations while improving comfort and better distributing pressure points, without ever forcing the shoulder into an unnatural position.

By raising the head of your bed slightly if you sleep on your back, you can further improve your comfort, especially during the first few nights after the pain begins.

Can a lack of sleep make pain worse?

And that’s not all: not getting enough sleep increases sensitivity to pain. The less you sleep, the more reactive your nervous system becomes. At night, prolonged immobility can also exacerbate shoulder pain. And the perception of pain seems more intense. It’s a two-way cycle: research on the relationship between sleep and pain now provides fairly solid evidence of this reciprocal relationship (Finan et al., 2013). The broader health consequences of poor sleep—beyond just the shoulder—are detailed in our article onsleep disorders.

This phenomenon is not limited to adults. Among children and adolescents, insufficient or poor-quality sleep is associated with a higher risk of neck and shoulder pain several years later (Auvinen et al., 2010), suggesting that sleep habits established early in life have effects that extend well beyond childhood.

And after shoulder surgery, does sleep return quickly?

Not always right away. Some people who have had shoulder surgery—particularly after rotator cuff repair—do not return to a normal sleep pattern until several months later. The recovery process itself, postoperative pain, stress related to the surgery, and the use of medications such as opioids all affect sleep quality during this period.

The good news is that this improvement is real and well-documented. A systematic review shows that shoulder surgery is an effective treatment for pain-related sleep disorders, with gradual improvement in the months following the procedure (Barandiaran et al., 2022). A prospective study focusing specifically on arthroscopic rotator cuff repair confirms a combined improvement in sleep and overall quality of life (Longo et al., 2021), and sleep quality is now recognized as a standalone indicator in postoperative follow-up, on par with mobility and strength (Khazzam et al., 2018).

This type of follow-up—both before and after surgery—is exactly the kind of issue addressed by our scientific advisory board, which is composed of shoulder specialists: surgeons, physicians, and physical therapists.

What specific steps can you take to sleep better?

Here are some simple steps—backed by research—to help reduce nighttime pain.

1. Change your sleeping position. Avoid sleeping directly on your sore shoulder, and try using an ergonomic shoulder pillowto distribute your weight more evenly throughout the night.
2. Invest in a good mattress. Medium-firm support can reduce pressure points, especially around the shoulders and hips. Your pillow should also keep your neck properly aligned.
3. Adjust the duration and intensity of your physical and sports activities. Notice the connection between your daytime activities and the quality of your sleep the following night: an occasional overdo often takes its toll a few hours later. After overexertion or intense exercise, taking it easy often helps prevent the problem from becoming a habit.
4. Take appropriate medication in the evening if needed. An anti-inflammatory or pain reliever can provide temporary relief—always following a doctor’s advice—but should not be used as a long-term solution. Applying cold or heat, depending on how you feel, before bedtime can also help reduce inflammation.
5. Do gentle exercises. Self-rehabilitation or physical therapy can gradually improve mobility and function, rather than seeking immediate relief.
6. Identify the cause of the pain. Don’t suffer in silence: a consultation can help pinpoint the causes, guide diagnostic tests, and tailor treatment more effectively than random adjustments.
7. Take care of your sleep hygiene. Regular sleep schedules, dim lighting, keeping screens at a distance, and relaxation before bed: these habits aren’t enough on their own, but they reinforce the effects of other measures.
8. If your pain is caused by issues in the neck rather than purely by the joints, a suitable ergonomic neck pillow can also improve your comfort, since the neck and shoulders often work together as a chain.

Frequently Asked Questions

How many people with shoulder pain also have sleep problems?

More than 80% of people who have been experiencing shoulder pain for more than three months report associated sleep disturbances (Cho et al., 2013).

Why is my shoulder pain worse at night than during the day?

Several factors come into play when you are lying down: a common question is why the pain worsens at night; the pressure on the joint changes depending on your position, and biological mechanisms specific to nighttime—such as inflammation or muscle relaxation—often explain this shoulder pain.

What is the best sleeping position if you have shoulder pain?

Avoiding direct pressure on the painful shoulder is the most consistently recommended guideline in the literature (Zenian, 2010; Holdaway et al., 2018). Sleeping on your back or on the opposite side, with a slight support under your arm, is generally better tolerated.

Can a lack of sleep really make shoulder pain worse?

Yes, the relationship works both ways: pain disrupts sleep, and insufficient sleep lowers the pain tolerance threshold (Finan et al., 2013).

How long does it take to get back to sleeping well after shoulder surgery?

This varies from person to person, but improvement generally continues for several months after surgery, particularly following rotator cuff repair (Longo et al., 2021; Barandiaran et al., 2022).

Should I see a doctor if the nighttime pain persists?

Yes. Certain symptoms, such as nighttime discomfort that has been disrupting sleep for several weeks, warrant seeking medical advice sooner rather than later to determine the cause—whether it involves the joints, tendons, or the neck—and to adjust treatment before the condition becomes chronic.

If the pain persists, worsens, is accompanied by a loss of strength, or occurs after exercise or an injury, you should seek medical advice. An accurate and early diagnosis can improve treatment and the functional prognosis.

An essential message: you are not alone

Many people struggle with shoulder pain every night. This is a common problem well known to the medical community, affecting both athletes—such as tennis players—and people who perform repetitive movements in their daily lives. By discussing this with healthcare professionals and implementing appropriate solutions, it is entirely possible to regain a good night’s sleep and enjoy pain-free days.

Find all of our articles on sleep and the shoulder in our Observatory.

Sources

• Health Insurance. Living with Chronic Shoulder Pain. ameli.fr/aveyron/…/living-with-chronic-shoulder-pain
• Auvinen et al., 2010. Is insufficient quantity and quality of sleep a risk factor for neck, shoulder, and low back pain? A longitudinal study among adolescents. European Spine Journal. pubmed.ncbi.nlm.nih.gov/19936804
• Barandiaran et al., 2022. Shoulder Surgery as an Effective Treatment for Shoulder-Related Sleep Disturbance: A Systematic Review. Arthroscopy. pubmed.ncbi.nlm.nih.gov/34478767
• Cho et al., 2013. Is shoulder pain lasting three months or longer correlated with depression, anxiety, and sleep disturbances? Journal of Shoulder and Elbow Surgery. pubmed.ncbi.nlm.nih.gov/22738644
• Finan et al., 2013. The association of sleep and pain: an update and a path forward. The Journal of Pain. pubmed.ncbi.nlm.nih.gov/24290442
• Hammad et al., 2022. The correlation between shoulder conditions and sleep disorders. Journal of International Medical Research. pubmed.ncbi.nlm.nih.gov/35676774
• Holdaway et al., 2018. Is sleep position associated with glenohumeral shoulder pain and rotator cuff tendinopathy: a cross-sectional study. BMC Musculoskeletal Disorders. pubmed.ncbi.nlm.nih.gov/30470225
• Khazzam et al., 2018. “Sleep Quality in Patients With Rotator Cuff Disease.” Journal of the American Academy of Orthopaedic Surgeons. pubmed.ncbi.nlm.nih.gov/29517624
• Longo et al., 2019. Sleep Disturbance and Rotator Cuff Tears: A Systematic Review. Medicina (Kaunas). pubmed.ncbi.nlm.nih.gov/31398952
• Longo et al., 2021. Arthroscopic Rotator Cuff Repair Improves Sleep Disturbance and Quality of Life: A Prospective Study. International Journal of Environmental Research and Public Health. pubmed.ncbi.nlm.nih.gov/33917277
• Mulligan et al., 2015. Sleep quality and nocturnal pain in patients with shoulder disorders. Journal of Shoulder and Elbow Surgery. pubmed.ncbi.nlm.nih.gov/25842028
• Zenian, 2010. Sleep Position and Shoulder Pain. Medical Hypotheses. pubmed.ncbi.nlm.nih.gov/20036076