Shoulder pain when you are sleeping or that wakes you up at night can leave you feeling tired and frustrated in the morning. Shoulder pain from sleeping is often due to your sleeping position. If you have damaged tendons in your shoulder, sleeping on your side could cause intense night pain and discomfort. Arthritis can also result in stiffness and shoulder pain after sleeping. Other causes of waking up with shoulder pain include rotator cuff injuries, frozen shoulder as well as pregnancy.
Pain in your shoulder can often feel worse during night-time. Although your body is resting, pressure on the shoulder while sleeping can aggravate inflammation in the shoulder joint. Also, burning nerve pain in your shoulder can feel worse if your mattress or pillow doesn’t support your body properly.
In this article, I will examine the many causes of shoulder pain from sleeping. If night pain in your upper back disrupts your sleep, you will also find helpful solutions to shoulder pain. At the end of the article, I will discuss the best sleeping position for shoulder pain.
Anatomy of the Shoulder
Your shoulder is a complex structure comprising of tendons, muscles, your shoulder blade (scapula), collarbone (clavicle), and upper arm bone (humerus). Dr Stephen Kishner, a specialist in physical medicine and rehabilitation, says that the shoulder joint has a wide range of motion. Because of the complexity and function of the shoulder joint, it is quite unstable and prone to injury.1
Dr Kishner explains that one common injury affecting the shoulder blade is to the rotator cuff – a group of muscles and tendons that give strength to the shoulder. A torn or tendon inflammation can cause intense pain and can be a major reason for shoulder pain after sleeping.
Symptoms of Shoulder Pain from Sleeping
The reasons for shoulder pain at night are many. Along with the pain, you may experience other uncomfortable symptoms. For example, injury, damage, or inflammation in the shoulder joint can also result in any of the following:
- Waking up with neck and shoulder pain
- Stiffness in the morning when trying to move your arms
- Intense pain in the shoulder when your sleep on your side
- Pain that radiates from your arm across your shoulder blades
- Throbbing pain in one shoulder and changing sleeping position doesn’t provide relief
- Waking up during the night with numbness in your shoulder or upper arm
- Severe shoulder pain after sleeping
- Shoulder spasms at night as a result of strained or overused muscles
- Sore shoulders and arms after sleeping
Causes of Shoulder Pain from Sleeping
Why do your shoulders hurt when you sleep? Let’s look at the many reasons for night-time shoulder pain while you are sleeping.
An acute or chronic shoulder injury
The most common reason for shoulder pain at night is an injury to your upper limbs or shoulder blade.
For example, you could suffer an acute shoulder injury if you fall on an outstretched arm or injure your shoulders by lifting heavy items. This can cause sharp intense pain in your shoulder joint that seems to get worse when you lie down in bed.
Other shoulder injuries can occur over time and result in chronic shoulder pain that lasts longer than 6 months. Because of the nature of the injuries, it could seem that there is no reason for waking in the middle of the night with a sore shoulder. The journal American Family Physician reports that arthritis, rotator cuff tears, shoulder instability, and overuse injuries can cause dull, achy night pain.2
If you are wondering why shoulder pain wakens you during the night, it could be that you have a frozen shoulder.
Dr. Sabrina Felson on WebMD explains that a frozen shoulder can cause achy pain in your right shoulder or left one. Very often the shoulder pain can become more intense at night and may disrupt your sleep patterns. A frozen shoulder will also limit motion in your arm and the pain and discomfort may last for up to 3 years.3
Physical therapy or shoulder manipulation can help to reduce shoulder pain and ease some of the painful symptoms of a frozen shoulder.
Rotator cuff tendonitis, shoulder impingement, or bursitis
A common reason for experiencing throbbing shoulder pain when sleeping on one side is damage to your rotator cuff.
Doctors from the American Academy of Orthopaedic Surgeons say that rotator cuff injuries often cause a lot of shoulder pain. As the rotator cuff injury progresses, shoulder pain during the night becomes more common. There are 3 main conditions in the shoulder joint that can cause night pain:4
Rotator cuff tendonitis. Overuse injuries to your shoulder joint can cause rotator cuff tendons to become irritated and inflamed. Doctors from the Cleveland Clinic say that rotator cuff tendonitis can often make sleeping uncomfortable and can awaken you from sleep with aching in the shoulder.5
Shoulder impingement syndrome. Impingement in your shoulder joint can result in persistent pain that interferes with everyday activities. Typically, shoulder impingement causes pain in one or both shoulders that gets worse when you are sleeping.6
Bursitis. Each shoulder contains a small fluid-filled sac called a bursa that helps reduce friction. Shoulder bursitis occurs when the bursa becomes inflamed and swell because of repeated small traumas or injuries. An inflamed bursa can also cause shoulder pain that intensifies during the night.
Rotator cuff tear
A more serious type of shoulder injury that can cause deep throbbing shoulder pain when sleeping on one side is a rotator cuff tendon tear.
Rotator cuff tears can cause acute shoulder pain if caused by a traumatic injury. Or, the shoulder pain at night can be long-term if the damage happens over time.
Doctors from the Mayo Clinic report that rotator cuff tears frequently result in night shoulder pain when you lie on the affected shoulder. The pain may start in the shoulder joint and travel down the arm.7
Brachial plexus injury
An injury to the network of nerves (brachial plexus) that run between your spine and your armpit can cause shoulder pain in any sleeping position.
Dr. Jimmy D. Miller from the North Mississippi Neurological Services says that injury to the brachial plexus nerves can be a cause of shoulder pain. The injury can cause you to wake up with a sharp pain in the shoulder.8
A brachial plexus injury can also cause armpit pain as well as a sore shoulder that wakes you in the middle of the night.
Myofascial pain syndrome
Waking up with a sharp pain in your shoulder blade could be caused by muscle pain in your shoulders and upper back.
Researchers in the journal BMC Medicine said that myofascial pain is a common reason for chronic and recurring shoulder pain. Trigger points and knots in the shoulder muscles can result in tender spots and tight muscles. In many cases, the pain during the night is intense enough to cause sleep disturbances.9
Studies have found that stretching the shoulder muscles and massaging helped to ease the painful symptoms. This also results in shoulder pain causing less discomfort during the night.
Shoulder pain from sleeping on the side
Your shoulder may hurt when your sleep on one side just because of your sleeping position.
Although overuse injuries and damage to your rotator cuff are common causes of night shoulder pain, it’s not true in every case. For example, researchers have found that not everyone who wakens in the night with shoulder pain has an injury-related cause.
The journal Medical Hypotheses reported that shoulder pain can be directly connected with the sleeping position. Sleeping on one side can cause pain in that shoulder due to the weight of the body on the shoulder joint. Shoulder pain from sleeping on one side can also occur if a person doesn’t change their position at all while sleeping.10
Shoulder pain while sleeping during pregnancy
During your third trimester, you may suffer from a sore shoulder while sleeping on one side. Some of the reasons for night-time shoulder pain during pregnancy could be that extra weight causes sore back muscles.
Try to change you sleeping position several times during the night to reduce pressure on the shoulder.
Acromioclavicular joint injury
Injury to your collarbone can cause varying degrees of nighttime shoulder pain in one or both shoulders.
The book StatPearls says that acromioclavicular joint injuries commonly happen if a person falls on their elbow or with an outstretched arm. This can cause pain that radiates from the neck to the shoulder. This can cause dull aching pains in the shoulder when sleeping on the side of the affected shoulder.11
Thoracic outlet syndrome
Pain in the thoracic region of your middle back can spread to your shoulder blades causing varying degrees of discomfort while you sleep.
Pregnancy and trauma are common causes of thoracic outlet syndrome. Doctors from the Mayo Clinic say that this can cause pain along the pathway of your brachial plexus nerves. Aching pains in your shoulder, neck, or hand are also symptoms of thoracic outlet syndrome.12
The Journal of Manual & Manipulative Therapy reports that thoracic outlet syndrome can result in pain that only occurs during the night. You may also wake up with numbness or be tingling in one arm.13
Other Causes of Waking Up with Shoulder Pain
There are other reasons for shoulder pain that could disrupt your sleep.
According to doctors from the American Academy of Orthopaedic Surgeons, shoulder arthritis can often cause night-time pain. For many arthritis sufferers, constantly waking up during the night with a painful shoulder causes chronic tiredness and fatigue.14
Dr. Gerard A. Malanga on Medscape says that a pinched nerve in your spine can cause a condition called cervical radiculopathy. This causes persistent neck pain that spreads to the shoulder as well as muscle weakness or tingling down one arm.15
Referred shoulder pain
Dull aching in your shoulder while you are sleeping may originate somewhere else in your back, spine, or neck. Sometimes the pain can cause a burning sensation along your shoulder blades or cause a constant sharp pain under your shoulder blade.16
The first signs of a heart attack usually involve squeezing chest pains that feel like a heavy weight on your chest. However, Dr. Melissa Conrad Stöppler on MedicineNet says that heart attack pain can also spread to the shoulders and down one or both arms. During a heart attack, intense discomfort may also be felt between the shoulder blades.17
Poor or uncomfortable bed
If you wake up with shoulder pain and you have upper back discomfort, it could be because your bed is uncomfortable.
The Journal of Chiropractic Medicine reported that beds older than 5 years may start to cause back pain, shoulder pain, and shoulder stiffness. Various studies have found that changing the bedding system is sometimes enough to improve sleep quality and prevent shoulder pain when sleeping. Just changing your mattress can help improve the quality of your sleep.18
How to Sleep with Shoulder Pain
The amount and quality of sleep that you get at night greatly impacts on your general health. Knowing how to prevent shoulder pain while sleeping can help you feel less fatigued during the day and have more energy. So, it’s important to find the best sleeping position for shoulder pain.
Dr. William C. Shiel on MedicineNet says that people who are prone to being disturbed because of shoulder pain while sleeping should not sleep with their arm extended above their head. Also, the best sleeping position for shoulder pain includes avoiding sleeping on your stomach. This helps to put less strain on your upper back and shoulders.19
Because your bed can be a source of shoulder pain while sleeping, you should make sure that it is comfortable without being too soft. Studies have shown that a medium-firm mattress can help reduce clinically diagnosed shoulder pain.20
If you have rotator cuff injuries, you may find it easier to avoid the night-time shoulder pain when sleeping on your back or on the side that isn’t affected.
How to Relieve Shoulder Pain at Night
What can you do to improve symptoms of shoulder pain at night and help to improve your sleep quality?
Stretches to relieve shoulder pain when sleeping
Doing regular gentle stretching exercises to free up a stiff shoulder may help to ease a sore shoulder that bothers you at night-time.
Doctors from UW Medicine say that many causes of shoulder pain can be managed by using simple exercises you can do at home. You can usually use your unaffected arm to give physical therapy to the arm with the painful shoulder.
Exercise to treat night pain in the shoulder:
- If your right shoulder causes pain at night, hold out your right arm in front of you.
- Keep your left elbow tight to your side and grip your right elbow with your left hand.
- Gently pull your right arm across your chest as far as you can without it hurting.
- If your shoulder joint becomes sore, try lowering your right arm.
- Hold for 30-60 seconds and relax.
- Repeat the exercise 3-5 times to help stretch the muscles in your shoulder and ease the pain.
Neck release to relieve shoulder pain after sleeping:
- Sit on a chair with your back straight and your shoulders slightly back.
- Lower your chin to touch your chest to stretch the tendons in your neck.
- Keeping your chin on your chest, gently tilt your head to the right and hold for 30 seconds.
- Gently tilt your head to the left side and hold for 30 seconds.
- Repeat the exercise to help strengthen tendons in your neck and shoulder to get rid of a painful shoulder while sleeping.
If a painful shoulder keeps you awake at night, you should try the RICE method for pain relief. RICE is an acronym for Rest, Ice, Compression, and Elevation. This is how to relieve pain from a shoulder to help you sleep better.
- Rest the affected shoulder and avoid any activity that causes pain or puts the strain on the arm or shoulder.
- Ice the sore shoulder by placing a cold pack or bag of frozen peas on the shoulder joint. Remember to wrap the cold compress in a thin towel to prevent damaging the skin. Hold on for 15 minutes every hour for the first 72 hours after a shoulder injury.
- Compress the shoulder by wrapping a large elastic bandage over the injured shoulder.
- Elevate the shoulder by avoiding lying down on the injured shoulder joint.
After the initial injury, you can switch to a warm compress to help relieve muscle pain and a sore shoulder.
How to Choose the Best Pillow for Shoulder Pain
According to the journal Physiotherapy Canada, having a good-quality and comfortable pillow is essential for a good night’s sleep. Researchers found that a low pillow, a feather pillow, and uncomfortable pillow can greatly increase incidences of shoulder pain and neck stiffness.21
How can you choose the best pillow for shoulder pain? Here are some helpful tips:
Support. A pillow should support your head and neck well and not go flat during the night. The pillow should be firm enough to keep your neck at a good angle while you sleep. Memory foam pillows are good for supporting your neck.
Height. You should also avoid a pillow that is too high because it can strain your neck and cause shoulder pain while you are sleeping. If you tend to sleep on your back, then the pillow height should be lower than if your sleeping position is on your side.
Fill material. According to the study mentioned above, while there was no significant difference in sleep quality scores for the different pillow types, it was found that the feather-pillow users consistently rated their sleep quality and pillow comfort low. 21
How to Relieve Rotator Cuff Pain When Sleeping
How can you improve your sleep quality and avoid waking up with shoulder pain if you have rotator cuff pain?
This is how to prevent intense rotator cuff pain while sleeping:
- Try sleeping on your back and placing a pillow under your affected shoulder. This helps to release some pressure from the inflamed rotator cuff as you sleep.
- Sleep on the unaffected side so that your sore shoulder is raised. Place a pillow between your legs to help keep your body aligned and prevent extra pressure on your upper back.
- Place a heat pack on your sore shoulder joint about 20 minutes before going to bed to increase blood circulation to the area.
When to See a Doctor
With proper rest and home care, your shoulder should heal and the rotator cuff pain during the night should go away. However, in some cases, you should see a doctor for persistent shoulder pain at night.
Doctors from the Mayo Clinic recommend seeing a doctor for shoulder pain in the following circumstances:
- You can’t move your arm without extreme pain.
- There is sudden swelling in your shoulder joint.
- There are warmth and redness around the shoulder.
- Chronic shoulder pain at night keeps you awake or prevents you from getting enough rest.
- Medscape. Shoulder joint anatomy.
- Am Fam Physician. 2008 Feb 15;77(4):453-460.
- WebMD. What is a frozen shoulder?
- AAOS. Shoulder impingement.
- ClevelandClinic. Rotator cuff tendonitis.
- Instr Course Lect.2009;58:447-57.
- MayoClinic. Rotator cuff injury.
- Am Fam Physician.2000 Nov 1;62(9):2067-2072.
- BMC Med. 2011; 9: 8.
- Med Hypotheses.2010 Apr;74(4):639-43
- NCBI. Acromioclavicular joint, injury.
- MayoClinic. Thoracic outlet syndrome.
- J Man Manip Ther. 2010 Jun; 18(2): 74–83.
- AAOS. Arthritis of the shoulder.
- Medscape. Cervical radiculopathy.
- WebMD. Referred shoulder pain.
- MedicineNet. 12 Heart attack symptoms and early warning signs.
- J Chiropr Med. 2009 Mar; 8(1): 1–8.
- MedicineNet. Thoracic outlet syndrome.
- J Manipulative Physiol Ther.2002 Feb;25(2):88-92.
- Physiother Can. 2011 Spring; 63(2): 183–190.