Shoulder pain at night: why it hurts lying down and how to sleep better

Shoulder pain that wakes you up, or stops you getting to sleep in the first place, is one of the most common reasons people finally see someone about their shoulder. Shoulder pain at night is especially typical of rotator cuff problems and frozen shoulder, and it usually has a lot to do with position: how you lie, where your arm rests, and how much pressure goes through the sore joint.

This guide explains why shoulders often hurt more when you lie down, sleeping positions and bedtime habits that often help, and the signs that mean you should get your shoulder checked. It is general information only, not medical advice. Please see your GP or physiotherapist about your own shoulder.

The short answer

• Night pain is common with rotator cuff problems, frozen shoulder and shoulder arthritis. It does not on its own mean something serious is wrong.
• Lying on the sore side squashes it, and lying on the other side can let the sore arm drop forward and pull. Supporting the arm with pillows often helps.
• A systematic review found that most people with rotator cuff tears had disturbed sleep, and that sleep quality was linked to pain.
• See your doctor if the pain started after a fall or accident, keeps getting worse, is there even when you rest the arm, or comes with fever, night sweats or weight loss.
• Shoulder pain with chest tightness or trouble breathing can be a heart attack. Call 000.

Why shoulder pain gets worse at night

Several things combine to make a sore shoulder worse in bed:

• Pressure. Lying on the painful side puts your body weight straight through the irritated tendons and joint.
• Position. Lying on the other side lets the sore arm fall across your body, and lying flat on your back can let it drop backwards. Both can stretch or compress sore tissue for hours at a time.
• Stillness. Staying in one position for a long time can leave the shoulder stiff and achy, so pain builds up and then wakes you when you roll over.
• Fewer distractions. During the day you are busy. At night, with nothing else to focus on, pain can feel louder.

A 2019 systematic review of people with rotator cuff tears found the majority had a sleep disturbance, that sleep quality was linked to pain, and that factors such as being stuck in one position at night could play a role. Poor sleep can then make pain harder to cope with the next day, so improving sleep is worth the effort.

Common causes of night-time shoulder pain

Rotator cuff problems

The rotator cuff is the group of muscles and tendons that hold and move the shoulder. Irritated or torn cuff tendons commonly ache at night and hurt when you lift your arm out to the side or overhead. Our article on rotator cuff injury physiotherapy explains the staged rehab approach.

Frozen shoulder

Frozen shoulder causes pain and a steady loss of movement in all directions. Night pain is often a major feature in the early, painful stage. Read more in frozen shoulder stages and recovery.

Shoulder arthritis

Wear-related changes in the shoulder joint can cause deep aching, stiffness and grinding, often worse after a busy day.

Pain from the neck

Sometimes pain felt around the shoulder blade or upper arm comes from the neck. A physio can check whether your neck is involved.

Sleeping positions that often help

There is no single perfect position, but these set-ups help many people. Give each one a few nights.

On your back

1. Lie on your back with a pillow under your sore arm, from elbow to hand, so the arm rests slightly forward of your body rather than dropping back.
2. Rest your hand on your tummy or on the pillow.
3. A small pillow under your knees can make the position more comfortable overall.

On your good side

1. Lie on the side that does not hurt.
2. Hug a pillow in front of your chest and rest your sore arm on top of it, so the arm stays level instead of falling forward.
3. A pillow behind your back can stop you rolling onto the sore side.

Semi-reclined

Some people sleep better for a while propped up on several pillows or in a recliner, with the sore arm supported on a cushion. This can be a useful short-term option during a bad flare.

Lying directly on the sore side is usually best avoided while the shoulder is painful.

A simple wind-down routine

Gentle movement before bed can ease stiffness. These are examples only, so check with your physio if you are unsure. Stop if pain becomes sharp.

Pendulum swings

1. Stand beside a table or bench and lean on it with your good hand.
2. Let your sore arm hang down loosely.
3. Gently rock your body so the arm swings in small circles or forwards and back. The arm stays relaxed and the movement comes from your body.

Supported table slides

1. Sit beside a table with your sore arm resting on a towel on the tabletop.
2. Slowly slide your hand forward along the table as far as is comfortable, then back.

Shoulder rolls

1. Sit tall with your arms relaxed.
2. Slowly roll both shoulders up, back and down a few times.

It can also help to avoid heavy lifting or long spells of overhead work late in the day, and to ask your GP or pharmacist about the best timing for any pain relief you use.

How physiotherapy helps

A physio will work out what is driving your pain, then combine exercise, activity advice and practical changes to your routine. For many shoulder problems, a gradual exercise program is the backbone of treatment. At a home visit, your physio can also look at your actual bed, pillows and chair and help you set up a comfortable position on the spot.

When to get your shoulder checked

Healthdirect advises seeing your doctor if:

• You have shoulder pain after an accident or a fall.
• Your pain is not going away or is getting worse, especially if it hurts when you are resting the shoulder.
• You have a fever, night sweats or unexplained weight loss.
• You have other symptoms that concern you.

Get medical attention immediately if you have injured your shoulder and the joint looks deformed, you cannot use your shoulder, the pain is intense, or there is sudden swelling. Shoulder pain can be a sign of a heart attack. If you also have chest tightness or trouble breathing, call 000.

Frequently asked questions

Does night pain mean I have a torn rotator cuff?

Not necessarily. Night pain is common with several shoulder problems, including tendon irritation without a tear, frozen shoulder and arthritis. An assessment can help sort out the likely cause.

How long will the night pain last?

It depends on the cause. Many people notice nights improving as the shoulder settles and gets stronger with treatment. Frozen shoulder tends to follow a longer course.

Can I see a physio at home for shoulder pain?

Yes. Khy Physio visits homes across Melbourne and the Geelong region. If you have a GP chronic condition management plan, you may be able to claim a Medicare rebate. See does Medicare cover physio.

Get a better night’s sleep

Our physiotherapists can assess your shoulder, set up your sleeping position and give you a plan to settle the pain, all in your own home. Make a referral or contact our team on 03 8824 0712.

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