How to Fix Shoulder Pain From Side Sleeping

Ryan Fiorenzi, BS, Certified Sleep Science Coach - Updated on July 5th, 2023

Shoulder pain is estimated to reduce sleep quality in 70% of sufferers. Pain can disrupt sleep, leading to a vicious cycle, as poor sleep can prevent healing and increase inflammation.

Research on sleep and shoulder pain is multidisciplinary and we've included data and advice from researchers in orthopedics, rheumatology, neurology, and sleep medicine. We'll discuss the most common causes of shoulder pain, how to sleep with shoulder pain, and tips for preventing shoulder issues.

Most Common Shoulder Conditions

Rotator Cuff Tendinitis

Rotator cuff tendinitis as shoulder muscular inflammation outlin

Rotator cuff tendinitis is the inflammation of the tendons that connect the rotator cuff muscles. It's usually caused by repetitive overhead movements or degenerative changes in the tendons, such as tennis players and pitchers.

Rotator cuff tendinitis typically causes pain and tenderness in the front or outer part of the shoulder. It may worsen with overhead movements or when lifting heavy objects. Other symptoms may include weakness and limited range of motion.

Treatment for rotator cuff tendinitis often involves a combination of rest, physical therapy, pain management, and corticosteroid injections or surgery in severe cases.

Shoulder Impingement Syndrome (SIS)

Shoulder impingement syndrome from rubbing rotator cuff outline

SIS occurs when the rotator cuff tendons become pinched or compressed within the narrow space beneath the acromion, a bony process of the shoulder blade. This condition can cause pain and limited range of motion.

SIS often causes pain in the front or outer part of the shoulder, which may radiate down the arm. Pain can be exacerbated by activities that involve overhead movements, such as reaching or lifting. SIS is positively correlated with the scores for lower sleep quality, increased sleep latency (how long it takes to fall asleep), sleep duration, habitual sleep efficiency, and sleep disturbance.

Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder condition or adhesive capsulitis syndrome outlin

A frozen shoulder is characterized by stiffness and a limited range of motion in the shoulder joint. The exact cause is unknown, but it is believed to involve inflammation and thickening of the joint capsule. It's characterized by stiffness, pain, and limited range of motion in the shoulder joint. The condition progresses through three phases: freezing, frozen, and thawing.

Treatment for a frozen shoulder usually involves pain management, physical therapy, and range-of-motion exercises. In some cases, manipulation under anesthesia or surgery may be required.

Shoulder Bursitis

Shoulder bursitis as medical painful bursa inflammation outline

Shoulder bursitis is the inflammation of the bursa sacs that cushion the shoulder joint. It can result from repetitive motions, trauma, or arthritis. Shoulder bursitis typically causes pain, tenderness, and swelling around the affected shoulder joint. Movements that involve raising the arm or putting pressure on the shoulder can worsen the symptoms.

Treatment for shoulder bursitis often involves rest, pain management, physical therapy, and in severe cases, corticosteroid injections or aspiration of the inflamed bursa.

Arthritis

Shoulder osteoarthritis infographic

Arthritis, such as osteoarthritis or rheumatoid arthritis, can affect the shoulder joint, causing pain, stiffness, and inflammation.

Shoulder arthritis can lead to pain, stiffness, swelling, and reduced range of motion in the shoulder joint. The pain is often worse with movement and can be accompanied by a cracking or grinding sensation.

Treatment for shoulder arthritis typically includes pain management, physical therapy, joint injections, and, in severe cases, joint replacement surgery.

How to Reduce Your Shoulder Pain

To alleviate shoulder pain associated with side sleeping, here are some recommendations to consider:

Address the Underlying Issue

Dr. Nick Ferran, an orthopedic surgeon at the Shoulder and Elbow of London, makes several recommendations: changing sleep position, getting a comfortable pillow, not laying on the injured shoulder, and taking painkillers at night 30 minutes before bed. But the best approach is to treat the underlying condition by seeing a specialist. This is especially important if you have popping, catching, or locking in your shoulder, persistent pain, and warmth/swelling/inflammation in the shoulder.

Ideal Sleep Positions for Shoulder Pain Relief

Back Sleeping

Sleeping on your back is considered the best position for overall spine alignment. To support the shoulders while sleeping on your back, place a pillow under the knees and a small pillow or rolled towel under the lower back for added support. This helps maintain a neutral spinal position and reduces strain on the shoulders.

If you have sleep apnea or are prone to snoring, understand that back sleeping can cause more apneas, snoring, and acid reflux. If you suffer from one or more of these issues, you may want to consider side sleeping.

Side Sleeping on Your Healthy Shoulder

Hugging a pillow can be helpful to keep the affected shoulder in a better position during the night. Sleeping with a pillow between the knees is also a good idea to maintain hip alignment. Side sleepers can keep neutral alignment by not curling into a ball.

Stomach Sleeping

Stomach sleeping is generally discouraged for those with shoulder pain as it can strain the neck and shoulders. However, if stomach sleeping is necessary, don't use a pillow to reduce strain on the neck and shoulders.

Be mindful that to change position during the night or in the morning, you may use the arm with the affected shoulder, which can aggravate your pain and inflammation.

Arm Position

Don't sleep with your arm over your head or under your pillow, which can cut off circulation and put your shoulder in an awkward position for long periods.

How to Change Your Sleep Habitual Sleep Position

Changing your habitual sleep positions isn't easy, but it is possible. Many have found success by placing pillows on the bed to make it difficult to move to undesirable positions. For example, if you're trying to stop yourself from laying on your injured shoulder, start the night by sleeping on your good shoulder and place one pillow snuggly behind you, making it difficult to turn to your other side, and hug another pillow against your chest, which will trap you between your pillows.

It's also recommended to remind yourself every night that you're not supposed to sleep on your affected shoulder. Over time this can help prevent you from laying on the affected shoulder.

Pillow Height

The best pillows for side sleeping are thicker to fill the space between your head and the bed. Back sleeping requires a smaller pillow, and for stomach sleeping, a small pillow or no pillow is best. Finding the right pillow to reduce shoulder and neck pain may require experimentation.

Choosing the Right Mattress

The choice of mattress can significantly impact shoulder pain and sleep quality. Many factors to consider when choosing a mattress include weight, age, sensitivity to heat, edge support, off-gassing, motion isolation, warranty, materials, and your dominant sleep position. One of the most important considerations is balancing comfort (soft mattress) and support (firm mattress). There have been some studies that have concluded that a medium-firm mattress is best for shoulder pain, but we think that there is a lot more research that needs to be done.

Side sleepers need a softer mattress, back sleepers need a medium-firm mattress, and stomach sleepers need a firm mattress. Using a 1-10 scale, with 1 being plush and 10 being very firm, side sleepers will be at the low end from 1-4, back sleepers from 4-7, and stomach sleepers from 7-10. Most people switch between positions at night but have a dominant sleep position.

Ultimately the best thing to do is try different mattresses and see how your shoulder responds. If you have a mattress in a guest bedroom, you could sleep in the guest bedroom for a few nights and see how your shoulder responds. We recommend a few nights as sleep researchers often don't consider the first night of sleep data as people generally don't sleep as well in a new environment on their first night. You could move the guest bedroom mattress into your bedroom to avoid this issue, but remember that you may be aggravating your shoulder if you move the mattress.

Another strategy is to pay attention to how your shoulder feels when you travel. Notice if the mattress you slept on in a hotel, air BNB, or at a friend's is softer or firmer, and how you felt when you woke up.

Hybrid Mattress for Shoulder Pain

After years of testing mattresses and speaking to manufacturers and customers, we've found that hybrid mattresses find the right balance between comfort and support. Some find that mattresses that are too soft are difficult to move in as they sink in too far. Mattresses that are too hard put more pressure on the shoulder. Hybrid mattresses have a soft upper layer for comfort and a bottom layer for support.

We've tested a lot of mattresses to create several reviews that you may find helpful:

The good thing about trying different mattresses is that mattress retailers offer great in-home trials. Many offer 100-night or 120-night trials to see if you like the mattress, with free delivery and free pickup if you want to return it.

How to Reduce Pain & Keep Your Shoulder Healthy

  1. Maintain proper posture: Practice good posture to ensure proper alignment of the spine and shoulders. Avoid slouching or hunching forward, both when sitting and standing. Engage your core muscles to support your upper body and keep your shoulders in a neutral position.

  2. Warm up and stretch: Before engaging in physical activities or sports that involve the shoulders, warm up your muscles with gentle exercises and stretches. This helps increase blood flow to the shoulder muscles, improving their flexibility and reducing the risk of injuries.

  3. Alternate ice and heat: Many orthopedic doctors recommend applying heat and ice in the morning and night, with the last treatment being ice, which acts as a pumping mechanism to the inflammation, moving it away from the affected area.

  4. Strengthen the shoulder muscles: Incorporate regular shoulder-strengthening exercises into your fitness routine. Focus on exercises that target the rotator cuff muscles, such as external and internal rotations, shoulder presses, rows, and scapular retractions. Strong and well-balanced shoulder muscles provide stability and support to the joint, reducing the risk of injuries.

  5. Practice proper lifting techniques: When lifting heavy objects, use your legs and core muscles instead of relying solely on your arms and shoulders. Keep the object close to your body and avoid twisting or jerking motions while lifting. If possible, use lifting aids or ask for assistance to reduce the strain on your shoulders.

  6. Avoid overuse and repetitive movements: Overuse and repetitive movements can strain the shoulder muscles and lead to injuries over time. If you engage in activities that involve repetitive shoulder movements, such as throwing, swimming, or weightlifting, make sure to vary your exercises and give your shoulders regular breaks to rest and recover.

  7. Take regular breaks from sitting: Prolonged sitting can contribute to poor posture and muscle imbalances, which may increase the risk of shoulder injuries. Take frequent breaks from sitting and engage in shoulder stretches and exercises to counteract the effects of prolonged sitting.

  8. Use proper ergonomics: Ensure that your workstation and everyday equipment, such as chairs, desks, and computer setups, are ergonomically designed. This helps maintain proper posture and reduces strain on the shoulders and neck. Adjust the height and position of your equipment to ensure that your shoulders are relaxed and not excessively elevated or rotated.

  9. Listen to your body: Pay attention to any discomfort, pain, or signs of overexertion in your shoulders. If you experience persistent or worsening shoulder pain, seek medical attention promptly. Early intervention can prevent minor issues from developing into more severe injuries.

  10. Stay active: Follow a balanced diet, including anti-inflammatory foods, exercise regularly, and maintain a healthy weight. A healthy lifestyle contributes to overall musculoskeletal health, reducing the risk of shoulder injuries. Additionally, staying hydrated helps keep the joints lubricated and can prevent injury.

  11. Seek professional guidance: If you are new to exercise or have pre-existing shoulder conditions, consult with a healthcare professional or a qualified fitness trainer. They can provide personalized guidance, recommend exercises suitable for your specific needs, and help prevent potential injuries.

Conclusion

Sleeping on your injured shoulder can exacerbate shoulder pain and hurt your sleep quality. Using better sleep positions, choosing the right mattress, and using pain relief techniques can minimize shoulder pain and improve your sleep. Remember to consult a healthcare professional for a proper diagnosis and personalized advice based on your condition.

References

Myung Kyung Lee, & Jihyun Oh (May 2022). The relationship between sleep quality, neck pain, shoulder pain and disability, physical activity, and health perception among middle-aged women: a cross-sectional study. BMC Womens Health, (1):186. doi: 10.1186/s12905-022-01773-3.

I. Tekeoglu, L. Ediz*, O. Hiz, M. Toprak, L. Yazmalar, G. Karaaslan(2013). The relationship between shoulder impingement syndrome and sleep quality. European Review for Medical and Pharmacological Sciences, 17: 370-374.

Ancuelle, V., Zamudio, R., Mendiola, A., Guillen, D., Ortiz, P. J., Tello, T., & Vizcarra, D. (2015). Effects of an adapted mattress in musculoskeletal pain and sleep quality in institutionalized elders. Sleep Science, 8(3), 115-120. https://doi.org/10.1016/j.slsci.2015.08.004

Jacobson BH, Boolani A, Dunklee G, Shepardson A, Acharya H. Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Appl Ergon. 2010 Dec;42(1):91-7. doi: 10.1016/j.apergo.2010.05.004. Epub 2010 Jun 26. PMID: 20579971.

Caggiari, G., Talesa, G. R., Toro, G., Jannelli, E., Monteleone, G., & Puddu, L. (2021). What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature. Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology, 22. https://doi.org/10.1186/s10195-021-00616-5

Hammad A, Grinbaum E, Chezar A, Israeli A, Rozen N, Rubin G. The correlation between shoulder pathologies and sleep disorders. J Int Med Res. 2022 Jun;50(6):3000605221103543. doi: 10.1177/03000605221103543. PMID: 35676774; PMCID: PMC9189537.