Shoulder Pain at Night
One of the most common symptoms experienced by people suffering from shoulder pain is poor sleep. This is significant, as it can lead to increased fatigue, psychological limitations, and delayed tissue recovery.
Studies on the prevalence of sleep disturbances in people with shoulder conditions have reported that up to 90% of individuals with rotator cuff-related shoulder pain, up to 90% of individuals with frozen shoulder, and up to 60% of people following shoulder surgery experience sleep issues.
Pain is a complex topic that goes beyond the scope of this blog, but there are a few reasons why pain might be more pronounced at night compared to during the day. Some possible explanations include:
Attention to pain - During the day, there are more distractions, so we may not focus on pain as much. At night, when the environment is quieter and less stimulating, pain can be perceived as more severe.
Circadian Rhythm - Due to multiple normal physiological changes that occur throughout the day, pain sensitivity is higher at night time.
Positioning - Certain sleep positions can increase pressure on the shoulder, which may exacerbate pain during the night. Since we tend to remain in one position for extended periods while sleeping, this can be a significant factor.
Anxiety/depression - People with chronic shoulder pain may be more prone to psychological conditions like anxiety and depression, which can indirectly affect sleep quality.
What Can You Do to Sleep Better?
Positioning: I often recommend specific sleep positions to my shoulder patients, and I’ve found these strategies can positively impact both their sleep quality and recovery process. Here are some positioning tips (and positions to avoid):
Supine (on your back): If you choose to sleep on your back, try tucking a pillow under the painful shoulder. This helps support the shoulder and prevents it from "hanging" in the air. For post-operative patients, this is usually the primary sleeping position, and I highly recommend it.
Side-Lying: When sleeping on your side, place a pillow between your elbow and trunk to provide additional support for the shoulder.
Avoid Sleeping on the Painful Side: Even if this is your preferred sleeping position, avoid lying on the affected shoulder.
Avoid Sleeping with Arms Over Your Head: Whether lying prone (on your stomach) or supine (on your back), avoid positioning your arms over your head.
Decrease overload on low capacity, inflammed tissues -
This is particularly important in post-operative cases when inflammation is more pronounced, and we want to protect the healing area. If the shoulder is not adequately supported, increased inflammation can occur, which can worsen night pain. It’s essential to follow post-operative guidelines, which often include using a sling to protect the area and improve sleep quality.
Consult with a medical professional if sleep disturbance persists
References:
Werner CM, Ossendorf C, Meyer DC, Blumenthal S, Gerber C. Subacromial pressures vary with simulated sleep positions. J Shoulder Elbow Surg. 2010;19(7):989-993. doi:10.1016/j.jse.2010.04.039
Cho CH, Jung SW, Park JY, Song KS, Yu KI. Is shoulder pain for three months or longer correlated with depression, anxiety, and sleep disturbance?. J Shoulder Elbow Surg. 2013;22(2):222-228. doi:10.1016/j.jse.2012.04.001
Teytelbaum D, Wegenka L, Wolk R, Ali A, Kaar CRJ, Karr S. Improvements in Sleep After Shoulder Arthroscopy Are Correlated With Improvements in Various Patient-Reported Outcomes: A Systematic Review. Arthrosc Sports Med Rehabil. 2024;6(2):100883. Published 2024 Feb 12. doi:10.1016/j.asmr.2024.100883
Daher M, Lopez R, Covarrubias O, Boufadel P, Fares MY, Abboud JA. Sleep disturbances in rotator cuff pathology: insights into mechanisms and clinical implications. Clin Shoulder Elb. 2024;27(4):514-518. doi:10.5397/cise.2024.00010
Toprak M, Erden M. Sleep quality, pain, anxiety, depression and quality of life in patients with frozen shoulder1. J Back Musculoskelet Rehabil. 2019;32(2):287-291. doi:10.3233/BMR-171010
Daguet I, Raverot V, Bouhassira D, Gronfier C. Circadian rhythmicity of pain sensitivity in humans. Brain. 2022;145(9):3225-3235. doi:10.1093/brain/awac147
