The best sleeping positions with shoulder pain depend on the reason you are having shoulder pain at night. Some of the common causes of shoulder pain include frozen shoulders, rotator cuff tendinopathy,  shoulder impingement, cervical radiculopathy, or if you’ve just recently had shoulder surgery.

Sleep is very important for a number of reasons. One reason specifically is its direct correlation with our nervous system.  When you don’t get the sleep that your body needs, your nervous system is on high alert, which can make the pain worse. So by not getting enough sleep, you can actually make your shoulder pain even more irritable.

You may also be trying to sleep in a position that is irritating the tissue and keeping you from being able to sleep. It is important to take the stress off the irritable tissue. So let’s go over some causes of shoulder pain and tell you what sleeping position would be best for you and your shoulder pain and what positions to avoid. You can watch the above video to see demonstrations of the positions discussed below.

Diagnoses For Best Sleeping Positions with Shoulder Pain

1. Rotator Cuff Tendinopathy

Let’s start with Rotator Cuff Tendinopathy, as this is one of the most common reasons people have shoulder pain. Rotator cuff pain generally comes from the rotator cuff tendon.  The rotator cuff is a collection of 4 muscles that cuff around the top of the humerus or shoulder. Most people that fall in this category experience pain on the outside of their shoulder. There is an area of the rotator cuff that naturally does not have a great blood supply, known as the avascular zone. Most people sleep in positions that further reduce the blood flow to this area. This is not a big deal for your average person, but when the tendon is already irritated, this is not helping. A healthy blood supply is extremely important especially when the body is injured and is in the healing process.

There is an acronym called PEACE & LOVE which walks you through the best steps to decrease your healing time. You can learn more about that here. 

How can we decrease the stress in this region to give you a better night’s sleep? 

The positions to AVOID are:

1. Sleeping ON the irritated side.  This will cause a constant stretch in the avascular zone which increases irritability
2. Sleeping on the non-affected side where the irritated shoulder is up and against you or rolled in front or behind the body.  By letting your shoulder stay against your mid-line it is putting a stretch in this region.

Avoid these initially until your rotator cuff tendinopathy has healed.

How can we sleep that doesn’t irritate this tissue?

There are two options that tend to work best:

1. Sleeping on your back with a pillow supporting your arm and keeping it from coming towards your midline
2. Sleeping on your non-affected side and have your arm supported —this is great if you can use your spouse, or you will need to support it with a couple pillows. Make sure there is some distance between your body and your upper arm and the pillow is filling that space so your arm is able to relax.

2. Impingement

Another reason you may be having some discomfort that is keeping you from getting a good night’s sleep is shoulder impingement.  Impingement occurs when either the rotator cuff or biceps tendon gets caught between the acromion and humerus when you lift your arm overhead. Now, this is not normal to have pinching with reaching overhead. You should be able to do this without any discomfort. 

If you find yourself having no issues during the day, but difficulty sleeping with your arms overhead, this may be your first warning sign to get looked at by a Physiotherapist.  People who tend to sleep on their stomachs with their arms overhead are the ones who will find this to be the most annoying. The arms being in an overhead position will further irritate these tendons and will keep you up at night or have you waking up with an achy shoulder.

So how can you sleep? 

This one is pretty straightforward. Figure out a way to not have your arms overhead and it will reduce the stress on these tissues.

3. Frozen Shoulder

Frozen shoulder involves a tightening of the shoulder capsule. There is a big correlation between this diagnosis and diabetes and is most common in middle-aged women.  It’s so common in middle-aged women, that many professionals simply call this the 50-year-old shoulder.  For this diagnosis the most comfortable positions are going to be similar to the two discussed with rotator cuff tendinopathy, but for a different reason. The reason for this is not due to an avascular zone, but to allow the capsule of the joint to have the least amount of stress on it and for the arm to feel fully supported.

So what’s the best sleeping position? 

For this, I like to have someone on their back with a pillow or two under their shoulder and one keeping their arm slightly out to the side.

4. Post Surgical

So for post-surgical, it really depends on the stage of healing that you’re in. After surgery, your surgeon and your therapist will come up with the best plan for you specifically. But, typically in the earlier stages after surgery, you will likely be sleeping in a recliner. This is going to allow you to be elevated to decrease stress at the surgical site and reduce your chances of moving in the middle of the night and rolling onto it.

After some time has passed since the surgery you may be able to go back to lying in bed in some of the other positions mentioned in this video. The key here is the position that will be most comfortable, will be directly correlated to what surgery you had done AND the tissues that were involved in that surgery. Ultimately, this is what is going to guide you to find the position that is going to be best suited for you.

Okay, there you have it, the best sleeping positions with shoulder pain.  It really comes down to what is the cause of your pain and finding the best position that doesn’t further stress the tissue.