After shoulder surgery, most people sleep more comfortably semi-upright for the first weeks, propped at about 30 to 45 degrees on a wedge of pillows or in a recliner. Support the operated arm with a pillow under the elbow and forearm, so the elbow sits slightly in front of your body. Wear the sling at night if your surgeon says so. Lying on the other side is often allowed from about 4 to 6 weeks, and on the operated side often from about 3 months. Your surgeon’s instructions come first.
Broken sleep is one of the hardest parts of the first weeks after shoulder surgery. Lying flat lets the arm drift backward and pull on the front of the shoulder, which is why many people wake at 2 or 3 in the morning. A supported, semi-upright setup reduces that pull.
Key takeaways
- Semi-upright first: many people sleep propped at about 30 to 45 degrees for the first 2 to 6 weeks.
- Elbow support: a pillow under the elbow and forearm keeps the elbow slightly in front of the body.
- Sling at night: most surgeons ask for the sling to stay on in bed for the first weeks.
- Side lying: the non-operated side is often allowed from about 4 to 6 weeks, with a pillow to hug.
- Operated side: often not comfortable or allowed until about 3 months or later.
- Sleep improves gradually: it is often broken for 4 to 6 weeks and improves over the following months.
Setting up the bed or chair
- Height: build a firm wedge of 3 to 4 pillows, or use a wedge cushion, so your upper body sits at about 30 to 45 degrees. A recliner chair does the same job.
- Elbow and forearm: place a pillow under the elbow and forearm of the operated arm. The elbow should sit level with, or slightly in front of, your body, never behind it.
- Hand: rest the hand on your stomach or on a pillow at about chest height, a little higher than the elbow, which helps limit swelling.
- Sling: keep it on in bed if your surgeon has said so, and check the strap is padded at the neck.
- Neck: support the head with a pillow so the neck stays roughly level with the body. Too many pillows under the head alone bend the neck forward. See pillow height for neck pain.
- Knees: a pillow under the knees stops you sliding down the bed during the night.
- Getting up: slide to the edge, lower your legs, and push up with the good arm. Keep the operated arm passive in the sling.
Week by week
- Nights 1 to 3: if you had a nerve block, the arm may be numb at first. Pain often rises as it wears off, commonly within about 12 to 24 hours, so many people are advised to start their prescribed pain relief before that happens.
- Weeks 1 to 2: semi-upright, sling on, elbow supported. Waking two or three times a night is common.
- Weeks 2 to 6: night pain often starts to ease. Some people lower the angle a little as comfort allows.
- Weeks 4 to 6 onward: lying on the non-operated side is often allowed, hugging a pillow so the operated arm rests in front at chest height. Your surgeon or physical therapist (PT) will say when.
- About 3 months onward: lying on the operated side often becomes possible, starting with short spells. For some people it takes longer.
Keep the elbow in front of you. Most night pain after shoulder surgery starts when the arm drifts back.
Common mistakes
- Lying flat too early: the arm falls back and the front of the shoulder is pulled into a stretch.
- No support under the elbow: a gap under the elbow lets the arm slide behind the body during sleep.
- Taking the sling off at night against advice: an unprotected arm can move into positions the repair is not ready for.
- Pain relief timed badly: a dose taken long before bed may wear off by the early hours. Ask your surgeon or pharmacist about timing.
- Long, still nights in a chair: move your ankles and feet when you wake, and get up to walk through the day to help circulation.
How long changes take to help
A supported, semi-upright position often helps from the first few nights. Sleep after shoulder surgery is commonly broken for the first 4 to 6 weeks and improves gradually over the following 2 to 3 months. Night pain that is getting worse rather than better after about 6 weeks is worth raising with your surgeon or PT.
Recovery pages for specific operations give their own timings: rotator cuff surgery recovery, shoulder replacement recovery and shoulder stabilization surgery recovery. For night pain from shoulder problems that have not been operated on, see how to sleep with shoulder pain.
Where else this could be coming from
- A stiff shoulder: night pain that returns after the first weeks, with movement that has stopped improving, can come from stiffness. See stiff shoulder after surgery.
- The neck: sleeping propped up can leave the neck stiff, with an ache over the top of the shoulder. See sleeping position for neck pain.
- The other shoulder: doing everything one-handed can make the other shoulder ache.
- Low mood: weeks of broken sleep wear people down. Tell your doctor if low mood lasts more than a couple of weeks.
Get it checked if
- Emergency: call your local emergency number if you have chest pain, sudden breathlessness, or a swollen, painful calf.
- Today: contact your surgeon today if the wound is red, hot or leaking, you have a fever, pain is not controlled by your prescribed pain relief, or the hand turns cold, pale or blue.
- Soon: get it checked if numbness or tingling in the hand is spreading or not easing, or if night pain is getting worse after about 6 weeks.
More on this area: desk and sleep guides.
Propped up, elbow supported in front, sling on if your surgeon says so, and the side you lie on decided by your surgeon’s timeline.
Written by Louise Yow, Neck & Shoulder Physio.