To sleep with shoulder pain, most people do better on their back with a pillow under the sore arm, or on the other side hugging a pillow so the sore arm rests at chest height. Lying directly on the painful shoulder usually makes it worse. The details change with the cause: rotator cuff problems, frozen shoulder and recovery after surgery in a sling each need a slightly different setup.
Sleep loss adds to pain, and pain adds to sleep loss. A good setup helps break that loop while the shoulder recovers.
Key takeaways
- Avoid the sore side: lying on the painful shoulder compresses it and often wakes people.
- On your back: a pillow under the elbow and forearm keeps the arm slightly forward of the body and off the stretch.
- On the good side: hug a pillow at chest height so the sore arm does not drop across the body.
- Frozen shoulder: the arm usually needs support in the position it rests in, slightly away from the body.
- After surgery in a sling: many people sleep semi-reclined for the first 2 to 6 weeks, with the sling on as the surgeon advises.
- Getting used to it: a new position often takes 1 to 2 weeks to feel normal.
Positions by condition
Rotator cuff problems and bursitis
These include rotator cuff tendinopathy, a rotator cuff tear treated without surgery, shoulder impingement and bursitis.
- On your back: place a pillow under the elbow and forearm on the sore side, so the elbow sits level with or slightly in front of your body. Rest the hand on your stomach.
- On the good side: hug a pillow lengthwise against your chest. Rest the sore arm on it with the elbow bent, so the arm stays at chest height and the shoulder does not roll forward.
- Avoid: sleeping with the sore arm above your head, or tucked under the pillow.
Frozen shoulder (adhesive capsulitis)
In the painful freezing stage, the shoulder often dislikes being moved into any stretch, including the stretch that happens when the arm falls away while you sleep.
- On your back: support the whole arm on pillows, with the elbow slightly away from the body and the forearm resting on a pillow across your stomach. Fill any gap under the elbow so the arm is not hanging.
- On the good side: hug a large pillow so the arm stays supported in front of you.
- Propped up: some people sleep better semi-reclined, with two or three pillows behind the back or in a recliner chair, during the most painful months.
- Expect change: night pain often eases as the frozen stage begins, which commonly takes many months. Stiffness may last longer than pain.
After shoulder surgery with a sling
This includes rotator cuff repair, stabilization surgery and shoulder replacement. Follow your surgeon’s instructions first. Your surgeon may give you different timings. Use theirs.
- Semi-reclined: many people sleep propped at about 30 to 45 degrees, using a wedge of pillows or a recliner, for the first 2 to 6 weeks.
- Sling on: most surgeons ask you to wear the sling in bed for the first weeks. Ask what your surgeon wants.
- Elbow support: a small pillow or folded towel behind the elbow stops the arm sliding backward, which pulls on the front of the shoulder.
- Side lying: lying on the good side is usually allowed once your surgeon or PT agrees, often after 4 to 6 weeks, with a pillow in front to support the operated arm.
- Lying on the operated side: often not comfortable until about 3 months after surgery or later.
Support the sore arm so it rests where it wants to be, not where gravity puts it.
Common mistakes
- Arm overhead: sleeping with the arm under the pillow or above the head pinches sore tendons.
- Unsupported arm: on the good side without a pillow in front, the sore arm drops across the chest and stretches the back of the shoulder.
- Propping the head alone: extra pillows behind the head bend the neck without taking weight off the shoulder.
- Painkillers at the wrong time: pain relief taken long before bed may have worn off by the early hours. Ask your doctor or pharmacist about timing.
- Long naps in odd positions: a nap in a chair with the arm hanging can leave it sorer at night.
How long changes take to help
A supported position often helps from the first few nights. For rotator cuff problems and bursitis, night pain commonly eases over 6 to 12 weeks as the tendon settles. For frozen shoulder, night pain can last many months. After surgery, sleep is often broken for the first 4 to 6 weeks and improves gradually over the following months. If you have set up well and night pain is getting worse, not better, after about 6 weeks, it is worth getting reassessed.
Where else this could be coming from
- A pinched nerve in the neck: arm pain or tingling at night that eases when the hand rests on top of the head. Shoulder pain usually gets worse in that position.
- Neck joint pain: an ache spreading over the top of the shoulder and shoulder blade, worse turning the head.
- Shoulder arthritis: a deep ache with grinding, stiffness in all directions and pain at rest in older adults.
- Calcific tendinitis: sudden, severe shoulder pain, often at night, that can make any position hard to tolerate for some days.
- Heart or lung causes: left shoulder pain with chest symptoms needs urgent attention, as below.
Get it checked if
- Emergency: call your local emergency number if shoulder pain comes with chest pain or pressure, breathlessness, sweating, nausea or feeling faint, or if after surgery you have calf swelling or sudden breathlessness.
- Today: see a doctor today if the shoulder is hot, red and swollen with fever, or after surgery if the wound is red, leaking or you have a fever.
- Soon: get it checked if night pain is constant and no position helps, if you have unexplained weight loss or night sweats, or if you cannot lift the arm at all after a fall.
More on this area: desk and sleep guides.
Support the arm, avoid the sore side, and give the new position a week or two.
Written by Louise Yow, Neck & Shoulder Physio.