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Causes

Sleeping position

In some cases, shoulder pain from sleeping occurs due to a person’s sleeping position.

A small 2017 study found that people who sleep with their dominant hand on their forehead while lying on their back were most likely to experience shoulder pain.

This position puts more stress on the neck and shoulder muscles than others. It also puts more stress on the spine through a muscle called the scalene. This muscle is attached to both the shoulder and the spine through the ribs.

The stress on these muscles can cause several types of pain. Tightness of the neck and shoulder muscles can cause a tension headache, whereas tightness of the scalene muscle can cause tingling, pain, and weakness of the arms.

However, it is worth noting that this was a small study. Scientists will need to carry out more research to verify these results.

Frozen shoulder

Frozen shoulder is a very painful condition that causes inflammation in the shoulder. This can lead to stiffness and difficulty moving the affected joint.

This condition develops over time, but pain and stiffness may occur very suddenly. Recovery can take 2–3 years.

Doctors do not know why frozen shoulder happens. However, there are a number of risk factors that make it more likely to develop. These include:

• diabetes
• stroke
• thyroid disorders
• shoulder injuries
• Parkinson’s disease
• cancer

The symptoms of frozen shoulder are:

• pain in one shoulder
• difficulty rotating and moving the shoulder
• neck pain

Osteoarthritis

Osteoarthritis is the most common joint disorder in the United States. Estimates suggest that 30.8 million people in the U.S. have this condition.

Osteoarthritis occurs when the cartilage at the end of a joint wears down over time.

There are several risk factors that may make osteoarthritis more likely. These include:

• being older
• being female
• having a family history of osteoarthritis

The symptoms of osteoarthritis include:

• pain
• aching
• stiffness

Osteoarthritis can affect any joint, but it is more common in the hands, hips, and knees.

Rotator cuff injury

The rotator cuff comprises four muscles that start on the shoulder blade and go into the shoulder joint. These muscles improve stability in the arm.

Sometimes, however, people injure this set of muscles, either through overuse or as a result of osteoarthritis.

Rotator cuff injuries (RCIs) range from inflammation of the tendons around the area to partial or complete tearing of the muscles.

Symptoms of an RCI include pain that may start off mild but gradually gets worse and difficulty moving the affected arm.

People are most at risk of an RCI when they are over 80 years old. There is also an increased risk of injuring one rotator cuff if the other is already injured.

Shoulder impingement

Shoulder impingement occurs when the shoulder joint traps some surrounding soft tissue. This can happen due to:

• inflammation around the joint
• muscular imbalance in the shoulder
• RCIs

Symptoms of shoulder impingement include:

• persistent pain that is not the result of an injury
• difficulty and pain raising the arm above the head
• pain when sleeping on the affected side

There are a range of treatment options available for shoulder pain due to sleeping. The best option will depend on the specific cause.

The sections below will outline some treatment options in more detail.

Reducing pain and inflammation

The first line of treatment for most types of shoulder pain is over-the-counter pain medication, such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs).

People with arthritis, shoulder impingement, or inflammation in the shoulder may also find that resting the joint helps reduce pain.

Shockwave therapy may help reduce pain in some cases, but this therapy does not heal shoulder injuries.

Physical therapy

Physical therapy and home exercises are very effective treatments for RCIs and shoulder impingement. When it comes to shoulder injuries, the aim of physical therapy is to gradually increase a person’s strength and range of mobility.

Doing physical therapy in a swimming pool can help reduce the burden of gravity on the joints and make it easier for a person to build up their mobility.

The type of physical therapy and exercise a person needs for their shoulder pain will depend on the underlying cause. A physical therapist will be able to advise people on which exercises are safe and which activities to avoid.

Corticosteroids

Corticosteroids are drugs that can reduce inflammation. They can provide short-term pain relief for some shoulder conditions.

For osteoarthritis, corticosteroid injections provide 1–2 weeks of pain relief. However, they can result in cartilage and joint damage if doctors inject them too often.

Similarly, for frozen shoulder, oral corticosteroids can improve symptoms within the first 6 weeks. However, the symptoms may come back after this time, even if people continue taking the treatment.

Steroid injections may be more effective for frozen shoulder when a person combines them with another treatment, such as physical therapy.

For RCIs, there is some evidence to suggest that corticosteroid injections are more successful if doctors use ultrasound to identify the best place to inject the medication.

Surgery

If a person does not find relief from pain medication, steroid treatments, or physical therapy, a doctor may refer them to surgery.

For people with osteoarthritis, this may involve joint replacement surgery. This procedure requires a surgeon to replace the joint with an artificial implant.

For RCIs, a person may need to undergo rotator cuff repair surgery. Depending on the severity of the injury, the surgeon may either smooth the tendon or reattach the tendon where it broke.

A doctor treating someone with frozen shoulder may recommend hydrodilation or arthroscopic capsular release surgery.

During hydrodilation, a doctor will inject anesthetic into the arm at a pressure high enough to stretch the joint. However, this treatment can be very painful.

Arthroscopic capsular release surgery involves a surgeon cutting out the inflamed muscle that is making the shoulder freeze. This is the most invasive form of treatment for frozen shoulder.

Around 30% of shoulder impingement cases do not respond to nonsurgical treatment and will require surgery.

There are several different surgeries for shoulder impingement, including:

• Subacromial decompression: During this operation, a surgeon will either remove the deltoid muscle that is causing the impingement entirely from the bone or separate some of the deltoid fibers, leaving the muscle attached.
• Bursectomy: Inflammation of a tissue called the bursa can cause shoulder impingement. During this operation, a surgeon will remove the bursa.
• RCI surgery: If the shoulder impingement is the result of an RCI, a doctor may refer a person for RCI surgery.

Prevention

To prevent shoulder pain from sleeping, a person can:

Change sleeping position

A 2018 study found that some sleeping positions may help reduce or protect against shoulder pain.

For example, positions that the researchers named “freefaller” and “starfish” — wherein a person lies with their arms extended above their head, either on their front or their back — were less associated with shoulder pain.

However, this study did not take into account other factors that could affect the amount of pain a person experiences after sleep.

Researchers should continue to study the effects of specific sleeping positions on pain to better understand the relationship.

Change the mattress

A 2015 study found that a medium-firm mattress helped reduce musculoskeletal pain in older adults.

Using medium-firm mattresses led to less pain than very firm mattresses, which suggests that having a mattress that is either too hard or too soft could make body aches worse.

Having the right pillow is also important. Different pillows can help reduce pain, depending on a person’s typical sleeping position.

• For back sleepers, choose a thinner pillow that is thicker at the bottom and cradles the neck.
• For stomach sleepers, choose a very thin pillow or no pillow at all.
• For side sleepers, choose a firm, thick pillow that keeps the head level with the shoulders.

It is important to replace pillows every 18 months. Once a pillow loses its shape, it does not support the head and body as it should.

Improve sleep hygiene

For some people, not getting enough sleep may lead to increased pain. One study found that people who got less sleep were two to three times more likely to develop a pain condition.

Poor quality sleep leads to an increase in two different kinds of protein in the body. High levels of these proteins, called interleukin-6 and C-reactive protein, can cause the body to feel more pain.

Sleep hygiene is a series of practices that help regulate a person’s circadian rhythm and promote a good night’s sleep.

Habits that help with sleep hygiene include:

• getting exposure to natural light in the daytime and darkness at night
• creating a relaxing bedtime routine and sleep environment
• avoiding stimulants such as caffeine or nicotine in the evening
• avoiding naps of longer than 30 minutes during the daytime

Although alcohol consumption may help a person feel drowsy enough to sleep, it also reduces sleep quality later in the sleep cycle. The Sleep Foundation recommend drinking in moderation and away from bedtime.

Home remedies

There are ways to treat temporary shoulder pain at home. For a shoulder injury, the National Institute of Arthritis and Musculoskeletal and Skin Diseases recommend the RICE approach:

• Rest the shoulder for 48 hours.
• Ice the shoulder for 20 minutes four to eight times per day.
• Compress the shoulder using a wrap or a bandage.
• Elevate the shoulder above the chest.

NSAIDs such as ibuprofen may also help reduce shoulder pain in the short term. People should not use NSAIDs for more than 1–2 weeks, as they can cause side effects such as stomach bleeding when a person uses them for long periods of time.

Curcumin, a component of the spice turmeric, may also reduce joint pain. A review of three studies found that curcumin made a significant difference to people with arthritis in all three.

A 2010 study suggests that curcumin combined with frankincense may work more effectively than diclofenac (Voltarol).

When to see a doctor

It is important to see a doctor if shoulder pain does not go away despite making improvements to sleeping positions, sleep hygiene, and the mattress.

It is possible that the shoulder pain is a symptom of an underlying condition that may need medical attention.