Shoulder pain at night is a common problem that can significantly affect sleep quality and daily functioning. Many people notice that the pain worsens when they lie down or change sleeping positions, making it difficult to rest and often leading to additional stress and fatigue.
In this article, we explain why shoulder pain occurs more frequently at night, explore the most common causes, and discuss when it may be time to seek professional help.
How Common Is Shoulder Pain at Night and How Does It Affect Sleep?
Shoulder pain that occurs or worsens during sleep is a common symptom among people with various shoulder conditions. Research suggests that up to 30–50% of adults may experience shoulder pain at some point, with a significant proportion reporting shoulder pain at night as their most pronounced symptom.
This type of pain often disrupts sleep quality by making it difficult to find a comfortable sleeping position and by causing frequent awakenings throughout the night. Lack of quality sleep not only slows down recovery but can also increase pain sensitivity and lead to additional muscle tension, further aggravating the condition.
For this reason, shoulder pain at night should be recognized as a serious symptom that deserves attention, timely diagnosis, and an appropriate treatment approach.
Most Common Causes of Shoulder Pain at Night
Shoulder pain at night can be a symptom of various conditions affecting the shoulder joint and the surrounding tissues. Some of the most common causes include:
1. Shoulder Impingement Syndrome
Shoulder impingement syndrome is a painful condition that occurs when the top of the shoulder blade (the acromion) compresses the soft tissues beneath it during arm elevation. This leads to inflammation of the rotator cuff tendons and the bursa, causing pain, reduced range of motion, and discomfort that often becomes more noticeable at night.
2. Rotator Cuff Tear
A rotator cuff tear can be partial or complete and may develop as a result of an acute injury or gradual wear and tear due to degenerative changes over time. In addition to shoulder pain—often worse at night—this condition commonly causes weakness and difficulty lifting or rotating the arm.
3. Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder is characterized by thickening and stiffness of the shoulder joint capsule, leading to pain and significant limitation of movement. It most commonly affects people between the ages of 40 and 60 and is well known for causing persistent shoulder pain at night and sleep disturbances.
4. Shoulder Tendinitis
Shoulder tendinitis involves inflammation or degenerative changes of the rotator cuff tendons. It may be acute or chronic and is often associated with repetitive strain, overuse, or aging. Pain frequently worsens during rest and can present as shoulder joint pain at night.
5. Calcific Tendinitis
Calcific tendinitis occurs when calcium deposits accumulate within the rotator cuff tendons. This condition can cause severe acute pain or chronic shoulder pain at night, most commonly affecting individuals between 30 and 60 years of age.
6. Shoulder Osteoarthritis and Inflammatory Arthritis
Shoulder osteoarthritis is a degenerative joint disease that leads to gradual cartilage breakdown, pain, and stiffness, particularly in older adults or those with a history of shoulder injuries. Inflammatory forms of arthritis—such as rheumatoid arthritis, psoriatic arthritis, or, more rarely, gout—can also cause shoulder pain that becomes more pronounced at night.
7. Referred Pain to the Shoulder
Referred shoulder pain occurs when pain originating in other parts of the body is perceived in the shoulder. For example, neck or upper back problems may cause pain radiating into the shoulder.
Cardiac conditions, such as a heart attack, can produce pain that spreads to the left shoulder, arm, or jaw. Certain tumors may also present as shoulder pain. Additionally, conditions affecting internal organs—such as gallbladder disease, liver problems, or pancreatitis—can cause pain in the right shoulder region, sometimes making diagnosis more challenging.
| Cause | Description |
|---|---|
| Shoulder Impingement Syndrome | Pain occurs when the acromion compresses the soft tissues beneath it during arm elevation, leading to inflammation of the tendons and bursa. |
| Rotator Cuff Tear | Partial or complete tendon tear caused by injury or gradual wear and tear. Commonly results in shoulder pain and weakness. |
| Frozen Shoulder | Thickening and stiffness of the shoulder joint capsule, causing pain and significant restriction of movement. |
| Shoulder Tendinitis | Inflammation or degeneration of the rotator cuff tendons due to overuse or aging, leading to pain and reduced mobility. |
| Calcific Tendinitis | Calcium deposits accumulate in the rotator cuff tendons, often causing severe shoulder pain, especially in people aged 30–60. |
| Shoulder Osteoarthritis | Degeneration of shoulder cartilage that causes pain and stiffness, commonly related to aging or previous injuries. |
| Inflammatory Arthritis | Conditions such as rheumatoid arthritis, psoriatic arthritis, or gout can cause shoulder pain, swelling, and stiffness. |
| Referred Pain | Pain originating from other areas (e.g. neck, heart, gallbladder) that is felt in the shoulder, often complicating diagnosis. |
Why Does Shoulder Pain Often Feel Worse at Night?
Although there is no single scientific explanation for why shoulder pain becomes more intense at night, several factors are known to worsen symptoms. Sleeping on your side, direct pressure on the shoulder, and mattress characteristics often contribute to increased discomfort during the night.
If you have shoulder tendinopathy, shoulder impingement syndrome, shoulder arthritis, or other shoulder conditions, overuse and strain of the shoulder during the day can lead to more pronounced shoulder pain at night. Chronic muscle tension and stress may also intensify pain during nighttime hours.
During the day, the weight of the arm and the effects of gravity help increase the space within the shoulder joint, reducing pressure on the bursa and the rotator cuff tendons. At night, however, this effect is lost when lying flat.
In addition, muscles are more relaxed during sleep and are not actively working to center the head of the humerus within the socket, which further reduces the available space in the shoulder joint.
Direct pressure from sleeping on the painful side can significantly worsen symptoms, especially when maintained for long periods during deep sleep. Prolonged pressure throughout the night directly compresses the subacromial space and places stress on already inflamed tissues and the bursa.
Uncontrolled arm movements during sleep or sleeping with the arm across the chest or overhead for extended periods can also contribute to increased pain at night and stiffness or discomfort after waking.
Tips to Relieve Shoulder Pain at Night While Sleeping
Going to bed with shoulder pain can be difficult, and falling back asleep after waking up due to pain can be even harder. Here are several practical tips to help relieve shoulder pain at night and improve sleep quality:
1. Rest Your Shoulder During the Day
Resting the shoulder during the day and avoiding movements that provoke pain can help reduce inflammation and irritation, making it easier to sleep at night.
2. Take Medication Before Bed
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may help relieve pain.
Taking them 30–60 minutes before bedtime allows enough time for the medication to take effect.
3. Sleep on the Pain-Free Side
Sleeping on the painful side increases pressure on the shoulder and may cause sudden pain that wakes you up.
Sleeping on the opposite side often reduces discomfort.
4. Place a Pillow Behind Your Back
People often change positions unconsciously during sleep. Placing a pillow behind your back can help prevent you from rolling onto the painful shoulder.
This is a simple but effective strategy.
5. Sleep on Your Back
If your shoulder hurts even when you are not lying on it, try sleeping on your back.
This position reduces pressure on both shoulders.
6. Change Sides of the Bed
If you find it easier to control your movements from the other side of the bed, consider switching places with your partner.
This may help prevent rolling toward the painful side.
7. Elevate the Head of the Bed
Slightly elevating the head of the bed can reduce the likelihood of turning onto the painful shoulder.
It may also decrease shoulder pressure and improve breathing.
These simple adjustments can significantly improve sleep quality. Experiment to find the combination of tips that works best for you.
When Should You See a Doctor for Shoulder Pain at Night?
Occasional shoulder pain—especially after physical activity or an awkward sleeping position—is not uncommon. However, there are situations in which it is important to seek medical attention as soon as possible.
You should see a doctor if:
- shoulder pain lasts longer than a few days and does not improve even with rest
- the pain wakes you up at night or worsens every time you try to sleep
- you are unable to lift your arm above shoulder level or have a limited range of motion
- you experience weakness in the arm, tingling, or loss of sensation
- the shoulder appears deformed, swollen, or is extremely tender to the touch
- the pain started after an injury or a fall
- the pain radiates to the chest, jaw, or left arm, which may indicate a serious condition such as a heart attack
Do not ignore pain that does not go away. Early diagnosis and timely treatment are key to preventing complications and achieving a better recovery.
Frequently Asked Questions About Shoulder Pain at Night
Why does my shoulder hurt more at night than during the day?
During sleep, your muscles are relaxed, and gravity no longer helps stabilize the joint. Lying on the painful shoulder further increases pressure and inflammation, making the pain worse.
Which side should I sleep on if my shoulder hurts?
It is recommended to sleep on your healthy side, with a pillow supporting your back. If possible, sleeping on your back is often the best option to reduce pressure on the shoulder.
Can my mattress affect shoulder pain at night?
Yes. Mattresses that are too firm or too soft may not provide adequate support and can increase pressure on the shoulder, especially if you sleep on your side.
Is shoulder pain at night always related to an injury?
No. Pain can also result from degenerative changes, poor sleeping positions, or referred pain from the neck, chest, or abdominal area.
Can cancer cause shoulder pain?
Unfortunately, yes. Tumors in the upper part of the lung (such as Pancoast tumors) can affect nearby nerves and cause pain radiating to the shoulder and arm. If the pain persists and is accompanied by coughing, weight loss, or difficulty breathing, seek medical attention immediately.
Do painkillers help if my shoulder hurts at night?
Yes. NSAIDs, such as ibuprofen, can reduce inflammation and improve sleep quality, especially if taken 30–60 minutes before bedtime.
Conclusion
Shoulder pain at night is a common issue that can significantly affect sleep quality and daily functioning. Understanding the underlying causes—from impingement and tendinitis to arthritis or referred pain—can help manage symptoms more effectively. Simple adjustments in sleeping position, support, and daily shoulder care often reduce discomfort, while early recognition of persistent or severe pain is key to preventing further complications and maintaining overall shoulder health.
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