Shoulder pain can often be exacerbated at night, by position, bedding, and the stillness of sleep.

Let’s face it: Pain and sleep aren’t a great mix.

People in pain often struggle to fall asleep, wake up frequently throughout the night or fail to enter restorative deep sleep stages once they do manage to get a few Zzzs. This is something I hear about a lot from my patients – especially those who come to see me with a stiff, painful shoulder.

I’m not surprised shoulder pain is so effective (unfortunately) at keeping people awake. As the most mobile joint in the body, a healthy shoulder requires coordinated action of dozens of muscles, tendons, ligaments and bones to function properly. The increased mobility can increase the margin for error, meaning the shoulders are often at risk of injury.

The problem, of course, is that losing sleep over a painful shoulder can actually worsen the pain and delay healing, not to mention cause other problems associated with sleep deprivation – low mood, memory problems and an increased risk of other health conditions. Not getting enough sleep has even been associated with reduced vaccine effectiveness, which has huge implications for anyone preparing to get a COVID-19 vaccine.

I encourage anyone with persistent shoulder pain to see a physical therapist, who can help them find relief. In the meantime, let’s take some time to better understand this common phenomenon and what you can do about it.

Shoulder pain causes

Repetitive overhead movement, advancing age, accidents and poor posture are primary risk factors for shoulder problems such as tendinitis,

osteoarthritis, frozen shoulder, impingement syndrome and rotator cuff tears. These conditions are associated with tissue damage, inflammation, swelling, stiffness and pain that can interrupt daily activities ranging from getting dressed to throwing a tennis ball to your dog.

Many people notice their shoulder pain gets even worse at night. This could be for a number of reasons, including:

• Sleeping position. Many people prefer to sleep on their side, but lying directly on the affected shoulder feels too uncomfortable. This forces them to toss and turn until they find an acceptable position – and may cause them to wake up with a yelp if they roll over onto their affected side in their sleep.

• Being still. Lying down in bed changes the relative position of your shoulder, diminishes the effect of gravity in the joint and allows the muscles and tissues to relax. Together, these changes can slow blood flow in the area and contribute to stiffness and worsening inflammation. If you struggle with a problem such as hypermobility or instability, you may even find your upper arm bone resting out of alignment when your body is in a horizontal position. Ouch!

• Mattress and pillow. Super-thick pillows and very firm mattresses can strain many tissues of the neck and shoulder.

• Cognitive and neurochemical changes. Emotionally and mentally, many of us simply perceive pain differently at night. Without other activities to keep us busy, we may focus on how uncomfortable we feel and how little sleep we’re getting, which can lead to a vicious spiral of worry and stress.

Anecdotally, I’ve even noticed that nighttime breathing patterns can influence a person’s shoulder pain. Most people breathe through their mouths as they sleep, which could strain the jaw and other tissues in the neck and shoulder area. Conversely, nasal breathing helps reduce pain and calm the nervous system, so going eight hours without it may prevent natural relief.

When you can't sleep

I mentioned that consulting with a physical therapist is one of the most effective solutions for nighttime shoulder pain. Once we diagnose your underlying condition and identify its contributing factors, we can implement a personalized treatment plan that will directly address your symptoms and help your shoulder heal. In the meantime, consider these strategies for managing your pain and getting better sleep:

• Use supportive pillows. For example, sleep on your nonaffected side and place a pillow between your knees and under your affected arm. Also try sleeping on your back with a pillow under your knees and another pillow tucked under the affected arm.

• Exercise. Perform gentle range-of-motion exercises at the neck and shoulder before and after bed.

• Practice good sleep hygiene. Go to bed at the same time every night, have a relaxing nighttime routine, dim the lights in the evening, avoid eating too close to bedtime, minimize alcohol and caffeine intake, and make your bedroom dark and cool.

Kim Gladfelter is owner of PhysioFit Physical Therapy & Wellness in Los Altos, which offers both in-person and virtual physical therapy and virtual therapeutic fitness. For more information, call 887-6046 or visit physiofitpt.com.