Shoulder pain that worsens at night can be one of the most frustrating things to deal with. You finally lie down to rest, but instead of relaxing, you are shifting around trying to find a position that does not hurt. For many people, shoulder pain feels manageable during the day, but becomes more intense or noticeable when they are in bed. If this sounds familiar, you are not alone. Night-time shoulder pain is common, but it is not something you should have to put up with.
This blog explores why shoulder pain tends to flare up at night, what conditions are commonly linked to it and most importantly, what you can do to get some relief.
Why Does Shoulder Pain Get Worse at Night?
There are a few reasons the shoulder becomes more painful at night. First, when you lie down, there is often increased pressure on the shoulder joint, especially if you are a side sleeper. The weight of your arm and lack of support in certain positions can irritate inflamed or sensitive tissues.
Secondly, at night, you are not distracted. During the day, you are moving about, busy with tasks or work. But at night, when everything is quiet, your brain has fewer things to focus on. Pain signals that may have been easy to ignore become much more noticeable.
There is also the issue of reduced circulation. Lying still for long periods can reduce blood flow slightly to certain areas, and if tissues are already irritated or inflamed, this can increase stiffness and discomfort.
Common Causes of Night-time Shoulder Pain
Several conditions can lead to shoulder pain that worsens at night. Some of the most common include:
Rotator Cuff Tendinopathy
This involves irritation or degeneration of the tendons in the rotator cuff. It often causes pain when lifting the arm, reaching behind your back or lying on the affected side. It can feel like a deep ache that wakes you up if you roll onto the sore shoulder.
Shoulder Impingement
Impingement occurs when structures in the shoulder become compressed during movement, particularly overhead or when lying on your side. It is often worse when the arm is raised or positioned across the body.
Frozen Shoulder (Adhesive Capsulitis)
This condition causes thickening and tightening of the shoulder capsule, leading to severe stiffness and limited movement. Pain is often worse at night and may disrupt sleep significantly.
Arthritis
Osteoarthritis or inflammatory arthritis in the shoulder joint can lead to dull aching pain that is worse after periods of rest. Some people also report increased discomfort with changes in temperature or weather.
Referred Pain from the Neck
In some cases, shoulder pain does not come from the shoulder at all. Nerve irritation or disc issues in the neck can cause pain that travels to the shoulder and upper arm. This can also worsen when lying down, especially if the neck is not well supported.
Bursitis
The bursae are small fluid-filled sacs that help reduce friction in joints. When the bursa in the shoulder becomes inflamed, it can cause sharp pain with movement and a deep ache at night.
What You Might Notice at Night
People with night-time shoulder pain often describe the following:
- Pain when lying on the affected side
- A dull ache that wakes them up during the night
- Discomfort when trying to turn or reposition in bed
- Difficulty falling back asleep after being woken by pain
- Stiffness in the morning that eases with movement
How to Sleep Better With Shoulder Pain
Improving your sleep when dealing with shoulder pain often comes down to positioning and support. Here are some tips:
Try sleeping on your back
This avoids direct pressure on the shoulder. Place a small pillow under the affected arm to keep it slightly elevated and supported.
If you must sleep on your side, sleep on the opposite side
Place a pillow in front of you and rest your painful arm on top of it. This can reduce strain and prevent it from pulling forward or rotating awkwardly.
Use a firmer pillow under your head
A well-supported neck can help reduce any strain coming from the cervical spine. If your pillow is too flat or too high, it can affect the shoulder joint.
Apply warmth before bed
A hot water bottle or warm compress over the shoulder before sleep can help relax the muscles and reduce tension.
Gentle stretching and mobility exercises during the day
Keep the shoulder moving within a pain-free range. Do not push into sharp pain, but avoid letting the joint become too stiff from disuse.
When to See a Physiotherapist
If your shoulder pain is disrupting your sleep regularly, it is worth getting it assessed. Night-time pain can be a sign of inflammation, mechanical restriction or muscular imbalance that needs attention.
A physiotherapist can:
- Assess your movement, posture and shoulder mechanics
- Identify if the pain is coming from the joint, tendons, bursa or neck
- Provide hands-on treatment to ease pain and improve mobility
- Prescribe exercises to support healing and prevent recurrence
- Offer advice on positioning, support and pacing
Getting an accurate diagnosis is important, especially if the pain has been going on for more than a few weeks or is getting worse. Imaging is sometimes required, but in many cases a clinical assessment is enough to understand the cause.
Final Thoughts
Shoulder pain that flares up at night is more than just an inconvenience. It affects your sleep, mood and overall quality of life. Fortunately, it is often manageable with the right treatment and a few simple changes to how you move and sleep.
At Red Physiotherapy Northampton, we work with patients every day who are dealing with night-time shoulder pain. With a tailored approach and careful guidance, it is possible to ease discomfort and get back to more restful nights.
If shoulder pain is keeping you up, do not ignore it. Help is available, and recovery is possible with the right support.