Aching or piercing shoulder pain caused by a rotator cuff injury can get in the way of a good night’s sleep. In fact, researchers report that people with rotator cuff tears have trouble falling asleep, staying asleep, and getting good quality sleep. 1 Ansok CB, Khalil LS, Muh S. Objective assessment of sleep quality in patients with rotator cuff tears. Orthop Traumatol Surg Res. 2020;106(1):61-66. doi:10.1016/j.otsr.2019.09.033
If you have a painful rotator cuff injury, a few strategies can help you get a more restful night’s sleep as soon as tonight. Learn about these strategies as well as ways to achieve long-term relief.
Why rotator cuff pain and sleep matter
Trouble sleeping is often what prompts people to seek medical help for a rotator cuff injury. 2 Jacobson BH, Boolani A, Dunklee G, Shepardson A, Acharya H. Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Appl Ergon. 2010;42(1):91-97. doi:10.1016/j.apergo.2010.05.004 In addition, chronic shoulder pain and insomnia have been linked to increased feelings of anxiety and depression. 3 Marcuzzi A, Skarpsno ES, Nilsen TIL, Mork PJ. The interplay between multisite pain and insomnia on the risk of anxiety and depression: the HUNT study. BMC Psychiatry. 2022 22:124. doi:10.1186/s12888-022-03762-0 , 4 Wong WK, Li MY, Yung PS, Leong HT. The effect of psychological factors on pain, function and quality of life in patients with rotator cuff tendinopathy: A systematic review. Musculoskelet Sci Pract. 2020;47:102173. doi:10.1016/j.msksp.2020.102173 Addressing these problems early may benefit you both physically and mentally.
Tips for getting better sleep despite rotator cuff pain
It can take weeks or even months to heal an injured rotator cuff. In the meantime, try these 5 strategies to get a better night’s rest:
1. Sleep on your back
While there is very little research about shoulder injuries and sleeping positions, 5 Holdaway LA, Hegmann KT, Thiese MS, Kapellusch J. Is sleep position associated with glenohumeral shoulder pain and rotator cuff tendinopathy: a cross-sectional study. BMC Musculoskelet Disord. 2018;19(1):408. Published 2018 Nov 23. doi:10.1186/s12891-018-2319-9 most physicians recommend sleeping on your back. Laying on your back won’t put pressure on the injured shoulder or force it into an awkward position.
For the first few days or weeks, when symptoms are at their worst, consider sleeping on a wedge pillow or in a recliner. Sleeping on a slight incline will help you avoid rolling on to your side or stomach in your sleep. Sleeping on the affected shoulder is usually painful 6 Zenian J. Sleep position and shoulder pain. Med Hypotheses. 2010;74(4):639-643. doi: 10.1016/j.mehy.2009.11.013 , 7 Kempf B, Kongsted A. Association between the side of unilateral shoulder pain and preferred sleeping position: a cross-sectional study of 83 Danish patients. J Manipulative Physiol Ther. 2012;35(5):407-412. doi:10.1016/j.jmpt.2012.04.015 and discouraged until you are fully healed.
2. Try a new mattress
There is not a lot of peer-reviewed medical research about how mattresses affect sleep, but a few small studies 2 Jacobson BH, Boolani A, Dunklee G, Shepardson A, Acharya H. Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Appl Ergon. 2010;42(1):91-97. doi:10.1016/j.apergo.2010.05.004 , 8 Verhaert V, Haex B, De Wilde T, et al. Ergonomics in bed design: the effect of spinal alignment on sleep parameters. Ergonomics. 2011;54(2):169-178. doi:10.1080/00140139.2010.538725 , 9 Hibi H, Ueda M. Body posture during sleep and disc displacement in the temporomandibular joint: a pilot study. J Oral Rehabil. 2005;32(2):85-89. doi:10.1111/j.1365-2842.2004.01386.x suggest what most people already believe: sleeping on a comfortable, high-quality mattress may help you get a better night’s rest, whether you have joint pain or not. A good mattress may take some pressure off the muscles in the neck, spine, and shoulders, helping improve sleep.
3. Try a new pillow
The height of your pillow may affect the amount of stress put on your shoulder, 10 Lei JX, Yang PF, Yang AL, Gong YF, Shang P, Yuan XC. Ergonomic Consideration in Pillow Height Determinants and Evaluation. Healthcare (Basel). 2021;9(10):1333. Published 2021 Oct 7. doi:10.3390/healthcare9101333 particularly if you are a side sleeper. There is no scientifically established “best” pillow or pillow height, so you may need to try out different pillows to identify one that works well for you. Your doctor or physical therapist may have recommendations or helpful tips for choosing a pillow.
4. Stay active
Don’t let your injured rotator cuff stop you from exercising altogether. Research shows getting regular exercise improves sleep time and quality 11 Tseng TH, Chen HC, Wang LY, Chien MY. Effects of exercise training on sleep quality and heart rate variability in middle-aged and older adults with poor sleep quality: a randomized controlled trial. J Clin Sleep Med. 2020;16(9):1483-1492. doi:10.5664/jcsm.8560 , 12 Yang PY, Ho KH, Chen HC, Chien MY. Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. J Physiother. 2012;58(3):157-163. doi:10.1016/S1836-9553(12)70106-6 , 13 Youngstedt SD. Effects of exercise on sleep. Clin Sports Med. 2005;24(2):355-xi. doi:10.1016/j.csm.2004.12.003 as well as mood and blood circulation. 14 Benefits of Physical Activity. Centers for Disease Control and Prevention. Last reviewed November 1, 2021. Accessed April 21, 2022. https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm
Even if you are wearing a shoulder sling, you can go for a walk. If you’re not wearing a sling, be sure to avoid exercises that could strain the injured shoulder and make your pain worse—for example, recumbent biking is a great choice, but fast- or moderately-paced swimming is probably not. Gentle movements and stretches that help maintain range of motion are usually okay. A physician or physical therapist can help you make safe choices.
5. Take an over-the-counter pain reliever before bedtime
Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and relieve pain, which may help you sleep. Keep in mind, NSAIDs may reduce pain but can damage your stomach lining if taken every day for an extended period, 2 Jacobson BH, Boolani A, Dunklee G, Shepardson A, Acharya H. Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Appl Ergon. 2010;42(1):91-97. doi:10.1016/j.apergo.2010.05.004 so they are not a good long-term solution. Acetaminophen is safer for your stomach and reduces pain but not inflammation. Topical pain relievers are typically safe but may be less effective at reducing your pain.
Choices about sleep positions, mattresses, pillows, activity level, and pain relievers may vary from person to person. You can talk to your physician about which sleep strategies are the most comfortable, safe, and affordable for you.
Of course, the strategies described above will not repair or heal your damaged rotator cuff. To really solve your sleep problem, you may need to treat your injured shoulder.
Non-surgical rotator cuff treatments for better sleep
If the rotator cuff injury happened recently, a physician may recommend resting the affected shoulder by wearing a sling for some or all of the day. If the injury’s initial inflammation has died down, he or she may prescribe physical therapy, particularly if the rotator cuff tear is considered minor or moderate. 15 Narvani AA, Imam MA, Godenèche A, et al. Degenerative rotator cuff tear, repair or not repair? A review of current evidence. Ann R Coll Surg Engl. 2020;102(4):248-255. doi:10.1308/rcsann.2019.0173
If your shoulder pain persists after these early treatments, a therapeutic injection or surgery may be recommended.
Rotator cuff repair surgery for better sleep
Depending on several factors, such as the severity of the tear and the patient’s age, a physician may suggest rotator cuff repair surgery. Research suggests that rotator cuff surgery may decrease pain and improve quality of life, including quality of sleep. 16 Cho CH, Song KS, Hwang I, Warner JJ. Does Rotator Cuff Repair Improve Psychologic Status and Quality of Life in Patients With Rotator Cuff Tear?. Clin Orthop Relat Res. 2015;473(11):3494-3500. doi:10.1007/s11999-015-4258-1 In one study of 326 patients who underwent surgery, 46% of patients reported improved sleep after 3 months, and 89% reported improved sleep after 12 months. 17 Dolan MT, Lowenstein NA, Collins JE, Matzkin EG. Majority of Patients Find Sleep Patterns Return to Normal 6 Months Following Rotator Cuff Repair [published online ahead of print, 2022 Feb 24]. J Shoulder Elbow Surg. 2022;S1058-2746(22)00217-8. doi:10.1016/j.jse.2022.01.122
Rotator cuff surgery is an elective procedure. This means that even if a physician recommends surgery, it’s up to you whether or not to have it. Be aware, though, that postponing surgery a year or longer may decrease the likelihood of a successful repair. 18 van der List JP, Kok LM, Alta TDW, van der List MPJ, van Noort A. Role of Delay Between Injury and Surgery on the Outcomes of Rotator Cuff Repair: A Systematic Review and Meta-analysis [published online ahead of print, 2022 Jan 31]. Am J Sports Med. 2022;3635465211069560. doi:10.1177/03635465211069560
Don’t let rotator cuff pain affect your sleep. Simple lifestyle changes and physician-supervised treatment can help decrease your pain and improve your sleep and quality of life.