Sleeping with arms up


What Does Sleeping With Your Arms Above Your Head Mean? Experts Say It Could Mean A Few Things

If you’re anything like me, then you probably don’t give a second thought to your sleep position until you’re having one of those nights that make you toss and turn for what feels like forever. After a night when I could only get comfortable with my arms splayed out behind me, I couldn’t help but wonder: What does sleeping with your arms above your head mean? Does it impact your sleep quality or your health? This might sound silly, but bear with me: Could it even reveal something crucial about your personality? According to experts, it could mean a whole lot.

Chris Brantner, a certified sleep science coach at, tells Elite Daily over email that sleeping in a certain position each night could just be a habit, and nothing more. Another explanation, he says, could be that you sleep with a partner, and raise your arms above your head to create extra space for cuddles.

However, sleeping this way could actually mean you aren’t breathing as easily as you should be. “Some people sleep with their arms above their heads, as it’s a natural way of opening up the lungs,” Brantner says. “If you don’t typically fall asleep in this position, but find yourself waking up like this, it could be a sign that you’re having trouble breathing in the middle of the night.” He adds that sleeping on your back can definitely lead to snoring, too.

It’s also possible that this position could lead to pain throughout the day. “Sleeping on your back in starfish position may induce lower back pain and sleep apnea,” Terry Cralle, RN, a Better Sleep Council certified clinical sleep educator, tells Elite Daily over email. Luckily, though, you don’t have to totally change the way you sleep if this position starts causing you discomfort. Just make some minor tweaks to make sure your body is well-supported: “If you experience back pain, consider placing a pillow or rolled-up towel under your knees to align the natural curve of your spine,” Cralle suggests.

If you sleep this way, you’re in the minority, according to a study by the Better Sleep Council. The 2017 research found that “starfish sleepers,” aka those who lie on their back with their arms up near their head or pillow, make up only seven percent of the population. Most people sleep in the fetal position, the study found.

But what does it all mean? Brantner admits he isn’t sure how much stock he puts into deciphering someone’s personality based on their sleep position alone. The truth is that personality types are complex, and while they might be based on a whole host of factors, including how you were raised, your natural inclinations, your learned behaviors, sleep probably isn’t one of them. But he says there is actually a common belief about what a starfish sleeping pattern can say about you: Basically, the sleep science coach tells Elite Daily, many people believe starfish sleepers aren’t comfortable being the center of attention, and may also be better listeners than other people. Whether that accurately captures your personality or not, embrace your uniqueness, you sexy starfish, you.

Side Sleepers: How to Sleep on Your Side the Right Way

Best Mattress for Side Sleeping

Finding the best mattress for side sleeping isn’t easy. Many mattress types can satisfy a side sleeper’s needs, but some are definitely better than others. Let’s take a look at what to consider when shopping for a mattress for side sleepers.

What mattress type is best for a side sleeper?

When you sleep on your side, you need a mattress that supports your curved areas: your neck and your waist. The muscles and ligaments of your back heal themselves during sleep. Good sleep posture and spine alignment promote the nightly healing and regenerative process. A supportive mattress helps keep your spine aligned during that restorative period and will have the biggest impact on your quality of sleep. But which mattress offers the best support for side sleepers?

Let’s look at a few mattress types for side sleepers to consider:

  • Foam mattress: This type of mattress is almost entirely made out of foam. The foam layer in these mattresses can have some contour support but may not offer enough for side sleepers.
  • Memory foam mattress: This is a soft mattress that can provide contouring comfort, but memory foam is known for sleeping hot and smelling funny. It also has low responsivity, making it harder to change positions.
  • Gel memory foam mattress: Similar to memory foam, a gel foam layer has contouring support. It takes a little longer to heat up than traditional memory foam, but you are still likely to wake up sweaty.
  • Latex memory foam mattress: Latex foam is more responsive and breathable than memory foam but also more expensive.
  • Innerspring mattress: Traditional innerspring mattresses usually feature a system of springs that are all connected beneath the mattress. Because of this, there is a lot of motion transfer when a partner gets in or out of bed. Innerspring mattresses have a tendency to be too firm for side sleepers.
  • Hybrid mattress: A hybrid mattress contains a pocketed coil base layer and a comfort layer made of foam, pillowtop cotton — or if you’re lucky — the Purple Grid™. The mix of support and softness makes this type of mattress a good pick for side sleepers. The individual pocket coils provide ultimate responsiveness and minimal motion transfer.

What is the Best Mattress for a Side Sleeper?

We think the Purple mattress is the best mattress for side sleepers for many reasons. The patented Purple Grid™, which is only available in Purple mattresses, is an all-natural elastic polymer that perfectly contours to the shape of your body. Soft, responsive, and super breathable, the Purple Grid™ provides proper spinal alignment and all-night comfort.

The Purple Grid™ is gentle on the shoulders and hips. Both get the brunt of the pressure when you’re a side sleeper. The Purple mattress is supportive but also gentle on your pressure points — those places on your body that press down into the mattress when you sleep. If you wake up with pain in your shoulders and hips or numbness in your legs or arms, it’s time to try a pressure relieving mattress from Purple.

All Purple mattresses feature the Purple Grid™, and you can even customize the thickness of this comfort layer with the Purple® Hybrid Premier. For the ultimate side-sleeper experience, we recommend the Purple® Hybrid and Purple® Hybrid Premier. Both models come in standard bed sizes and can ship directly to your front door.

Rest easy with Purple’s 100-night risk-free trial and 10-year warranty.

Best Pillows for Side Sleepers

Pillows aren’t just for your head and neck, they help keep your entire spine in the proper position while you sleep. Your pillow should support the natural curve of your neck—your head shouldn’t curve down nor be propped up too high. A good rule of thumb is that your ear, shoulder, and hips should be aligned.

Test out different pillows until you find the perfect fit. If you have large shoulders, you need a larger pillow. A pillow that’s too high or too flat can cause muscle strain on your back, neck, and shoulders. The ideal side sleeper pillow will be adjustable so you can sleep in different positions comfortably.

Side sleepers actually need two pillows for good alignment and maximum comfort—one for their head and another for their knees. But beware of the fetal position—you don’t want to over-round your lower back.

If you’re sick and tired of pillows letting you (and your head) down, it’s time to put your body in perfect harmony with the Purple Harmony Pillow. Guaranteed not to fall flat and let your head down, this Purple pillow is a side sleeper’s dream come true.

The Purple® Harmony Pillow is made with the same Purple Grid™ technology as Purple mattress, containing over 1500 air channels so you can keep a cool head all night. Responsive, adaptive, and supportive, this pillow will put your joints, your spine, and your smile into perfect harmony.

Is Side Sleeping Bad for Your Shoulder?

Some doctors discourage side sleeping because it can cause damage to the rotator cuff of your shoulder. Side sleepers place a lot of pressure on this group of tendons, so they need a pillow with good support.

Minimize left or right shoulder pain by making sure you’ve got your three pillows in check. You’ll need one to provide proper neck support, one thin pillow between your knees, and one more in front of your stomach.

If you have shoulder pain from sleeping on your side, you can minimize the discomfort by wearing an arm sling to bed. The sling will keep you from sleeping with your arm in a strange and uncomfortable position throughout the night. Of course, you can always sleep on your good side to alleviate shoulder pain, but old habits are hard to break. To help, place a pillow at your back or sleep with your back to the wall to keep from returning to the bad shoulder side.

Make sure you have a mattress that hugs your curves in all the right places, and your pressure points will find sweet relief. A mattress with a little give will provide just the right type of comfort to reduce shoulder pain.

Two Sleeping Positions to Avoid

What sleeping position provides the best muscle and joint health?

The truth is that one sleeping style does not necessarily work for everyone. I would have to say however that there are two sleeping positions in particular that correlate with neck and shoulder problems:

1. Sleeping on your stomach is not a great idea. The main problem with this position is that you must turn your head to one side in order to breathe effectively. People tend to consistently turn their head to the same side as a preference: the long-term result can be “wear and tear” on the joints of the cervical spine. This situation is absolutely comparable to sitting at a computer all day with your monitor off to one side. It is bad ergonomics to be constantly rotated to one side, whether it is for eight hours a day gazing at a computer screen or eight hours per night sleeping with your head turned to one side.

If you must sleep on your stomach, I would recommend placing pillows under your torso and neck. This will at least lessen the amount of neck rotation that you need to breathe.

2. The second sleeping position that patients often find themselves is side-lying with the arms in an overhead position. Many people report that they will wrap the pillow around their head and secure it in place with their arms.

This position places stress on the downward-facing shoulder. The body weight placed on this shoulder in many cases will cause a compression of the nerve bundle as it passes into the arm. The symptoms of this include waking up with numbness in the arm and hand.

Lying on the side also tends to push the head of the humerus forwards, placing it in an ideal position for impingement of the rotator cuff tendons. I have seen many patients who delayed their recoveries from shoulder injuries because they insist on sleeping on the injured shoulder.

Be creative about changing your sleeping position. I had a patient tell me this week that he changed the placement of his bed so that he wouldn’t need to turn to the side in order to avoid the morning sunlight coming in his window. Great idea!

As always, I welcome any tips that you might have in regards to changing an unfavorable sleeping position. Please share your thoughts in the comments below.


If you wake up from a long night of side sleeping with shoulder, neck, or back pain, this article is for you. We’ll discuss some other sleep positions which might be better for your pain, then give you some tips for how to improve your shoulder problems if you’re really a die-hard side sleeper.

A quick disclaimer: this post is for those with shoulder strain and ache; not chronic pain, frozen shoulder, severe shoulder pain, or other serious medical concerns. If you have pervasive problems which go beyond normal aches and pains, please seek help from a medical professional, who can give you a treatment plan for your particular injury, be it an x-ray or physical therapy.

The Best Sleeping Position for Shoulder Pain

Your shoulder is what the doctors call a ball-and-socket joint. This means that the top of your upper arm bone is rounded – the “ball” – and it rotates around in the concave part of your shoulder blade – the “socket” – leading to the range of motion your shoulder has. That ball is kept in the socket by a bunch of muscles, soft tissues and tendons.

The group of muscles and tendons around your shoulder joint is called your rotator cuff. When these muscles and tendons are strained by laying in one position for a long time (like for a whole night of sleep), this is broadly called a rotator cuff injury. One type of common rotator cuff injury involves the strain of the rotator cuff tendons by an awkward sleep position: aka, “sleeping on it wrong”. The compression of your shoulder into an unforgiving mattress can also restrict blood flow to your arm, resulting in the pins-and-needles feeling. These various issues with side sleeping can make you wake up sore, or worse, interrupt your sleep.

What can you do to remedy this? If you have shoulder problems, try a different sleeping position to relieve the injured shoulder of having to support your weight, which will help it heal faster. To get the pain relief you need without creating more injuries, you should try to sleep on your back, because it will help your spine remain aligned while keeping your weight off your injury.

Why not sleep on your stomach? Excellent question. Because unless you have a superpower that lets you breathe through your pillow, you’ll have to turn your head to sleep on your stomach. And that is exactly the kind of awkward position which will cause you neck pain in addition to probably exacerbating your existing shoulder pain. You don’t want that kind of hassle in your life – take it from a former stomach sleeper.

What If You Really Want to Sleep on Your Side?

If you don’t want to try sleeping on your back, you can at least sleep on the right side. By “right”, in this case, we mean “correct”, because the correct side is the left side.

Wait, you may be saying, there’s a correct side to sleep on? Why?

The answer has to do with how your stomach is oriented. See, your stomach is essentially a bag with tubes coming out of both ends. But, the tubes aren’t at the top and bottom; they’re both on one side, specifically, your right side. This means that when you sleep on your left side, your dinner sits in the part of your stomach that’s meant to digest food. However, when sleeping on your right side, gravity forces the food into the tubes coming from your stomach, one of which is your esophagus. This, in a lot of people, can lead to acid reflux.

So sleeping like a southpaw can help you with indigestion, but both your shoulders are just as susceptible to injury. What should you do about that? The answer is that you get an optimal mattress for your sleeping style. Side sleeping naturally ends up putting pressure on your shoulders and hips, but a good mattress can help. Amemory foam mattress can help you to do this by relieving this pressure and responding to your body with firm pressure.

So you should get a high-quality memory foam mattress, and that’ll fix the problem, right? Not entirely. While having an excellent mattress can greatly alleviate your shoulder and hip pain, even the best mattress in the world can’t help you with neck pain resulting from an unsupportive pillow. Ideally, your pillow should support your head and neck without lifting it too high: you want to remain in a neutral position, with your spine straight from neck to tailbone. Because memory foam molds to your body, you may want to seriously consider amemory foam pillow.

Ultimately, you’ll need to find out what works for you. But we hope this guide could help you get started and let you know that it’s completely possible for you to wake up completely refreshed and pain-free. Good night!

Why Sleeping on Your Side Is Killing Your Shoulder

Do you experience shoulder pain without a clear reason? The answer could lie in the way you sleep at night. Changing your sleeping position and trying some at-home remedies can help you relieve your stiffness and discomfort. Let’s talk about the connection between your sleeping position and shoulder pain, as well as when you should see a doctor.

Can Sleeping Wrong Cause Shoulder Blade Pain?

Our posture affects us during all hours of the day, including when we sleep. Certain sleeping positions can put extra strain on the shoulder muscles, resulting in soreness and stiffness. When you sleep in a position that adds pressure to your rotator cuff, the added stress can result in tearing. You can develop tendinitis or shoulder impingement syndrome from your bone pressing against your tendons.

Do I Have Neck and Shoulder Pain From Sleeping Wrong?

In most cases, you can determine the source of your shoulder pain with a doctor’s assistance. However, you can monitor your symptoms to see if they resemble the signs of tendonitis. Tendinitis can start as stiffness and pain that occurs when you have pressure on your shoulder or lift your arm. Rotator cuff pain may also come from arthritis, a tissue injury or nerve damage.

What Is the Best At-Home Treatment for Neck and Shoulder Pain?

When you have mild shoulder or neck pain, at-home solutions can often solve the problem. You can do simple stretches to keep your muscles flexible. Try squeezing your shoulder blades, rolling your shoulders down and backward or bringing your ear to your shoulder 10 times. Applying heat or ice reduces inflammation and relaxes the muscles. Over-the-counter painkillers can also help.

Best Sleeping Positions for Shoulder Impingement

You have a simple solution for shoulder pain that comes from an improper sleeping position. When you keep pressure off your shoulder, you promote healing and reduce your risk of further damage.

Two sleeping positions work best for an ailing shoulder: sleeping on the unaffected side and sleeping on your back. When you sleep on your side, keep your neck and back straight to reduce potential strain. Sleeping on your back lowers pressure on both shoulders and puts your spine in a neutral position.

How Can I Avoid Shoulder Pain Related to My Sleeping Position?

If you want to prevent shoulder pain from your sleeping posture, you can adjust your position. Sleeping on your stomach strains your neck, back and shoulders. Since you have to turn your head to the side, you put your neck and spine out of alignment. You may continue to sleep on your side if you keep your spine straight and you experience no pain.

When Should I See a Doctor for Shoulder Discomfort?

Shoulder pain that interferes with everyday activities or persists after a few weeks may need attention from a doctor. If you have persistent or severe shoulder pain, OrthoBethesda can help. Our staff specializes in a wide range of musculoskeletal disorders. Contact us today by booking an appointment online or calling our office at 301-530-1010.

Rotator Cuff Tendonitis

Rotator Cuff Tendonitis Fundamentals

The rotator cuff is a group of four tendons that covers the humeral head and controls arm rotation and elevation. These muscles and their tendons work together with the deltoid muscle to provide motion and strength to the shoulder for all waist-level and shoulder-level or above activities.

Rotator cuff tendonitis is an inflammation of a group of muscles in the shoulder together with an inflammation of the lubrication mechanism called the BURSA. In fact, ‘bursitis’ should not be considered a diagnosis but rather a symptom of rotator cuff tendonitis.

This condition is often caused by or associated with repetitive overhead activities such as throwing, raking, washing cars or windows and many other types of highly repetitive motions. It may also occur as a result of an injury. Rotator cuff injuries are the most common cause of shoulder pain and limitation of activities in sports in all age groups. Rotator cuff tendonitis is the mildest form of rotator cuff injury.

The shoulder has a unique arrangement of muscle and bone. The rotator cuff (which is muscle) is sandwiched between two bones much like a sock lies between the heel and the edge of a shoe. In the same way that repeated walking eventually wears out the sock, the rotator cuff muscles fray with repeated rubbing on the bone. As the muscle begins to fray, it responds to the injury by becoming inflamed and painful. With continued fraying, like a rope, it may eventually tear.

What are the symptoms?

The classic symptoms include a ‘toothache’ like pain radiating from the outer arm to several inches below the top of the shoulder. Pain may also occur in the front and top of the shoulder. It may interfere with sleeping comfortably. It may even awaken people from a sound sleep with a nagging pain in the upper arm.

The symptoms are usually aggravated by raising the arms overhead or in activities that require reaching behind the body, such as retrieving an object from the back seat of a car. Furthermore, reaching behind the back to fasten underclothing or to pass a belt may aggravate the arm and shoulder pain.

A clicking in the shoulder may occur when raising the arm above the head.

What are my treatment options?

A thorough history and physical exam will nearly always lead to a correct diagnosis. X-rays will often show changes on the arm bone where the rotator cuff muscles attach, but an MRI provides the definitive diagnosis. This test clearly shows the muscles and indicates if the muscle is inflamed, injured or torn.


The following steps should be taken as a conservative approach to treating rotator cuff tendonitis:

  • Stop or markedly decrease the activity that required the use of the shoulder at or above shoulder level.
  • Apply ice to the affected area.
  • Take anti-inflammatory medication to reduce arm and shoulder pain.
  • Begin an exercise program to maintain flexibility.
  • Avoid carrying heavy objects with the affected arm or using shoulder-strap bags on the affected side.

In the early phases, over-the-counter anti-inflammatory medications may provide benefit. However, to allow the inflammation to resolve, it is vital to curtail any repetitive activity and it is equally important to try to keep the elbow below the shoulder level when using the arm.

Daily stretching while in a hot shower is also beneficial. If shoulder pain becomes more severe, prescription strength medication or a cortisone type injection may help.

Cortisone injections can be very effective in the treatment of the pain. When used, injections should be done in conjunction with a home exercise program for flexibility and strengthening, modification of activities and ice. Other pain controlling options include heat, ice, ultrasound and therapeutic massage.

For a young patient under the age of 30 and with a first time episode of rotator cuff tendonitis that is treated immediately with the above protocol, the average length of time for rehabilitation is two to four weeks. For those with recurrent episodes of tendonitis and some risk factors, rotator cuff tendonitis may take months to heal and in rare cases may require surgery.


If symptoms persist, surgery to remove a spur on the acromion can increase the space available for the inflamed tendon and may prevent further fraying or complete rupture. If an MRI shows a complete muscle injury, surgical repair may be required.

Surgery for recurrent rotator cuff tendonitis (bursitis) is occasionally performed to:

  • Remove a prominence or spur on the undersurface of the acromion.
  • Remove chronically inflamed, thickened and fibrotic bursal tissue.
  • Inspect the tendons and tidy up and sometimes repair a tear in the tendons.

These procedures are often done in combination. This can be done either through an open or an arthroscopic approach with the start of an early rehabilitation program one or two days after surgery and advancing to a more comprehensive program between two and five weeks after surgery. The initiation and progression of these exercises is dependent upon the patient’s findings at surgery, surgical procedure and rate of healing.

Share Facebook Twitter LinkedIn Email Get useful, helpful and relevant health + wellness information enews

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

FREE Mattress

Do you have shoulder pain after sleeping?

Waking up with shoulder pain is a bad way to start your day. When the pain does not get better within a few days, radiates down the arm, the shoulder area or the arm feels weaker, it may be time to visit the doctor. Let’s take a closer look at the shoulder and why you may be feeling that pain.

A Brief Anatomy Lesson

The shoulder is a major ball and socket joint. It is also of the most mobile joints of the body. As such, joint stability is sometimes compromised. The head of the humerus is larger than its accompanying socket. The surrounding tendons, ligaments, and muscles help anchor the bones of the joint. Typically, injuries may occur from overuse, degenerative causes, or falls.

The shoulder is made up of 3 bony components:

  • Clavicle or collarbone
  • Scapula or shoulder blade
  • Humerus or upper arm bone

The shoulder joint also includes ligaments, tendons, and muscles. The ligaments, muscles, and tendons that stabilize our shoulder are known as the ‘Rotator Cuff’, as they form a ‘cuff’ around the humerus. Specifically, the shoulder muscles which are called the teres minor, subscapularis, supraspinatus, and infraspinatus.

Shoulder pain can make very simple tasks painful. Changing position while in bed can become impossible. Many conditions can cause shoulder pain after sleeping. These include poor sleep hygiene to improper sleeping positions. Stress and anxiety can lead to tension in the muscles around the back, neck, and shoulder area. Rotator cuff issues and some medical conditions that are not related to the shoulder at all.

For instance, the gallbladder – which is a small sac-shaped organ located beneath the liver – can cause such issues. After the liver secretes bile, it is stored in the gall bladder. However, there are times that the gallbladder becomes inflamed. The resulting pain can be felt between the shoulder blades.

Typical Reasons For Shoulder Pain

Shoulder pain as a result of trauma is not unusual due to the reduction of joint stability. Here are some of the more common shoulder ailments.

  • Rotator Cuff Tendinitis (tendonitis): The rotator cuff tendons are inflamed or irritated. This is an acute condition.
  • Rotator Cuff Tendinosis: Rotator cuff tendinosis is a chronic or recurring condition caused by repetitive wear and tear (degeneration) of the rotator cuff tendons.
  • Torn Rotator Cuff: This rotator cuff injury occurs when one of the shoulder muscles or tendons of the rotator cuff become torn. The tear can be partial or complete. Rotator cuff tears can occur as a result of shoulder injuries or degeneration.
  • Shoulder Impingement: Impingement occurs when the rotator cuff rubs against the part of the shoulder blade called the acromion. The bursa (or space) between the rotator cuff and acromion narrows when you lift your arm. This can lead to impingement as blood flow is reduced and the tendons can start to fray. Sometimes Impingement Syndrome requires surgery to ease the pain and improve mobility. Surgery can also reduce damage to the tendons.
  • Frozen Shoulder (Adhesive Capsulitis): Adhesive capsulitis is very painful and disabling. It occurs when the connective tissue around the glenohumeral joint becomes inflamed and stiff. This greatly restricts movement as even gentle bumping can result in extreme pain and cramping. The cause is not known.
  • Shoulder Bursitis: This is an inflammation of the bursa or space between the acromion part of the shoulder blade and humerus.
  • Shoulder Arthritis or Osteoarthritis: Osteoarthritis involves the “wear and tear” of the entire joint including the bone, ligaments, cartilage, as well as the joint lining.
  • Rheumatoid arthritis: Rheumatoid arthritis is an autoimmune disorder that causes pain and inflammation.
  • Bone Spurs: A bone spur is a bony growth that forms on normal bone. Sometimes, these require arthroscopic surgery. During this surgery, the doctor will make a series of small incisions to remove bits of extra bone. They are can be caused by localized inflammation process such as with osteoarthritis.
  • Shoulder Separation: This injury involves the separation at the AC joint (acromion-clavicle joint). It typically occurs as a result of trauma.

Treatments For Shoulder Pain After Sleeping

Shoulder pain treatments depend upon the origin of the pain. For simple strains or sprains, rest and intermittent icing may be in order. On the other hand, for an acute fracture or severe degenerative arthritis, shoulder replacement surgery may be required. Chiropractic care and physical therapy are often effective for both acute and chronic pain. Sometimes, injections that include pain reliever and steroids are also of value for stiffness and joint pain.

The Importance of Sleep Position

A poor sleep position is another cause of shoulder pain after sleeping. Sleeping without your spine in a neutral position can put excess pressure on your cervical spine as well as on your neck and shoulder muscles. Many people who suffer from sleep apnea sleep on their left side so that their tongue does not fall back blocking air flow. However, this can cause left shoulder pain as well as numbness and tingling if a “pinched nerve” results.

A poor mattress can also contribute to shoulder pain due to the incorrect positioning head, neck, and back. A too firm mattress will not contour to our body. A sagging mattress may not provide enough support for the back and shoulders. Many people who suffer from joint pain find a memory foam mattress to be of benefit as this provide body contouring around the bones and joints but is firm enough to provide proper support.

Pillows can also affect body alignment. Too many or overstuffed pillows can cause back and shoulder pain. Pillows come in a wide variety of materials such as foam, memory foam, feathers, and fiberfill. They also come in many shapes and sizes depending on whether you want them for your under your head, under your knees, or as back support.

Shoulder pain can also be triggered by your sleep position. For instance, sleeping on the stomach does not keep the spine in a neutral position which adds stress to the muscles surrounding the spine. Side sleeping, on the other hand, can put undue pressure on the shoulder. While sleeping on your back with a pillow beneath the knees can maintain proper spinal alignment.

If you experience shoulder pain after sleeping, and you have not had a recent injury, you may first want first to try changing your sleeping position. If the shoulder pain continues after a few days or worsens despite trying rest, over-the-counter pain relievers and icing, you may want to visit your health care provider to determine the source of the pain and best treatment plan.

Enjoyed this article? Read more here!

There are basically three conditions that can cause shoulder pain to worsen at night: bursitis, tendonitis, and rotator cuff injuries. This is because the inflammation involved in each can pull on the shoulder joint, especially when the area is compressed (as when laying on your side in bed).

This can make your shoulder feel stiff and painful. You may also experience muscle spasms, numbness, or tingling that radiates down to your fingers.

Shoulder pain that worsens at night may be caused by the following:

  • Bursitis. This condition is caused by an inflammation of the bursa, a fluid-filled pad that cushions joints. Once bursitis develops in the shoulder, you are subjected to a vicious cycle of swelling, pain, and more swelling, leading to more pain … until you appropriately treat the condition. Bursitis in the shoulder is a common culprit of nighttime shoulder pain because laying on your side can compress the bursa, increasing the level of pain you’d normally feel with the bursitis.
  • Tendonitis. This also is an inflammation-due-to-repetitive-use type of injury. When it occurs in the shoulder, the tendons that attach muscle to bone become inflamed and irritated, causing pain and stiffness in the area. Pain usually worsens at night, making it difficult to go to sleep or stay asleep at night. This may be because the effects of gravity when laying down cause the muscles and tendons in the shoulder to settle in a slightly different position, decreasing blood flow to the area and aggravating the pain of tendon issues like tendonitis.
  • Rotator Cuff Injuries. The rotator cuff consists of muscles and tendons that connect the upper arm to the shoulder blade. The rotator cuff stabilizes the shoulder and enables smooth movement of the joint. Damage to the rotator cuff of the shoulder is a common overuse injury that can also result from a fall, lifting too heavy an object, or a car accident. It causes swelling and pain in the shoulder that can worsen at night because your position in bed – especially if you lay on your side – can further irritate and inflame the damaged muscles and tendons of the rotator cuff.

What to Do About Nighttime Shoulder Pain

If one shoulder hurts when sleeping, try laying on the other side. While people often do not control their bodies while asleep, you could try building a wall with pillows to prevent rolling over onto the injured shoulder while asleep. If that doesn’t help, try sleeping semi-upright either in a chair or by propping a few pillows under the upper body to alleviate pressure on the affected shoulder. Ask your doctor for a list of stretches that can be done to loosen the shoulder; these may be especially beneficial to do before going to bed.

However, if shoulder pain is a fact of life for you, it may be time to seek treatment.

Your orthopedic doctor will physically examine your shoulder, assess your medical history, and may order tests that can help with a diagnosis and identifying the cause of your shoulder pain. In general, an X-ray can identify structural issues such as bone fractures or spurs or the presence of arthritis; for soft tissue assessment, an MRI may be required.

Depending on your diagnosis, your doctor might prescribe corticosteroid injections to counter the effects of swelling. Specific exercises or stretches may be recommended and, if all else fails, surgery may be necessary to fix the problem. Most shoulder repairs can be done arthroscopically, requiring small incisions in a relatively quick procedure that involves less trauma to surrounding healthy tissue than is typical in traditional “open” surgeries. In some cases, a joint replacement surgery may be the best way to treat your pain for long-term symptom relief.

The Orthopaedic Associates of Central Maryland offer all manner of orthopedic treatments under one roof. If your shoulder has been aching and shows no sign of improvement, schedule your appointment by calling (410) 644-1880 or use the request an appointment form. We look forward to seeing you.

When you sleep, your brain recharges, your cells repair themselves and your body releases vital hormones necessary to prepare you for the day ahead. When you sleep is important, but how you sleep can have a substantial impact on you physically and if you are sleeping in the wrong position, this can have a detrimental effect on your body.

The science of sleep

Recently, we conducted a survey that yielded some interesting results. It found that adults between 18-50 years old will sleep an average of 6-8 hours. This is lower than the recommended period of 7-9 hours for that age range. The effects of lack of sleep are medically documented and can cause a massive array of problems if a proper sleep pattern isn’t regulated and maintained.

This includes initial problems such as memory loss and being less focused to long term issues such as quadrupling the risks of a stroke, heart disease and diabetes.

Every person has a unique sleeping pattern. However, it’s important to remember you’ll actually die from sleep deprivation before food starvation. You can go without food for two weeks. With no sleep whatsoever, you’ll likely be dead within ten days. A good sleep routine is crucial, but this must go hand in hand with the proper sleeping positions to ensure maximum comfort and rest.

Over half the people surveyed stated that they enjoyed good quality sleep, with almost 40% saying they had lower quality sleeping patterns. One cause of this could be due to sleep positioning.

Physical Effects of Sleep Positions

The Foetal Position:

This is actually one of the worst positions you could choose when sleeping. An estimated 40% of people sleep in this position which is certainly a worrying statistic. Having your knees curled into your chest and your head pointed downwards can cause back issues.

This position can also lead to an irregular sleep pattern. The foetal position can impair deep breathing, which is crucial for an optimised sleeping pattern.

However, if you are pregnant, this position can actually prove beneficial. Since the baby can kick during the night, it may hit the stomach. This can force gastric acid into the throat, causing shortness of breath, painful swallowing and potentially choking the mother. It is recommended for pregnant women to sleep on their side with a pillow under the abdomen and one between their legs.

Lay on back, arms up:

Whilst this may be thought of as a common position, only 50 in 1000 people tend to sleep like this. This is quite a comfortable one for the majority of the lower body, however, having arms tucked behind your head can put excess pressure on the nerves in your shoulders. This can lead to eventual nerve damage, with symptoms including a tingling sensation and numbness.

Snoring is also a common problem here. It is caused by the effects of gravity on the upper airway, Sleeping on the back creates a narrowing of the breathing passages, which leads to snoring and also a higher likelihood of airway obstruction.

The good thing is that sleeping on your back reduces the risk of facial wrinkles and outbursts of skin blemishes as your face is not in direct contact or under pressure against the pillow.

On back, arms lay at sides:

According to our survey only 6% of respondents stated this was their preferred sleeping position.

This is considered to be an all-round position for maintaining the health of your neck and your spine, provided certain precautions are made, such as not using too many pillows. Too many pillows will arch the neck, leading to soreness and stiffness overnight.

It also increases blood flow to the heart, which can lead to long term benefits such as reduced risk of heart attacks.

The spine isn’t meant to be naturally straight. It has several curves and bends. Placing a pillow under the knees will maintain this natural curve and reduce pressure on the sciatic nerves. This can lead to long term problems, such as sciatica. A symptom which produces constant pain from the compression or irritation of the sciatic nerves.

Snoring is especially prevalent in this position too, along with sleep apnoea. This is a disorder which causes pauses in breathing for intervals. This leads to a build-up of carbon dioxide in the bloodstream, causing you to inhale sharply and deeply on irregular intervals. This in turn, wakes you up, preventing a proper restful cycle of sleep.

Lay on front, arms by side:

This is not recommended sleeping posture. According to data from our survey, only 3% of people prefer to adopt this position.

Sleeping on the front can increase pressure on the base of the spine and also the neck, which has to be bent to one side for breathing. It is not the optimal angle for breathing effectively, so you may find yourself constantly turning the head. This can lead to disrupted sleep patterns.

A soft pillow (or no pillow at all) is recommended for this position to minimise the pressure on the neck. Otherwise, this position can lead to chronic back and neck ache. This culminates in disc degeneration within the spine over the long term.

Conversely, those with already-damaged spines (herniated disks for example) or degenerative issues are recommended to sleep on their front. This is to allow as little pressure as possible to be placed on the back during sleep.

Sleeping on front, arms up:

Again, this is not recommended, although 3% of people surveyed maintain this sleep position. Although the arms can support the head, it still puts strain on the neck and back regions. Again, this can lead to chronic aching of those areas, with problems such as sciatica and disc degeneration appearing after a long period of time.

Whilst snoring is abated, you can also put pressure on joints in your arms and shoulders. The shoulder is one of the most unstable joints in the body. Sleeping like this could lead to numbing/tingling sensation and symptoms including postural shoulder pain.

Sleeping on side, arms down:

Side-sleeping is the most popular position, with over a fifth of people surveyed selecting it. It reduces snoring immensely by keeping the airways more open and it also keeps your spine stretched in a natural position. This can help prevent or allievate back pain.

It’s also a good position for those who suffer from acid reflux. This is because your head is resting higher than the oseophagus, preventing food or acid from coming up.

However, the downside is that it can cause skin ageing, as your skin sags due to gravity. It can also put pressure on vital organs such as your intestines, liver and lungs. Over a long period of time, this can lead to problems with those organs such as irritable bowel syndrome and reduced breathing capacity.

Sleeping on side, arms up:

16% of people surveyed preferred this position. Whilst you can still get certain benefits from sleeping on your side, having your arms up or in front of your body can have a detrimental effect over the long term.

Shoulder and arm pain is quite common, as blood flow is restricted in this position, along with excess pressure on key nerves. This can induce numbing and tingling sensations from time to time. Once blood flow is not restricted (when you move positions for example), you will find the tingling and numbness will subside.

If you find sleeping like this prolongs the tingling and numbness even after moving position, an underlying symptom may be the early stages of carpal tunnel syndrome. This position often exacerbates this particular injury.

Fixing the problems

There are several ways to alleviate the issues associated with bad sleeping posture. These include:

1. Placing support pillows under your knees, neck or under the back. Those with recurrent back problems are recommended to use pillows under the knees. This maintains the natural curvature of the spine and reduces pressure. Remember, a pillow is designed to keep the spine in a natural alignment. It should not be placed too high or too low, otherwise you risk putting more pressure on the neck or back.

2. Ensure you the right type of mattress to accommodate your positioning. If you are unsure if you have the right mattress for your positioning, you can follow the advice of sleep expert Michael Breus, PhD:

“If you wake up in the morning and have some low back pain and can stretch and get rid of it in 15 or 30 minutes, which means you’re on an inappropriate mattress for you. The right mattress, on the other hand, is one on which you feel no pressure, almost like you’re floating in air.”

If a mattress is too firm, it can put pressure on vulnerable points such as the spine. This can place the natural alignment of your spine out of position. If a mattress is too soft, the same points will not be properly supported. Breus recommends spending at least 15 minutes lying on a potential new mattress to check if it feels good for your body.

3. Taping a bottle to the front of your clothing to prevent front sleeping.

4. Use extra pillows as support to keep you in a new position during the night

Remember, poor sleep posture will have a negative effect on your physical health, both in the short and long term. By adopting the optimal position for your body, you ensure a better night’s sleep and reduce the risk of ill health.

Our survey revealed that only 11% of people rated their quality of sleep as ideal. For the country to adopt a better sleeping pattern, we need to understand just how our sleep is hurting us.

Let us know how you would rate the quality of your sleep.

This One Sleep Position May Be Destroying Your Health

In Defense of Stomach Sleeping

“I sleep on my stomach with my head under a bunch of pillows so if someone wants to come in and try to kill me they can’t tell if I’m there or not, so they’ll just leave.” — Wiz Khalifa

Sleeping, since it represents about ⅓ of your day, can be a wonderful way to undo the text neck, the excessive flexion whilst at the desk, and the forward head posture.

Specifically, sleeping on your stomach puts your neck in extension (the opposite of what it does when you are at the computer and on your phone), thereby restoring some order of balance to the system.

Stomach sleeping undoes creep.

It also opens up the airway, encourages nose breathing, and assists with proper oxygenation through exertional diaphragmatic breathing.

I have talked about how to set you up for nightly proper sleep here .

What we know about the nocturnal oxygen saturation is that these levels normal fall as compared to daily oxygen saturation.

Typically, evening oxygenation levels fall by 4–5%.

While this is a normal physiological process, if your saturation levels in the day are already low (due to lack of movement, excessive sitting/computer work, or excess weight) if you have a straight neck, this can further complicate the oxygen game.

Normally we should have a lordosis (or backward curve) in the neck.

This is essential not just for spinal mechanics, but for cerebellar function and the spinal cord that lives inside the spine.

As the world pulls our head forward — into our desks, on our computers, scrolling on Instagram, driving, sitting on the couch at night — this can further reduce our forced vital capacity.

Meaning that if we are inactive during the day, and sleep with a pillow, AND we have developed a straight curve in the neck, the ability to properly take in enough air overnight decreases by another 30%.

Why is this important?

Well for one, it increases the workload on the heart.

If your cells are not getting enough oxygen, we will see things like blood pressure and heart rate begin to elevate as your heart will try to work hard to get the necessary oxygen to the entire body.

Think about the ABCs you learned when you took a CPR course. Remember what the A was?


The first thing they do when assessing someone is to open the airway.

Not surprisingly, they achieve this by putting the neck in extension through a head tilt.

They put the neck in extension, and lift the jaw to open the airway.

This is what sleeping on your stomach does — it allows for your neck to be in extension and opens the airway.

This is why sleeping on your back can potentially be disastrous.

(Don’t even get me started with the beds that elevate and bring you into a flexed position).

With back sleeping, your airway is closed off, and it continues to perpetuate the root problem — flexion, flat neck, reduced oxygen capacity.

Stomach sleeping, by definition, is sleeping in extension, with your head rotated to one side.

In other words, the opposite of flexion and being bent over like you typically are during the day.

Because you are on your belly, your diaphragm will also get stronger as this is what is known as exertional breathing.

Meaning, the diaphragm has to work against resistance (your body).

Just like any muscle, the diaphragm needs resistance training in order to grow stronger.

Diaphragmatic breathing is directly related to your ability to expand your thoracic cage, commonly referred to as chest expansion.

You should be able to expand your chest by at least by 2–3 inches in the coronal plane.

What we find with back sleepers, and especially back sleepers with flat degenerating cervical spines, is the accessory muscles of respiration (namely the scalenes, SCM, and upper trapezius) start to work harder and overcompensate for a weakened diaphragm.

This is important because breathing will now happen in the sagittal plane (ie the rib cage will move up and down), rather than the coronal plane (in and out).

Overactivation of these muscles (in particular the SCM and scalenes) will cause them to overdevelop, further straightening the neck, and bringing your neck into flexion.

And we kind of need our rib cages to be able to expand.

Like, 24/7.


Also interesting to note is the diaphragm is innervated by nerves coming out of 3rd, 4th and 5th levels of the neck.

So it is a double win if you can maintain the cure in your neck so as not to damage the phrenic nerve (C3,C4, C5) that feeds the diaphragm.

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *