How to relieve rotator cuff pain at night: tips for sleeping better

Your rotator cuff is a powerhouse of four shoulder muscles and tendons that work together to keep your shoulder stable and strong. When these rotator cuff tissues are irritated or injured, it can take a toll on your sleep. What’s more, a lack of quality sleep can intensify your pain. This pain-sleep cycle affects up to 80% of people with chronic pain. 

Small lifestyle adjustments, like changing your sleep position and doing targeted exercises, can make a big difference in relieving rotator cuff pain at night.

Read on to learn how to relieve rotator cuff pain at night — especially with exercises recommended by Hinge Health physical therapists.

Causes of rotator cuff pain

Your rotator cuff plays a crucial role in shoulder stability and movement, allowing you to lift, rotate, and control your arm with ease. This group of four muscles and their associated tendons help keep your shoulder joint secure, but sometimes they can get injured — whether from sudden trauma or gradual changes in your shoulder. When your rotator cuff is irritated or injured, simple movements like reaching, lifting, or throwing can become painful.

Here are some of the most common causes of rotator cuff pain. 

• Injury. A sudden strain on the rotator cuff can stretch or tear the muscles and tendons. This often happens during fast or forceful movements like throwing, swinging a racket,  lifting something heavy overhead, or other activities that your body isn’t yet prepared for. “Most of us don’t move our arms fast in everyday life, so the speed of these activities can contribute to injury,” says Caleb Wolters, PT, DPT, a physical therapist at Hinge Health. 

• Overuse injury. Repetitive movements, such as frequent throwing, swimming, or overhead lifting, can put extra demand on your rotator cuff, sometimes leading to temporary discomfort or irritation. This is especially common in athletes and those with physically active jobs, but anyone who regularly uses their shoulders for tasks like painting, gardening, or reaching overhead may notice occasional soreness. Over time, natural changes in your rotator cuff can make it feel a bit more sensitive and tender. Staying active and incorporating strengthening exercises can help keep your shoulders strong and resilient.

• A direct blow. “Impact to the rotator cuff tissues — such as being hit with a ball or falling on an outstretched hand or shoulder — can result in painful bruising and swelling,” says Dr. Wolters. Depending on the severity of the impact, this type of injury can range from mild discomfort to more intense pain from a partial or full tear. A tear may sound scary, but rotator cuff tendons are strong and often heal with conservative treatments. 

Why does your rotator cuff hurt at night?

Rotator cuff pain often feels more noticeable at night. During the day, movement helps keep blood flowing to your shoulder, which can ease stiffness and discomfort. But when you lie down to sleep, your shoulder can remain in one position for an extended period, leading to increased stiffness or irritation. Additionally, inflammation tends to build up throughout the day. Without the distraction of daily activities, you may become more aware of lingering soreness when you settle into bed.

Your sleep position can also affect how your shoulder feels at night. “The way you sleep can put extra pressure on your shoulder, and if it’s already irritated, that may lead to more soreness,” says Dr. Wolters. Other factors, like the firmness of your mattress or how much you toss and turn during the night, can also influence your discomfort.

How to sleep with rotator cuff pain 

If you’re wondering how to relieve rotator cuff pain at night so you can get a better night’s sleep, adjusting your sleep position may help ease discomfort. “If your shoulder is already irritated, certain sleeping positions may amplify soreness,” says Dr. Wolters. Small modifications can reduce pressure on your affected shoulder and make sleeping more comfortable.

• Side sleepers: If lying directly on your sore shoulder causes increased discomfort, try sleeping on your opposite side. “You can also use a pillow or two to support your sore arm and keep it in a comfortable position,” says Dr. Wolters. This may keep your shoulder joint in a more comfortable position.

• Back sleepers: “Using a pillow to support your arm while you sleep can help ease shoulder tension and reduce soreness,” says Dr. Wolters. If it’s uncomfortable to lay flat on your back, Dr. Wolters suggests sleeping in a reclined position. When your upper body is slightly elevated, it can take pressure off your shoulder.

• Stomach sleepers: When you sleep on your stomach, your shoulder can be in an uncomfortable position, especially if your arm is stretched overhead. To prevent discomfort, try keeping your arms by your sides or bent near your face. Placing a thinner pillow underneath your head and a small pillow under your chest can also help. If you often have shoulder pain after stomach sleeping, try sleeping on your back or side. Hugging a body pillow on your side can support your shoulder and can mimic stomach sleeping.

These rotator cuff exercises, recommended by Hinge Health physical therapists, are a great starting point for recovery. Movement helps stimulate blood flow, reduce inflammation, and promote healing, which can ease nighttime discomfort. Strengthening the surrounding muscles improves joint stability and reduces strain on irritated tissues, making it easier to find a comfortable sleeping position, and preventing pain from disrupting your rest. “Try doing these exercises an hour before bedtime to help decrease pain and promote restful sleep,” Dr. Wolters says.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for

rotator cuff pain at night

Wondering what to do for rotator cuff pain at night? Here are a few approaches that can help ease discomfort and improve sleep quality. 

• Try physical therapy and targeted exercises. Targeted exercises can help strengthen your rotator cuff and improve mobility, reducing nighttime shoulder pain over time. Doing physical therapy exercises in the evening is a great way to get your body moving and ease inflammation before bed, notes Dr. Wolters. Gentle movement can also promote relaxation, especially when paired with calming music or deep breathing. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Apply ice or heat. Both ice and heat can provide relief, depending on what feels best for you. “Ice can help reduce inflammation contributing to pain, while heat relaxes tight muscles and makes movement easier,” says Dr. Wolters. You can use ice or heat for 15 to 20 minutes before bed, but avoid falling asleep with either to protect your skin.

• Take over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for shoulder pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Modify your sleep position. If you wake up with shoulder pain, adjusting how you sleep can take pressure off your shoulder and help break the pain-sleep cycle. Finding the right position may take some trial and error, but small changes — like using pillows for support — can make a big difference. If you’re unsure what works best, a physical therapist can recommend adjustments based on your specific needs. But there are no right or wrong ways to sleep. If your usual sleep position isn’t causing you pain, or you’ve found other adjustments that work for you, stick with it.

What if your shoulder pain isn’t getting better?

Most rotator cuff pain improves with time, movement, and self-care. But if pain persists and continues to disrupt your daily life, check in with a healthcare provider, such as a physical therapist. They can help rule out other causes like neck pain, which can radiate to the shoulder, and discuss options like a cortisone injection. Cortisone is a type of steroid used to decrease pain and inflammation so you can engage ‌in exercise and physical therapy with ease. If symptoms continue to persist despite conservative treatments, surgery may be an option, but it’s usually an elective procedure. Your provider can guide you through these decisions, keeping your goals and lifestyle in mind.

Tips to prevent shoulder pain during the day

Simple adjustments to your daily routine can promote shoulder health and keep pain from interfering with sleep. Here are some key strategies. 

• Stay active. Targeted shoulder exercises are designed to help with recovery, but any type of movement — like walking, stretching, or even household chores — can improve circulation, joint mobility, and tissue health. Strengthening your shoulder and surrounding muscles can provide better support and reduce strain on your rotator cuff.

• Ease into new or demanding activities. “If you’re trying a new activity or one you haven’t done in a while, your body may not be able to tolerate a high dose at first,” says Dr. Wolters. Whether it’s a sport, workout, or physical task, start slow and gradually increase duration or intensity to prevent pain. It’s normal to feel some fatigue, but sharp or lingering pain may be a sign to adjust your approach. It’s all about finding your movement sweet spot.

• Be mindful of repetitive movements. Repetitive overhead motions, heavy lifting, or prolonged positions that strain your shoulder can contribute to irritation. If your daily routine involves these movements, take breaks, alternate tasks, or modify how you perform them. Using both arms to lift things can also help reduce pain in your shoulder. When lifting overhead, try to keep your elbows close to your body and raise your arms in front of your body, instead of to the side to reduce irritation in your rotator cuff. 

• Change positions. Staying in one position for too long — especially when sitting at a desk or looking at a screen — can put strain on your shoulder. Regularly shifting positions and moving throughout the day helps reduce tension and stiffness. If you work at a computer, adjust your workspace setup to ease the strain on your shoulder. Taking frequent breaks to stretch or move your shoulders can help keep your joints flexible, reducing stiffness and pain.

• Prioritize healthy habits. A well-balanced lifestyle supports overall tissue health and resilience. “The less inflammation throughout your body, the healthier your body is as a whole, and the more resilient your tissues are to activity and movement,” explains Dr. Wolters. Eating a diet rich in fruits, vegetables, and protein helps support muscle recovery, while staying hydrated throughout the day can help reduce inflammation and promote joint health.

PT tip: Strengthen your shoulders 

Strong shoulders are more resilient and less prone to pain or injury. “I recommend focusing on building as much strength as you can in your shoulders so they can better handle daily activities,” says Dr. Wolters. While lifting weights is a great option, you don’t need special equipment to strengthen your rotator cuff muscles and tendons. Bodyweight exercises like planks and push-ups can help, as can simple at-home movements using household items. Try overhead lifts or rows with a reusable grocery bag filled with canned goods to challenge your shoulder muscles and those surrounding it. If your shoulder feels sore, try shortening the motion, Dr. Wolters says.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Athwal, S. & Armstrong, A. D. (2022, June). Rotator Cuff Tears. OrthoInfo — American Academy of Orthopedic Surgeons. Retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/rotator-cuff-tears/

2. Cheatle, M. D., Foster, S., Pinkett, A., Lesneski, M., Qu, D., & Dhingra, L. (2016). Assessing and Managing Sleep Disturbance in Patients with Chronic Pain. Anesthesiology Clinics, 34(2), 379–393. doi: 10.1016/j.anclin.2016.01.007

3. Armstrong, A. D. (2021, July). Shoulder Impingement/Rotator Cuff Tendonitis. OrthoInfo — American Academy of Orthopedic Surgeons. Retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/shoulder-impingementrotator-cuff-tendinitis/

4. Christensen, B. H., Andersen, K. S., Rasmussen, S., Andreasen, E. L., Nielsen, L. M., & Jensen, S. L. (2016). Enhanced function and quality of life following 5 months of exercise therapy for patients with irreparable rotator cuff tears – an intervention study. BMC Musculoskeletal Disorders, 17(1). doi:10.1186/s12891-016-1116-6

5. Simons, S. M. & Roberts, M. (2021, April). Patient education: Rotator Cuff Tendinitis and Tear (Beyond the Basics). UpToDate. Retrieved from https://www.uptodate.com/contents/rotator-cuff-tendinitis-and-tear-beyond-the-basics

6. Powell, J. K., Costa, N., Schram, B., Hing, W., & Lewis, J. (2023). “Restoring that Faith in my Shoulder”: A Qualitative Investigation of how and why Exercise Therapy Influenced the Clinical Outcomes of Individuals with Rotator Cuff-Related Shoulder Pain. Physical Therapy and Rehabilitation Journal, 103(12). doi:10.1093/ptj/pzad088