How to Sleep With a Frozen Shoulder

Dr Shoaib Muhammad, MD, is a member of the Royal College of Physicians of London, an experienced doctor and published medical researcher with a passion for advancing medical knowledge and improving patient outcomes. With extensive experience in preventing, identifying, and managing physical and mental health issues, Dr Shoaib dedicates his life to providing patients with the highest quality of care at his tertiary care hospital.
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Sleeping with any condition isn't easy, and a frozen shoulder is no different. Fortunately, there's a lot you can do for a more comfortable sleep.

If you're new to this condition, we'll start off with a section on what it is and how it works. If you don't need that part, just use the links below to skip forward.

What Is A Frozen Shoulder?

Your shoulder is a complex joint containing, muscles, tendons and ligaments. Deformities in any one of these structures can lead to a frozen shoulder.

The signs of a frozen shoulder appear slowly and progress gradually over time, resulting in stiffness, pain, and restricted range of movement.

That's due to the disruption of affected parts of your shoulder. It's normal not to be able to sleep on one side throughout the night.^[1]

The Phases of Frozen Shoulder

• Freezing phase: If your shoulder is painful, resting from most activities is beneficial in this phase to help the pain.
• Frozen phase: Shoulder becomes tightened; stretching exercises are recommended in this phase. Use your shoulder when possible but be gentle.
• Thawing phase: Passive stretching doesn’t increase pain in this phase and it's recommended to increase your shoulder's range of movement.^[2]

The Anatomy of Your Shoulder

The shoulder joint is covered with connective tissues and consists of various parts. Let's take a look at what they do.^[3]

Glenohumeral joint

This part originates from top of the humerus and inserts into shoulder blade (scapula). It has following functions:

• Completes range of motion.
• Shoulder rotation.
• Shoulder movement in forward and backward directions.^[3]

Shoulder capsule

Components of the shoulder capsule and their functions.

Rotator Cuff

It consists of a band of four muscles (SITS): Supraspinatus, Infraspinatus, Teres minor and subscapularis and tendons. It has the following functions.

• Stabilises your shoulder and control its movements.
• Provides flexibility due to its soft tissue architecture.
• Provides protection to your shoulder against chronic wear and tear.^[3]

Common causes of Frozen Shoulder

• Diabetes.
• Surgery.
• Broken arm, rotator cuff injury, bursitis or tendonitis etc.
• Strain from carrying a big object.
• Bodily pain from a blow or an accident.
• Sleeping in the wrong position.
• Lack of exercises.
• Heart conditions.
• Neurologic problems e.g. Parkinson's Disease.

Symptoms of a Frozen Shoulder

Pain Worsens at Night

Decreased blood flow into your body occurs at night. It can cause water retention in your kidneys, exerting internal pressure on your whole body.

At night, inflammatory conditions also worsen. The entire body swells quickly, and the pain in your shoulder gets deeper. That's due to high pressure in response to swelling and inflammation.^[4]

Heavy Pressure in Your Shoulder

All inflammatory processes in your body worsen at night, including a frozen shoulder. This is because inflammation of the capsule, commonly called adhesive capsulitis, puts heavy pressure on your shoulder, and you feel pain.^[4]

Poor Sleep Quality

Your sleep may be affected due to pain and stiffness in your shoulder. This stiffness hardens overnight, and you may feel discomfort as a result. Finding comfortable sleep positions becomes difficult due to a frozen shoulder.^[4]

Melatonin hormones regulate quality sleep; when melatonin levels drop due to poor quality sleep, you awake all night and may feel intense pain in your shoulder.^[5]

Decreased Range of Motion

Suppose your stiffness in your shoulder doesn't get treated.

In that case, it can lead to disability, and it's common to then be unable to complete the range of motion required during simple activities such as.

• Household activities.
• Lifting heavy objects.
• Combing your hair.
• Washing clothes and cutlery items.
• Scratching your back.
• Reaching for something up high.
• Sleeping.

People between 40 and 60 get it worse and it affects women more than men.^[3]

Restricted Shoulder Muscle Contraction

Connective tissues in your shoulder area become thickened, contract, and then develop a scar that restricts shoulder muscle contraction.

When that happens, it prevents the shoulder bone's free movement in its socket.

You may feel limited when lifting heavy objects. It occurs due to sleeping in the wrong position during a frozen shoulder condition.^[6]

Pain Lying on Affected Side

Lying on the affected side or in one position the whole night compresses your joint capsule, impeding blood flow to the affected side; the compression of the joint capsule leads to shoulder pain.^[5]

Sleep Positions Good for Frozen Shoulders

Lying on Your Unaffected Side

Lying on an unaffected arm while sleeping is best for dealing with a frozen shoulder, as it allows your arm to move where it's more comfortable.

You can use body pillows for the affected shoulder. Pillows under the neck and affected shoulder keep you in better alignment while you sleep on the unaffected side.^[5]

You can also use a cushion in the armpit area of your affected shoulder.^[4]

Sleeping on Your Back

Sleeping on the back provides relief, as it allows easier breathing and benefits patients with heartburn and back pain.

It's advisable to put a pillow under your affected shoulder to hold the weight of your head and neck. This helps keep the muscles of your affected shoulder relaxed throughout the night and not wake up in the morning tense or tired.^[5]

Sleep Positions to Avoid

Sleeping on Your Affected Shoulder

Sleeping on the affected side can aggravate the pain. Sleeping on the affected side increases pressure on the joint.

Still, sleeping in one position all night is not easy, so use a pillow beneath the affected shoulder to ease pressure on your affected shoulder.^[7]

Sleeping on Your Stomach

Sleeping on your stomach is not ideal for a frozen shoulder as it pulls the affected shoulder toward the chin. This causes strain in your shoulder muscles, including the affected one. For that reason, this position aggravates pain and stiffness in the shoulders.^[7]

Avoid Rolling Over Frozen Shoulder

Avoid rolling the frozen shoulder while you sleep to reduce strain and chances of impeding blood flow circulation to the affected shoulder during a night of sleep.

This one can be tricky, since you're asleep. But experiment as much as possible with pillow and sleep positions to minimise movement at night.^[6]

Other Frozen Shoulder Tips

Here are some other steps you can take to improve your frozen shoulder situation.

Visit a Physical Therapist For Exercises

You should practice all the guidelines for stretches and exercises your physiotherapist advises before sleeping.

• Stretching and strengthening exercises recommended by your physical therapist can help you regain your range of motion. Stretching exercises include towel stretching, finger stretching, and cross-body stretching. These stretches relieve tightness and, hence, decrease pain.
• Mobilisation exercises are also helpful in reducing inflammation in the affected shoulder. Range of movement is regained through Transcutaneous electrical nerve stimulation (TENS) that may be applied by your physiotherapist.
• Physiotherapists also use Thera-balls and Thera-bands to treat frozen shoulder patients in their clinics.
• They may also use heat pads and cold packs  for 10 to 15 minutes at a time to manage swelling, inflammation and pain

All these manoeuvres practiced by your physiotherapists improve blood circulation of the affected shoulder and are helpful in healing pain, swelling, stiffness and inflammation.

Dietary Changes

Healthy fats contain omega-3, which is helpful to reduce inflammation in your shoulder, promotes good health and improves sleep quality. Fresh fruits and vegetables are also suitable for managing pain in a frozen shoulder.

Include anti-inflammatory items in your diet to reduce pain in your affected shoulder. These item includes:

• Natural ingredients: nuts, fish, turmeric.
• Food items: oranges, spinach and tomatoes
• Drinks: Ginger tea

Avoid These Items

• Alcohol
• Sodas
• Caffeine
• Smoking and tobacco products^[8]

Anti-Inflammatory Medications

Sleeping eight hours in a peaceful environment with fewer distractions enhances the level of melatonin hormone that regulates the quality of your sleep. Your shoulder may not disturb you and wake you up at night.

Before bed, avoid heavy meals, including burgers, pizza and dairy items.^[8]

Inflammation and pain can decrease the quality of your sleep. You need to check with your doctor first, but anti-inflammatory medications like ibuprofen, aspirin, or naproxen sodium can help.^[6]

Walk Before Going to Bed

It can help if you do warm-up exercises before bed to keep the muscles of your affected shoulder warm and relaxed. Walk for an hour to warm your body and improve circulation to your affected shoulder.

Get a Professional Massage

A massage on your affected shoulder by a professional massage therapist would also be helpful to relax stiff and tightened shoulder muscles. It really helps that blood circulation.

How to Ease Pain When You Wake Up

Let's wrap up with a few tips for when you wake up. 

• Bathing or taking a hot shower when you wake up releases stiffness and reduces inflammation in your affected shoulder. 
• Use your unaffected shoulder as much as possible throughout the day. 
• Maintain good body posture to avoid head and neck pressure on your affected shoulder while sitting, standing, or walking.
• Engage yourself in peaceful activities and practice yoga to release stress a little while dealing with frozen shoulders throughout the day.
• Avoid lifting heavy objects, weight training, or lifting through the affected shoulder.
• Keep a soft pillow below your frozen shoulder while watching TV or using a mobile device.

I hope this helps and I wish you the best with your frozen shoulder healing journey. 

References:

1. How To Sleep With A Frozen Shoulder - 7 Tips For A Peaceful Sleep [Internet]. [cited 2023 Sep 23]. Available from: https://www.rheumatologycarehouston.com/how-to-sleep-with-a-frozen-shoulder-7-tips-for-a-peaceful-sleep/

2. rehabilitation-protocol-for-frozen-shoulder.pdf [Internet]. [cited 2023 Sep 23]. Available from: https://www.massgeneral.org/assets/mgh/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-frozen-shoulder.pdf

3. Harvard Health [Internet]. 2010 [cited 2023 Sep 23]. How to release a frozen shoulder. Available from: https://www.health.harvard.edu/pain/how-to-release-a-frozen-shoulder

4. How Should I Sleep With Frozen Shoulder Pain? - shoulder clinic Hyderabad [Internet]. 2019 [cited 2023 Sep 23]. Available from: https://hyderabadshoulderclinic.com/how-should-i-sleep-with-frozen-shoulder-pain/

5. How To Sleep With A Frozen Shoulder? | 8 Science-Based Hacks [Internet]. 2022 [cited 2023 Sep 23]. Available from: https://shouldersavvy.com/how-to-sleep-with-frozen-shoulder/

6. How to Sleep with a Frozen Shoulder | Sleeping Positions [Internet]. [cited 2023 Sep 23]. Available from: https://frozenshoulderclinic.com/frozen-shoulder-sleep-positions/

7. aicaos. AICA Orthopedics. 2022 [cited 2023 Sep 23]. How to Sleep with a Frozen Shoulder. Available from: https://aica.com/how-to-sleep-with-a-frozen-shoulder/

8. How to Sleep with a Frozen Shoulder at Night? Pain Relief Guide [Internet]. [cited 2023 Sep 23]. Available from: https://www.hexahealth.com/blog/how-to-sleep-with-a-frozen-shoulder-pain-at-night