How Should You Sleep With Tendonitis In Your Shoulder?

How can I sleep with shoulder tendonitis? Every month, thousands of people consult their favorite search engine to find an answer to this question.

In this article, I’ll try to answer them as fully as possible. But let’s say it straight away:

1. the best sleeping position is the one that suits you best,
2. you won’t aggravate your problem by sleeping on the painful shoulder (so if that’s your preferred position, you can keep it).

That said, in the absence of a miracle solution (because, alas, there isn’t one), I hope you’ll find something to help you better understand and manage your problem.

Happy reading! 🙂

♻️ Last updated: October 2023. Written by Nelly Darbois, physiotherapist and doctor of public health
👨‍⚖️ Declaration of financial interests: Amazon affiliate links. My complete declaration of financial interests is available in the legal notice section.

Shoulder tendonitis: what is it?

When we think that someone has shoulder tendonitis, we assume that their pain is due to a tendon problem.

The truth is, in 2023, it’s pretty uncertain (scientifically speaking).

In general, tendonitis occurs when :

• the affected person has probably overused his shoulder (for example in an artistic, sporting or professional context);
• we can’t explain the pain in any other way (for example, we’ve ruled out a fracture or the consequences of a shoulder dislocation).

Recent tendonitis, less than 3 months old

When this tendonitis is less than 3 months old, we suspect that something has been damaged or disturbed, without knowing exactly what. We suppose it could be a tendon, but without any certainty.

In any case, we assume that the thing involved should heal within 45 days to 3 months. At that point, the pain should disappear.

Persistent tendonitis lasting more than 3 months

When pain has been present for more than 3 months, we consider that whatever has been damaged or disturbed should be healed. In principle, whatever has been damaged or disturbed should no longer create pain. So another explanation is needed.

For tendinitis lasting more than 3 months, the latest scientific knowledge points to a multi-localized inflammatory state (Lo, 2022; Lo, 2023). In other words, biochemical traces of inflammation are localized in several places:

• in certain shoulder tendons;
• in the subacromial synovial bursa (a specific anatomical structure inside the shoulder);
• in the glenohumeraljoint (the largest joint in the shoulder);
• in blood serum.

According to the researchers, this explanation still requires further research to be confirmed.

Sleeping with shoulder tendonitis: what’s the problem?

Sleeping with shoulder tendonitis can disrupt sleep in a number of ways:

• the pain may make it difficult to fall asleep at the start of the night, or later after waking up.
• The pain can cause multiple awakenings during the night.
• It can also prevent you from getting sufficiently restful sleep.

The problem is that the less you sleep, the more sensitive you become to pain (Chang, 2022), and the more you’re embarrassed to sleep. It’s a vicious circle.

So you’re right to ask: how can I make sure that my tendonitis bothers me as little as possible (if at all) when I sleep?

To answer this question, I propose to examine the following 3 questions, in the light of international scientific literature:

1. Can you improve your sleep simply by treating your tendonitis?
2. Is there a specific solution for sleeping better with shoulder tendonitis, even if it proves difficult to treat?
3. How can you sleep better with pain, wherever it may be?

Can treating shoulder tendonitis improve your sleep?

What if all you had to do to improve your sleep was to treat your tendonitis? The answer depends on whether we’re talking about recent (less than 3 months) or persistent (more than 3 months) tendinitis.

Let’s take a look at each of them.

Recent tendonitis, less than 3 months old

For tendonitis less than 3 months old, whether you treat it or not, it should heal in 45 days to 3 months maximum. For more details on this subject, I invite you to read my dedicated article on healing times for shoulder tendonitis.

As a result, if you find yourself in this situation, whatever you do should restore you to normal sleep, at worst within the same timeframe.

In the meantime, let me remind you that the best position for falling asleep with shoulder tendonitis is the one that suits you best.

If you’re fine sleeping on the affected shoulder, there’s no serious evidence that it can worsen your problem.

Persistent tendonitis lasting more than 3 months

For tendonitis lasting more than 3 months, it seems obvious: if you treat your shoulder tendonitis, you should feel less pain and sleep better.

But if you’re wondering how to get a better night’s sleep with shoulder tendonitis, it’s probably because :

• or you have already tried a number of treatments, without any success from a sleep point of view;
• or you’re in the process of trying it out, but for the time being the effects on your nights are slow to make themselves felt.

So you ask yourself whether there might be a specific solution. A specific solution which, if not cure your tendinitis in all circumstances, could at least reduce its influence on your sleep. That’s what I’ll be looking at in the next section.

Sleeping better with shoulder tendonitis: a specific solution?

Is there anything specific you can do to make your shoulder tendinitis less bothersome at night?

Unfortunately, having scoured the international scientific literature, I couldn’t find anything like it.

That said, there are of course a number of basic gestures, which you’ve probably already thought of, that deserve a moment’s thought. For example:

• changes in sleeping position;
• changes to bedding (mattresses and pillows in particular).

Change your sleeping position?

Let’s make it clear from the outset that, whether you like it or not, there’s a good chance you’ll automatically change position during the night. This is the case for the majority of people, who change on average every hour (Skarpsno, 2017).

In other words, the question is: is there a preferred position for falling asleep, at the start of the night, or during the night if you wake up? The answer is: the best position for falling asleep (or going back to sleep) is the one that suits you best.

And that’s even though you’ll find plenty of articles on the web telling you that it’s better to sleep on your back, stomach, etc. There are no serious scientific studies to back up this advice. There are no serious scientific studies to back up this advice.

Even if you lie on the side where it hurts, there’ s no evidence that it makes the problem worse. (Note that this is also true for any kind of sleeping position). So if this is your favorite position for falling asleep, you don’t necessarily have to change it.

Change mattress or pillow?

Here too, there is no scientific evidence that changing mattress or pillow can help tendonitis sufferers sleep better.

That said, it may well be that in your specific case, one mattress (or pillow) may suit you better than another. It’s possible, and you’re free to try (even if it can be a bit complicated to try out a new mattress properly; it’s hard to go back…).

Note: nursing pillows made of microbeads can also be very comfortable (see on Amazon), as well as small foam pillows that fit between the legs (see on Amazon).

The overall strategy to be considered in the case of pain that interferes at night comprises 3 steps (Perrig, 2011):

1. firstly, to ensure that the basic principles of good sleep hygiene are respected;
2. then consider drug-free approaches;
3. and, if need be, approaches with medication.

In the following sections, I’ll take a brief look at each of these 3 stages (which I hope will one day be the subject of specific articles!).

Drug-free approaches

There are many drug-free approaches to treating pain-related insomnia. You may even have already tried a number of them. Many of these approaches have already been the subject of scientific studies. In 2022, researchers reviewed all these studies (Whale, 2022).

Here is a list of the different approaches that have been studied:

⚫ psychotherapeutic interventions including:

• behavioral and cognitive therapies (CBT) ;
• acceptance and commitment therapy ;
• mindfulness-based interventions;
• relaxation ;

⚫exercise-based interventions including:

• walking programs ;
• Tai-chi-chuan;

⚫ interventions based on the use ofphysical agents:

• hypdrotherapy ;
• different types of massage (“classic” massage; lymphatic pumping techniques; foot reflexology) ;
• manual joint mobilization (manual therapy);
• a program based on ultrasound, electrical stimulation of the skin (TENS, for Transcutaneous Electrical Nerve Stimulation) and laser;
• light therapy (exposure to a certain type of light);
• use of a magnetic mattress topper.

Now let’s take a look at approaches involving medication.

Approaches using drugs

Studies on drug approaches to pain-related insomnia were the subject of a consequent review in 2021 (Herrero Babiloni, 2021). The researchers reviewed all the scientific work that has investigated:

• the effect of painkillers on insomnia;
• the effect on pain of drugs used to treat insomnia.

Here is the list of these drugs:

➡️ Pain medication ⬅️

⚫ analgesics and anti-inflammatories :

• non-steroidal anti-inflammatory drugs (NSAIDs) ;
• acetaminophen (paracetamol) ;

⚫ opioids ;

⚫ corticosteroids ;

⚫ cannabinoids ;

⚫ antidepressants :

• tricyclic antidepressants ;
• serotonin and norepinephrine reuptake inhibitors ;
• atypical antidepressants: bupropion

⚫ muscle relaxants :

⚫ anti-hypertensive medications :

⚫ anti-epileptic drugs :

• gabapentin ;
• pregabalin ;
• topiramate ;

➡️ medications for insomnia ⬅️

⚫ benzodiazepines ;

⚫ antidepressants ;

⚫ non-benzodiazepines ;

⚫ melatonin;

⚫ orexin antagonists ;

⚫ quetiapine ;

⚫ olanzapine.

As I said in a previous section, unfortunately there are no specific studies on the pain of shoulder tendonitis.

To date, the best we can do is look at what’s been said about insomnia related to chronic back pain. That’s where the most studies are to be found.

At the end of the day, you’re in the bestposition to know what’s right for you. To do this, you probably use certain selection criteria:

• does the approach seem credible? For example, how credible is the fact that a mattress is magnetic or not, compared to the simple fact that it is more or less firm?
• Is there solid scientific proof?
• Is it expensive?
• Is it difficult to implement?
• Are there any side effects?
• Does this leave me more or less autonomous? (For example, going to see a therapist once a week for 3 months may give you less than a solution you can implement on your own).
• Will it have a positive effect on my overall physical and mental health? Beyond the specific problem I’m trying to treat? (As in the case of regular physical activity, for example).
• Do my friends and family support me in this choice?
• Do the healthcare professionals around me support me in this choice?

Note that not everyone will give the same weight to each of these criteria, depending on their preferences. So there’s no one right solution for everyone.

Getting the best possible sleep: basic recommendations

Surfing the web, it’s easy to find lots of general recommendations for better sleep:

• avoid taking long naps during the day;
• go to bed at the same time every day;
• avoid physical exercise just before going to bed;
• Etc.

Does it really work? Does giving people this kind of advice improve their sleep, on average, as opposed to telling them nothing at all? What do the scientific studies say about this? Well, as astonishing as it may seem, it’s not very good.

To arrive at this answer, I consulted two reviews of the scientific literature:

• one from 2015, looking at theeffectiveness of recommendations for better sleep hygiene in the general population (i.e., the population that doesn’t have serious sleep problems but could still get better sleep) (Irish, 2015);
• the other from 2023, of the same type, but this time for people with chronic pain (Gupta, 2023).

The following is an outline of the sleep hygiene recommendations examined in these reviews:

• avoid naps lasting more than an hour or two during the day;
• go to bed at the same time every day;
• waking up at the same time every day;
• avoid physical exercise intense enough to make you sweat, in the hour just before going to bed;
• avoid staying in bed longer than necessary (no more than two or three times a week);
• avoid exciting activities just before going to bed;
• avoid going to bed feeling stressed, angry, upset or nervous (personal comment no. 1, easy to say!);
• have a comfortable bed ;
• have a comfortable bedroom (temperature not too high, as much darkness and as little noise as possible);
• avoid thinking, planning or worrying in bed (personal note #2: again, easy to say!);
• avoid nicotine, caffeine and alcohol;
• regular physical activity.

So, does it work to recommend all this? Simple answer: we don’t know.

On the one hand, there are very good reasons to think it might work. On the other hand, very few good quality studies have looked to see if it really works in real life (and with inconclusive results).

In practice, I think it might be worth testing (or retesting) some of these recommendations.

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If you have any questions, comments or experiences to share, don’t hesitate to drop us a line in the comments! 🙂

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