Why Pain Wakes You at Night, and How to Sleep Better

Shoulder pain that wakes you at 2am, a stiff neck every morning, or snoring that needs looking into. A practical guide to pain, sleep and what actually helps.

Pain that wakes you at night is one of the most common things people mention to us, usually as an afterthought at the end of an appointment. It is worth raising much earlier, because poor sleep and persistent pain feed each other, and the two are far easier to treat together than separately.

Poor sleep is rarely caused by one thing. Usually, it is a stack of small ones: a late coffee, a warm room, a sore shoulder, a phone at midnight. Occasionally it is something that needs proper medical investigation. Knowing which you are dealing with is the place to start.

When pain is what is waking you

Pain and sleep affect each other in both directions. Pain makes sleep harder, and poor sleep lowers your pain threshold the following day. Research following people who had both chronic musculoskeletal pain and insomnia found that the two reinforce each other, and concluded that both need treating together.¹

The patterns we see most often:

•      Shoulder pain that wakes you when you roll onto that side, often the first sign of a rotator cuff or bursal problem.

•      Neck pain and headaches that are worse first thing, which frequently trace back to pillow height or a day spent at a screen.

•      Low back or hip pain that makes turning over in bed difficult.

•      Jaw pain or clenching that flares overnight. We have written separately about jaw pain and TMJD.

Best sleeping positions for neck, shoulder and back pain

There is no single correct sleeping position, and shifting during the night is normal and healthy. What matters is that your spine is reasonably supported in whatever position you favour.

•      On your side. Your pillow needs to fill the gap between your ear and the mattress, so the height should roughly match the width of your shoulder. Too flat and your neck bends down all night; too high and it bends up. A pillow between your knees keeps the top hip from dropping forward, which helps low back and hip pain.

•      With a sore shoulder. Avoid lying on the painful side. If you sleep on the other side, hug a pillow so the sore arm is supported rather than hanging across your body.

•      On your back. Use a thinner pillow, and put a pillow under your knees to take some strain off your lower back.

•      On your front. This is the hardest position for the neck, because your head stays rotated for hours. If you cannot sleep any other way, use a very thin pillow or none at all, and place a pillow under your hips.

If you wake with a stiff neck most mornings, the pillow is the first thing to change. Pillow height matters considerably more than the material it is made from or what it costs.

The sleep basics still matter

Sleep hygiene is an unglamorous term for the habits that make sleep more likely. These are the ones best supported by evidence.

•      A consistent wake time, including weekends. This anchors your body clock more reliably than a consistent bedtime does.

•      Morning daylight. Getting outside early helps set the timing of your melatonin release that night.

•      A cool, dark, quiet room. Your core temperature needs to fall for sleep to begin.

•      A caffeine curfew. Caffeine has a half-life of about five hours, so a 3pm coffee is still half in your system at 8pm.

•      Less alcohol in the evening. It shortens the time taken to fall asleep, but it fragments the second half of the night and relaxes the airway.

•      Getting out of bed when you are awake. Lying there frustrated teaches your brain that bed is a place for being awake.

•      Avoiding phone/computer/TV screens before bed. Ideally, stopping this a few hours before bed can give your body the best chance to produce the melatonin it needs to have a healthy night’s sleep. Use this time instead to play a board game with the family, read a book, or hand write that novel you’ve wanted to start for years.

Screens and blue light before bed

Evening light does affect your body clock. In one controlled study, exposure to LED lighting in the hours before bed delayed the onset of melatonin release compared with dim light.²

The popular remedy is less convincing. A 2023 Cochrane review found the evidence that blue-light filtering glasses improve sleep quality inconclusive, with no clear benefit for eye strain either.³ Anecdotally however, I find blue-light blocker glasses beneficial for myself, and many patients have reported that they help them as well.

Reducing overall light and stimulation in the last hour before bed is more likely to help. Dim the lamps and switch on night mode.

How osteopathy can help with pain that disturbs sleep

Osteopathic treatment does not treat insomnia directly, and we would be cautious of anyone who claims otherwise. What it can do is remove an obstacle. If a painful shoulder, a stiff neck or an aching back is waking you or stopping you settling, treating that removes one of the reasons your sleep is broken.

At Grassroots Healthcare that means hands-on treatment for the painful area alongside practical advice: sleeping positions, pillow height, how to support a sore shoulder or hip, and gentle movement before bed. If your symptoms are worse after a day at a desk, it is worth reading our guide to desk setup, neck pain and headaches as well. Where stress and pain are both involved, we work alongside your GP rather than in place of them.

When it is not just pain

If you sleep a full night and still wake unrefreshed, pain may not be the main problem. Loud snoring with pauses or gasping, daytime sleepiness, morning headaches or a dry mouth can point to obstructive sleep apnoea, where the airway repeatedly narrows during the night. Osteopathy does not treat sleep apnoea, and left untreated it carries real cardiovascular and road safety risk, so it is worth raising with your GP.

We have written a separate guide to how sleep apnoea is diagnosed in Australia, home sleep studies and CPAP.

Where to start

If pain is waking you, that is something we can help with directly. If you are snoring, waking unrefreshed, or feeling sleepy during the day, start with your GP and ask about a sleep study.

Pain keeping you awake? Our osteopaths at Grassroots Healthcare in Canungra may be able to help. Book an assessment online or call 0422 071 200.

References

1. Frange C, Hachul H, Hirotsu C, Tufik S, Andersen ML. Temporal analysis of chronic musculoskeletal pain and sleep in postmenopausal women. J Clin Sleep Med. 2019;15(2):223–234. https://doi.org/10.5664/jcsm.7622

2. Park HR, Choi SJ, Jo H, Cho JW, Joo EY. Effects of evening exposure to light from organic light-emitting diodes on melatonin and sleep. J Clin Neurol. 2020;16(3):401–407. https://doi.org/10.3988/jcn.2020.16.3.401

3. Singh S, Keller PR, Busija L, et al. Blue-light filtering spectacle lenses for visual performance, sleep, and macular health in adults. Cochrane Database Syst Rev. 2023;8:CD013244. https://doi.org/10.1002/14651858.CD013244.pub2

This article is for general information and does not replace individual clinical assessment. Citations retrieved via PubMed.