A broken humerus, the long bone of the upper arm, significantly challenges restorative sleep, which is necessary for healing. The instability and intense pain associated with this fracture, often compounded by a cast or sling, frequently disrupt nighttime rest. Finding a comfortable position becomes difficult because any slight movement causes sharp discomfort. Addressing this need requires a strategic approach to positioning, support, and pre-sleep preparation.
Optimal Positioning Strategies
The most effective strategy involves adopting a semi-reclined or upright position to manage pain and swelling. Sleeping flat on the back should be avoided, as this increases pain and makes it difficult to get out of bed without disturbing the injury. Instead, patients often find relief by sleeping in a recliner chair or by propping the upper body up in bed using pillows or a specialized bed wedge.
This elevated posture helps prevent blood from pooling at the injury site, reducing swelling and associated pain. Ideally, the injured arm should be positioned to keep the hand and elbow slightly above the level of the heart for continuous fluid drainage. When lying on the back, the arm should be stabilized and supported on pillows alongside the body, ensuring there is no pressure directly on the fracture site.
Avoid sleeping on the injured side, as the pressure is extremely painful and risks further displacement of the fracture fragments. If side sleeping is preferred, only sleep on the uninjured side, using a large body pillow to support the fractured arm and prevent accidental rolling. Stomach sleeping is generally not recommended because maintaining proper alignment and support for the injured limb is nearly impossible.
Using Support and Immobilization Aids
External aids are necessary to achieve and maintain the optimal elevated and stable position throughout the night. A foam wedge pillow is highly effective for creating the semi-reclined angle in bed, providing a consistent slope that supports the back and head. For the arm, a “nest” of standard or specialized pillows should be constructed to cradle the humerus and provide support from the shoulder to the hand.
The arm requires continuous support to prevent the weight of the limb from pulling on the shoulder joint, which causes significant discomfort. Pillows should be placed directly beneath the affected arm and palm while lying on the back to keep the limb elevated and cushioned. A large pregnancy pillow can also be used, allowing the individual to lie on the uninjured side while resting the injured arm upon it.
The prescribed sling or splint should typically be worn during sleep to limit arm movement and stabilize the fracture. If the physician approves removing the sling, the arm must still be fully supported by pillows to maintain immobilization. Support aids restrict mobility and prevent the arm from moving away from the body, ensuring the fracture fragments remain aligned for healing.
Managing Pain and Discomfort Before Bed
Strategic pain management must begin well before attempting to fall asleep to minimize nighttime awakenings. If approved by a doctor, over-the-counter or prescription analgesics should be taken 30 to 60 minutes before bedtime. This timing allows the medication to reach its peak effectiveness when the body is settled for sleep, providing a longer window of relief.
Applying cold therapy to the injury area, if approved by a physician, can reduce inflammation and numb pain receptors before bed. A wrapped ice pack can be used for up to 30 minutes to reduce localized swelling. Care must be taken to ensure the cold pack does not directly rest on the skin or compromise any cast materials.
Pre-sleep anxiety about pain or accidental movement can interfere with the ability to fall asleep, making relaxation techniques valuable. Simple deep breathing exercises help calm the nervous system and shift focus away from discomfort. Minimizing trips out of bed by moderating fluid intake and emptying the bladder fully before sleep helps maintain the stable position and prevent unnecessary movement.
Preventing Accidental Nighttime Movement
Because the body naturally moves during sleep, safety measures are necessary to prevent accidental rolling onto the injured side. The “pillow barrier” technique involves placing several rolled towels or firm pillows along the uninjured side of the body. This physical blockade serves as a tactile reminder that prevents unconsciously turning over to the injured side.
If sharing a bed, sleeping alone initially or creating a significant space barrier between partners is advisable to prevent bumps or jostling. Clear communication about boundaries and the injured arm’s position is important if sleeping with a partner. Sleeping in the center of the bed provides maximum space and reduces the risk of falling out during a movement attempt.
Safe ingress and egress from the bed require conscious, slow movements, using the uninjured arm for leverage and support. Keeping a dim light on is helpful for middle-of-the-night trips to the bathroom, preventing stumbles or accidental contact with the arm. Place necessities, such as water, pain medication, and a phone, on the uninjured side’s nightstand to minimize reaching or straining the fracture.