Nurses and Shift Work: What the Research Shows About Sleep and Pain

Last updated: October 2026

Shift work is linked to poorer sleep in nurses: a meta-analysis of 29 papers found worse sleep quality on rotating shifts and fixed night shifts than on fixed day shifts (Chang & Peng, 2021b). The picture for pain is narrower than often assumed, since a meta-analysis of 18,199 nurses found rotating shifts linked to more back pain but not to more neck or shoulder pain (Chang & Peng, 2021a). Below is what each study found, what one diary study of 684 nurses showed about night shifts, and what the pillow does for anyone sleeping at odd hours.

Key takeaways

Across 29 papers, nurses on rotating shifts and fixed night shifts reported worse sleep quality than nurses on fixed day shifts (Chang & Peng, 2021b).
Across 17 studies of 18,199 nurses, rotating or irregular shifts were linked to more back pain (OR 1.40), but not neck or shoulder pain (Chang & Peng, 2021a).
A Pillowise fitting takes three measurements (shoulder width, neck circumference and neck length) and adds sleeping position and bed type to choose from seven sizes.

How does shift work affect nurses' sleep?

A systematic review and meta-analysis pooled 29 papers that measured sleep quality in nurses with the Pittsburgh Sleep Quality Index (Chang & Peng, 2021b).

Compared with nurses on fixed day shifts, those on rotating shifts reported worse sleep quality (standardized mean difference 0.38), and those on fixed night shifts reported worse still (0.58). The gap for rotating shifts was narrower in nurses over 40.

The included studies were cross-sectional and self-reported, so they show a link rather than cause.

Is shift work linked to musculoskeletal pain?

A second meta-analysis by the same authors pooled 17 studies covering 18,199 nurses, 12,786 of them on rotating or irregular shifts (Chang & Peng, 2021a).

Rotating or irregular shifts were linked to more back pain (odds ratio 1.40). The differences for neck, shoulder and upper limb, and hip and lower limb pain were not statistically significant.

Do more night shifts mean more pain?

A study of 684 nurses on rotating shifts used daily diaries over 28 days. A higher share of night shifts was not linked to more musculoskeletal pain or headaches, and nurses working half or more of their shifts at night reported less lower-limb pain (Stavås et al., 2024).

The authors note a possible healthy worker effect: nurses who tolerate nights well may be the ones who keep working them. Shift work and pain is a mixed picture, and it is reported that way here.

What does short sleep have to do with the neck and shoulders?

In a survey of 1,602 female nurses in Taiwan, 33.9 percent reported chronic neck discomfort and 34.7 percent chronic shoulder discomfort, and sleeping under 7 hours was the leading modifiable risk factor the authors identified (Chin et al., 2021). The design was cross-sectional, so it shows association, not cause.

What does pillow height change?

Day or night, the neck holds the angle the pillow sets for as long as the person sleeps. In a radiographic study of 16 adults, raising the pillow from 0 to 10 to 20 cm increased T1 slope and C2-7 Cobb angle while neck tilt decreased (Kim et al., 2015).

In a pilot EMG study of 15 adults lying on their side, the height matched to shoulder width produced the lowest neck and shoulder muscle activity (Jiao et al., 2025).

Why do generic pillows miss?

A standard contoured pillow, not fitted to the individual, performed no better than ordinary shapes in a randomized study of 106 side sleepers (Gordon et al., 2009). No single optimal pillow height can be specified, because it depends on four variables that differ from person to person: cervical alignment, body dimension, contact pressure, and muscle activity (Lei et al., 2021).

What we measure

Pillowise is a fitted cervical pillow that licensed healthcare providers measure and dispense, made in seven sizes.

Our sleep specialists take three measurements: shoulder width, neck circumference, and neck length. Combined with sleeping position and bed type, an algorithm identifies the best-fitting pillow from seven sizes.

Shoulder width is the measurement the EMG study found mattered most. A height matched to it produced the lowest neck and shoulder muscle activity during side sleeping (Jiao et al., 2025), and body dimension is what drives the individual optimum (Tian et al., 2025).

A systematic review of 11 studies covering 309 participants identified a 7 to 11 cm unloaded central height among the parameters supporting spinal alignment and sleep comfort (Radwan et al., 2021). The size is chosen from those three measurements plus sleeping position and bed type, rather than from a single stock height.

Pillowise pillows are made from premium Dutch memory foam and certified to OEKO-TEX Standard 100, meaning every component has been tested against the standard's limits for harmful substances.

Scope

The shift-work studies measured sleep and pain, not pillows, and most were cross-sectional. No study has tested whether a pillow changes sleep or pain in shift workers, and we make no such claim. The pillow studies are small, and the most recent systematic review found no clear advantage for any pillow type in chronic neck pain (Ghosh et al., 2025).

For providers

Nurses and other shift workers often sleep at hours the body resists, in rooms built for nighttime sleep. Asking when a patient sleeps, not only how long, gives the sleep conversation more to work with.

Sleep position and bed type stay the same whether someone sleeps at night or during the day. Those are the inputs that matter for pillow height.

A fitted pillow extends the work of the visit into the hours between visits, alongside the exercise, manual therapy, and other care the provider is already delivering.

Common questions

Does shift work make nurses sleep worse?

It is linked to worse sleep quality. Across 29 papers, nurses on rotating and fixed night shifts reported worse sleep than nurses on fixed day shifts (Chang & Peng, 2021b). The studies were cross-sectional and self-reported.

Does shift work cause back or neck pain?

The evidence is mixed. A meta-analysis of 18,199 nurses linked rotating shifts to more back pain but not to more neck or shoulder pain (Chang & Peng, 2021a), and a diary study of 684 nurses found no link between the share of night shifts and pain (Stavås et al., 2024).

Does a nurse who sleeps during the day need a different pillow?

Not because of the time of day. Pillow height depends on body dimension and sleeping position (Lei et al., 2021), and those stay the same whether sleep happens at night or after a night shift.

Is a contoured pillow from a store enough?

Not reliably. A standard contoured pillow, not fitted to the individual, performed no better than ordinary shapes in a randomized study of 106 side sleepers (Gordon et al., 2009), and no single optimal height can be specified because it depends on four variables that differ from person to person (Lei et al., 2021). A contour helps only if its height matches the person using it. That is what the fitting settles, in a provider's office.

Find a Pillowise provider or become one

Pillowise pillows are clinically measured and dispensed exclusively through licensed healthcare providers as part of broader sleep, posture, and recovery education.

To locate a Pillowise provider near you, visit: Find a Reseller

Licensed healthcare providers interested in offering Pillowise may register here: Become a Reseller

References

Chang, W.-P., & Peng, Y.-X. (2021a). Differences between fixed day shift nurses and rotating and irregular shift nurses in work-related musculoskeletal disorders: A literature review and meta-analysis. Journal of Occupational Health, 63(1), e12208. https://doi.org/10.1002/1348-9585.12208

Chang, W.-P., & Peng, Y.-X. (2021b). Influence of rotating shifts and fixed night shifts on sleep quality of nurses of different ages: A systematic literature review and meta-analysis. Chronobiology International, 38(10), 1384-1396. https://doi.org/10.1080/07420528.2021.1931273

Chin, W.-S., Chen, Y.-C., Lin, T.-T., Guo, Y. L., & Shiao, J. S.-C. (2021). Short sleep and chronic neck and shoulder discomfort in nurses. Journal of Occupational Health, 63(1), e12236. https://doi.org/10.1002/1348-9585.12236

Ghosh, S. K., Goyal, M., & Goyal, K. S. (2025). Effect of pillow on pain, disability and sleep quality in patients with chronic neck pain: A systematic review. Rehabilitación, 59(3), 100922. https://doi.org/10.1016/j.rh.2025.100922

Gordon, S. J., Grimmer-Somers, K., & Trott, P. (2009). Pillow use: The behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual Therapy, 14(6), 671-678. https://doi.org/10.1016/j.math.2009.02.006

Jiao, R., Xiao, W., Wang, M., Yu, S., & Li, H. (2025). The impact of pillow height on neck muscle activity: A pilot study. Sleep and Breathing, 29(1), 40. https://doi.org/10.1007/s11325-024-03219-6

Kim, H. C., Jun, H. S., Kim, J. H., Ahn, J. H., Chang, I. B., Song, J. H., & Oh, J. K. (2015). The effect of different pillow heights on the parameters of cervicothoracic spine segments. Korean Journal of Spine, 12(3), 135-138. https://doi.org/10.14245/kjs.2015.12.3.135

Lei, J.-X., Yang, P.-F., Yang, A.-L., Gong, Y.-F., Shang, P., & Yuan, X.-C. (2021). Ergonomic consideration in pillow height determinants and evaluation. Healthcare, 9(10), 1333. https://doi.org/10.3390/healthcare9101333

Radwan, A., Ashton, N., Gates, T., Kilmer, A., & VanFleet, M. (2021). Effect of different pillow designs on promoting sleep comfort, quality, & spinal alignment: A systematic review. European Journal of Integrative Medicine, 42, 101269. https://doi.org/10.1016/j.eujim.2020.101269

Stavås, J. A., Nilsen, K. B., & Matre, D. (2024). The association between proportion of night shifts and musculoskeletal pain and headaches in nurses: A cross-sectional study. BMC Musculoskeletal Disorders, 25 (1), 67. https://doi.org/10.1186/s12891-024-07196-5

Tian, S., Yao, C., Wang, Y., Cao, X., Sun, Y., Wang, L., & Fan, Y. (2025). The individualized optimal pillow height and neck support design for side sleepers. Medical and Biological Engineering and Computing, 63 (2), 535-544. https://doi.org/10.1007/s11517-024-03204-x