Traditional approaches to night time compression include using short-stretch bandages, however, many people struggle to apply them comfortably (often they are too tight and can cause more harm than good) or they unravel during sleep, leaving limbs without adequate compression. Unfortunately, these occurrences often discourage people from wearing any kind of compression at night and create big gaps between periods of wearing garments that can lead to increased swelling in affected areas.
Thanks to recent improvements in product designs and wearability, night-garments are becoming increasingly popular alternatives to bandaging and patients are quickly seeing the great results that around-the-clock management of oedema brings.
How does a lymphedema night-time compression garment work?
The goal of a night-garment is essentially the same as a stocking or arm sleeve that you might wear during the day- to encourage the movement of lymphatic fluid back to the heart and help reduce and prevent swelling. The difference, however, lies in the way they are constructed to achieve this, making them very different to your day wear.
Lower compression levels
During periods of rest or sleep, our body’s internal pressure is lower than when we are active during the day and standing vertically. We don’t have the same external forces (like gravity or body weight) bearing down on our limbs, so our compression garments don’t need to work as hard to contain swelling. The ideal external pressure from any garment (day or night) should be just sufficient enough to counteract capillary filtration pressure. When we are standing, this filtration pressure is higher, so garments for day-time (or when you are active) need to exert a higher pressure than when we are laying horizontally¹. Night-garments, therefore, are constructed with lower levels of compression.
Textured surfaces that aid in lymphatic drainage
When you visually compare a night garment with day hosiery, you will see immediately that they are thicker and have a more textured surface with ‘channels’ integrated into the fabric. This special design, when in contact with skin, helps to create differential pressures that create tissue stretch and open up the lymphatic channels to allow for better lymph flow. In some garments, like the Jobst Relax, the textured surface helps stimulate lymphatic flow by micro-massaging the skin. In garments like the Jovipak and Solaris Tribute, special vertical channels are integrated into the design that encourages lymph to flow towards alternative functional pathways.
Foam technology that breaks tissue fibrosis and improves micro-circulation
Many night garments contain foam inside them which, when applied to the skin under external pressure, creates both high and low-pressure points in the underlying tissues. This is an important design feature, as it helps break up stagnant proteins, increase venous reabsorption and improves the drainage of lymphatic fluid. The benefits of this for the patients can be seen by a reduction in swelling, improved micro-circulation within the tissues and a reduction or reversal of fibrotic tissue growth (Jovipak, 2016).
Softer materials that increase comfort and wearability
If you’ve ever used a night garment, you will know that they feel very different to day-hosiery. Their design is more centred on using foams and breathable, lightweight materials, that keep you cool and comfortable during the night. The bonus of increased comfort is that people are more inclined to keep them on for the entire night period! Daytime garments in comparison are stiffer and made using more resistant fabrics.
The benefits of wearing a night-time garment
The majority of Lymphedema patients can benefit from practising compression at night (see contraindications below). In particular, patients with ‘creeping refill’ will benefit from wearing a night garment, as well as those who have tissue fibrosis, Hyperkeratosis (skin thickening) and/or fluctuations in their swelling.
Patient night-garment study reveals the benefits of 24hr compression
A study conducted by Nurse Consultant, Justine Whitaker, observed patients’ during 315 nights of wearing night-compression garments and reported positive experiences from compressing over a 24hr period. Observations included, “Reduced swelling, improved pain management and better sleep with an increase in swelling in 89% of all patients when night-time compression was not used” (Whitaker, J. 2016).
An increase in swelling was documented in 89% of all patients when night-time compression was not used.
The study explained that over 80% of patients reported a reduction or management of their oedema when wearing night-time compression, which continued to have a positive effect for up to 24 hours. The top three reasons for not being compliant in wearing night-compression included fatigue, heat and stable oedema².
Continuing compression therapy throughout the night period resulted in many patients being able to successfully avoid rebound oedema and reduce interstitial fluid in their affected regions.
Is there any reason I shouldn’t wear a night garment?
Although the majority of lymphedema patients will be suitable candidates for night-garments, there are some health conditions which may prevent others from wearing them. Contraindications for wearing night-garments include:
Before purchasing any type of compression wear, we recommend that you consult with your primary caregiver and undergo a full assessment of your compression therapy needs.
What is the lifespan of a night garment?
Unless you are an avid sleepwalker, your night garment should last for a lot longer than your day wear. Check with the manufacturer of your garment to see what the recommended lifespan is, as it will differ from product to product. Changes in limb volume and diameter will have an effect on the efficiency of your product, so they should be reviewed and replaced from time to time for optimal therapeutic benefits. Carefully following washing instructions of your garment will also ensure a longer lifespan.
1: Lymphoedema Framework. Template for Practice: compression hosiery in lymphoedema. London: MEP Ltd, 2006.
2: Whitaker, J (2016): ‘Lymphoedema Management at Night: views from patients across five countries’, British Journal of Community Nursing, 21 (Sup10) pp. S22-S30
Lohmann-Rauscher, 2017: TributeNight™. Custom designed therapeutic nightwear.
Montagano, P. 2011: Night Time Garments. Guidelines and Resources.