We often don’t think about sleep as a tool for managing our lymphedema, but it actually provides an extremely important opportunity for us to restore Lymphie limbs to better functioning levels and reduce swelling. Sleep is a time for physical restoration and plays a crucial role in repairing and rejuvenating major functions of the body. For people living with lymphedema, sleep can have a profound impact on their condition and be further enhanced when night compression is utilised at the same time.

Simplifying the night-time care process

Getting a good night’s sleep and managing your lymphedema swelling at the same time has been made heaps easier thanks to night garments. Used as an alternative to self-bandaging, night garments are best described as inelastic compression devices that address unmet compression needs over a 24-hour period. Around-the-clock management of oedema is important because it helps to prevent the re-accumulation of fluids while we sleep.

Night-garments have a range of benefits including:

  • They compliment day-time gains in reducing or managing limb swelling
  • Can help soften tissue fibrosis by creating localised tissue stretch and differential pressures (Lohmann-rauscher, 2017).
  • Offer patients an alternative to short-stretch bandaging
  • They provide greater levels of comfort and allow you to sleep in more natural positions
  • Can help stimulate lymphatic capillaries (the entry point of lymph)
  • They protect your limbs

The different types of night garments for lymphedema

Night garments for lymphedema are broken up into three main categories:

  1. Foam padded liners with adjustable straps
  2. Foam sleeves and pads
  3. Short-stretch velcro wraps

They can be custom-made or bought as ‘ready-made’ garments, and come in a range of different products for all regions of the body, including lower extremity garments (legs, hips, groin), upper extremity garments (trunk, torso, arms) and head and neck garments.

Foam padded liner with adjustable straps

These garments are constructed with a soft inner foam liner that is encased in an outer shell made of durable fabric. The pressure levels are controlled by a number of inelastic straps, that are easily adjustable to provide more or less pressure. They provide gradient pressure, which means that they have the greatest amount of compression at the distal end (ankle or wrist) of the garment and gradually decreases towards the proximal end (top) of the garment. 

The main advantage of a foam liner with straps is that it gives patients more independence to manage their lymphedema because they can fit the garments without assistance and can quickly adjust the straps to get the most effective pressure for their needs. Other benefits include:

  • They offer an effective alternative to traditional bandaging
  • In some garments, the inner foam liner is designed in a chevron pattern and helps facilitate lymph movement by creating high and low-pressure ridges in the tissue
  • Patients can precisely adjust the levels of pressure to suit their individual needs
  • Suitable for patients with moderate to severe lymphedema

Foam sleeves and pads 

Foam filled night garments are made with a combination of foam pieces and fabrics and are constructed using sophisticated pressure mapping technology. The foam elements are moulded into clever ‘channels’, that when in contact with the skin, apply directional or bidirectional compression to the tissues. This design feature helps to stretch the tissues and stimulate lymph flow by encouraging it to move through alternative pathways (Lohmann-Rauscher, 2017).

These night garments use graduated compression and have a similar application to that of day garments- they slide easily onto the limb and do not require any additional strapping or tightening to achieve the desired compression levels. They are custom-made to meet the unique needs of each patient and are suitable for mild to severe cases of lymphedema.

Benefits of these garments include:

  • Foam channels that encourage lymph to flow towards alternative functional pathways
  • They create tissue stretch, which contributes to the reabsorption of interstitial fluids and particles back into the circulatory system
  • They are made with textured fabrics which create a micro-massaging effect and stimulate lymph flow
  • Better anatomical fit thanks to custom-made measurements
  • Flat knit technology with gradient compression

 

Short-stretch velcro wraps

Velcro wraps, or velcro binders as they are also called, are a great alternative to traditional bandaging and elastic compression garments, particularly when:

  1. Patient mobility is a factor (if they have trouble putting on traditional compression garments or taking them off, or applying traditional bandages)
  2. Patients have fluctuating oedema and rebound oedema
  3. The oedema is aggressive and harder to manage with more traditional methods (like bandaging or elastic day-garments)

These wrap systems are made of rigid, inelastic fabrics that have minimal stretch. They work by using adjustable velcro straps that wrap around the affected area and overlap, providing proper support and pressure to control oedema. Before fitting velcro wraps, a smooth cotton liner is applied to the leg or arm to help protect the skin. They do not contain a foam layer and can be worn during the day or night.

To achieve the correct compression levels, some products use colour coded systems that require the patient to match coloured straps together to get the right pressure level. Other products require special measuring guides to help vary bandwidths and control the gradient compression throughout the device.

Benefits of using velcro wrap garment include:

  • They exert higher working pressure and lower resting pressure
  • They can be used during the daytime, resting periods or sleeping
  • It makes dealing with size fluctuations easier, as the devices are easy and quick to adjust
  • The overlapping system helps to prevent gaps forming in the wrap
  • They provide certain patients with more independence to manage their lymphedema
  • They are available in custom measures or off-the-shelf versions
  • Certain products are available in all four levels of compression (20-30, 30-40, 40-50 and 50+ mmHg).

 

Choosing the right garment to suit your individual needs

It’s important to always remember that no two lymphie limbs are the same! Furthermore, a night-garment that works for one person may not be ideal for another. There are many things to consider when choosing a night-garment, including the stage and severity of your lymphedema, your ability to tolerate night compression, your skin condition, lifestyle factors and your physical ability to don certain garments. All these points should be assessed by a qualified garment fitter in order to determine the most appropriate product for your needs. Before purchasing any kind of compression wear, it’s best to check with your caregiver that you do not have any health issues that may contraindicate the use of a night-garment.

 

Links to products:

Sigvaris Medafit

ReidSleeve Classic

Circaid Graduate

Jobst Relax

Jovipak

Solaris TributeNight

Jobst FarrowWrap

Circaid Juxa Fit

Solaris Ready Wrap

 

References:

Lohmann-Rauscher, 2017: TributeNight™. Custom designed therapeutic nightwear.

 

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