Night-time compression for lymphedema management is an area that has been overlooked in the past, with the majority of our focus being placed on perfecting our day-time practices of reducing swelling. Research has proven that wearing compression garments during the day is one of the most effective ways to manage swelling, particularly when wearing flat-knit, custom-made garments that have graduated compression strength. These special garments help maintain existing swelling as well as preventing limbs from filling up again throughout the day.
The problem is that swelling doesn’t simply stop when we lay down and go to sleep! Even with the best practices in place during the day, many people with lymphedema experience swelling and fluctuating oedema during their sleep¹.
Understanding the importance of 24-hour compression
Resting and elevating your limbs helps to temporarily relieve swelling but it doesn’t stop the process of oedema forming and liquid inevitably continues to enter the interstitial tissue space. As explained by Jeannette Zucker (DTP), “Even when you are elevating and responding well to this modified intervention, there is a continuous deposition of protein that continues to accumulate in your tissues. These proteins attract water, so eventually, at some point in time, the attraction for water will be greater than gravity. No matter what you do, [your limb] will still continue to progress and present with swelling.”
Lymphedema occurs due to a variety of conditions that result in the reduction of lymph flow. Regardless of the reason is for this lymphatic dysfunction, it results in the same problem- a change in the tissue pressures and the effectiveness of these pressures to keep water out of the places it should not be. This abnormal change in the ‘restrictive properties’ of these pressures allows movement of protein-rich fluid into the interstitial tissue space and makes the tissues swell². The proteins act like water magnets and suck more liquid out of the capillaries which rapidly overwhelms the area and results in oedema.
Unfortunately, this process and the damage it causes to the tissues is irreversible. The pressures inside the tissues change permanently and can no longer be regulated by our bodies natural processes. This is why people with lymphedema are required to wear external compression garments- because they recreate the pressure that our bodies can no longer produce. External compression increases the interstitial pressure and prevents fluid from filtering out of the capillary network (Bates, 1992). If compression is not continuously worn oedema will return rapidly.
Organise your night management with the best tools
It goes without saying that each case of lymphedema is unique to the person that lives with it. Thankfully, night-time compression comes in a variety of shapes, sizes and applications, meaning that there is sure to be something that suits your specific needs and personal preferences!
1Traditional multi-layer short-stretch bandaging
Inelastic or short-stretch bandaging is perhaps the most common form of night compression due to their easy accessibility and low cost (compared to night garments). Bandaging involves wrapping limbs and digits with two or more layers of bandages and padding (like foams and cotton) to help drain lymph fluid and stop it from accumulating in the interstitial tissue space. Short-stretch bandages create a constant low resting pressure when at rest and a higher working pressure when active. This helps to create a massage-like effect which stimulates the flow of lymph. Bandaging also helps to reduce the volume of limbs and restore them back to their normal shape as well as softening the skin and subcutaneous tissues.
It’s very important to be taught by a trained lymphedema therapist how to properly apply bandages. If they are not correctly applied, it can lead to issues like over-compression, not enough compression and swelling could increase or build up unevenly.
Velcro wraps are convenient alternatives to traditional bandages. These devices are made of rigid, inelastic materials that have very little stretch. They wrap around the affected limb and are secured with adjustable velcro straps which overlap to avoid any gaps. Velcro wrap systems are great for patients who have physical limitations and difficulties donning traditional bandages. Patients can be shown how to tighten garments easily and adjust the pressure as needed, allowing them to remain independent with their night care regime.
Another bonus of these wraps is that they are very quick to re-adjust if they become loose, which is ideal for patients who struggle with big fluctuations in swelling throughout the day.
3Foam padded liners with adjustable straps
These night garments are made with a soft foam liner that is encased in an outer shell made of durable fabric. A series of inelastic straps control the pressure and are easily adjustable to provide more or less compression. Their easy-to-use system means that most patients can fit the garment without assistance.
In some garments, the foam liner incorporates a chevron pattern that helps direct lymph flow by creating high and low-pressure ridges in the tissue.
4Foam sleeves and pads
Foam filled sleeves and pads are made using sophisticated pressure mapping technology, which moulds pieces of foam and fabric into ‘channels,’ that apply directional or bidirectional compression to the tissues. When in contact with the skin, these garments help 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 slide onto limbs much like a day-garment would. Their level of pressure is predetermined and cannot be further adjusted as they don’t have straps.
1: Whitaker, J (2016): ‘Lymphoedema Management at Night: views from patients across five countries’, British Journal of Community Nursing, 21 (Sup10) pp. S22-S30
2: Scallan J, Huxley VH, Korthuis RJ. Capillary Fluid Exchange: Regulation, Functions, and Pathology. San Rafael (CA): Morgan & Claypool Life Sciences; 2010. Chapter 4, Pathophysiology of Edema Formation. Available from: https://www.ncbi.nlm.nih.gov/books/NBK53445/
Bates DO, Levick JR, Mortimer PS. Subcutaneous interstitial fluid pressure and arm volume in lymphoedema. Int J Microcirc Clin Exp 1992; 11(4): 359–73.
Lohmann-Rauscher, 2017: TributeNight™. Custom designed therapeutic nightwear.