Lymphedema

Compression Stockings and Sleep Apnea: Can Support Hose Help You Sleep Better?

Doctors often recommend compression stockings for a variety of health conditions — from deep vein thrombosis to leg swelling (edema) of pregnancy to lymphedema to varicose veins. But new research published in the November 2011 issue of the American Journal of Respiratory and Critical Care Medicine suggests that this type of medical therapy may benefit people with a sleep disorder called obstructive sleep apnea.

Researchers in Paris, France, instructed a group of people with obstructive sleep apnea to wear stockings to wear the support hose daily for 1 week; the comparison group did not wear stockings for 1 week. After a week, the groups switched. During the study, every night the researchers measured each participant’s neck fluid volume.

The researchers theorized that preventing fluid accumulation in the legs by using stockings would then prevent fluid from building up in the neck – and their theory proved correct in this small study of 12 people. When the people in the study wore the stockings, they had 62% less fluid in the legs, 60% reduction in the size of their necks (indicating less fluid buildup), and 36% fewer sleep apnea incidents per hour.

Sleep apnea, which causes between 5 and 30 brief interruptions in sleep per hour, doesn’t just leave you drowsy. Obstructive sleep apnea can wreck serious havoc on your health.

According to the National Heart, Lung and Blood Institute of the National Institutes of Health, the airway blockage caused by sleep apnea can increase your blood pressure, as well as increase your risk of heart attack, stroke, obesity, diabetes, heart failure and arrhythmias. It also increases the likelihood that a person will be involved in work-related or driving accidents.

Doctors treat obstructive sleep apnea by prescribing lifestyle changes (like losing weight and avoiding alcohol) and oral appliance and continuous positive airway pressure machines to make breathing at night easier.

Compression wear are prescribed for people with a wide variety of venous insufficiency disorders. Using compression hosiery and compression stocking aids can promote blood flow, reducing the risk of blood clots, leg swelling and other vein problems.

If you have vein problems or chronic sleep apnea, you should be followed by a doctor to monitor your progress and ensure that the treatments recommended for you are working. Talk to your doctor about the study findings or for answers to any questions you have about your medical conditions.

Source: Redolfi S, Arnulf I, Pottier M, Lajou J, Koskas I, Bradley TD, Similowski T. Attenuation of obstructive sleep apnea by compression stockings in subjects with venous insufficiency. Am J Respir Crit Care Med. 2011 Nov 1;184(9):1062-6.

Intermittent Pneumatic Compression Basics

If you have deep vein thrombosis, or DVT, chronic vein disease, or need surgery that will keep you in bed for lengthy periods of time, your doctor may recommend you use intermittent pneumatic compression.

That’s a mouthful! What’s intermittent pneumatic compression? Let’s break it down:

• Intermittent – in intervals
• Pneumatic – using air
• Compression – with a squeezing motion

This intermittent therapy helps prevent blood clots from forming in the extremities, especially useful for people with vein problems, lymphedema, or after surgery. Your legs or arms are inserted into a plastic or cloth sleeve and an air pump inflates the sleeve with air at regular intervals. This squeezing action provides pressure that helps circulate blood from your veins and back to your heart and reduces the chance that you’ll develop dangerous clots.

Doctors may also refer to the machine that pumps the air as a sequential compression device.

Using these devices can cut the risk of deep vein thrombosis by up to 60%, some research studies show. In addition to using intermittent pneumatic compression, your doctor may recommend that you take medications to thin your blood and use compression stockings to support your veins and improve blood flow.

Debulking and Lymphedema

Debulking is a type of surgery sometimes used in patients with lymphedema, a condition that causes swelling and fluid accumulation in the upper or lower extremities.

Generally, the fluid accumulation associated with lymphedema is treated with compression therapy and compression garments. Bandages or gauze are wrapped around the affected limb, and a supportive stocking or arm sleeve that compresses the lymph and blood vessels is placed on top. This process of wrapping and applying compression garments, though it can sometimes get tedious, helps support the lymph system and helps the person’s body better eliminate the extra fluid buildup.

A person with lymphedema may also need to use a sequential compressive device, or compression pumps, which provide intermittent pressure to the arm or leg to help the body get rid of extra fluid. People with lymphedema slide their arms or legs into a sleeve and turn on the compression pumps. The sleeves inflate with air and add pressure to the limb.

In some cases, though, a person may have such severe lymphedema that he or she may investigate surgical therapies. If a person has oozing, weeping lymph fluid, can’t walk or do regular activities at home, or experiences daily severe pain because of lymphedema, surgical therapy could be an option. Doctors stress that debulking surgery for lymphedema doesn’t cure the condition, and in some cases, it may worsen.

There are several different ways that surgeons may attempt to debulk a lymphedema patient and improve the person’s ability to drain lymph fluid. The most common type of debulking is making a small skin flap and removing a small portion of skin and underlying tissue. Surgeons then close the wound and allow it to heal. A few months later, surgeons repeat the same approach in a different area of the affected limb.

Sometimes suction is used to help with debulking, by using a vacuum to suck up underlying tissue, but lymphedema often comes back quickly after this procedure. And in rare cases, a technique is used to take all skin and subcutaneous tissue from the affected limb. Then doctors graft the person’s cut-away skin back onto the body. There are many life-threatening complications associated with this type of surgery.

In all cases, there are serious complications associated with debulking and lymphedema. A patient may experience nerve damage, increased risk of bacterial infection, ulcers, large scar tissue formation, weeping sores, and cosmetic skin problems after debulking.

Note: All information on About Compression Stockings is for your education purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor or health care provider.

Lymphedema Arm Sleeve: What You Need to Know Before Buying

If you have arm lymphedema, your doctor may recommend compression therapy to help reduce fluid from collecting in your upper extremities. Before you buy a special sleeve for your lymphedema, here are some of the most common questions users often have about these compressive garments.

How They Work

With compressive therapy, your arm is covered in several layers of gauze, bandages, or other fabric, and then topped off with a lymphedema arm sleeve. The sleeve is made of a tightly woven mesh fabric that supports and protects the lymph network in your arm. The fibers of the sleeve press on the blood vessels and lymph network, making it easier for your body to eliminate extra fluid

Types

A lymphedema arm sleeve varies by the level of compression it provides and the fabric used to construct the sleeve. People with mild to moderate lymphedema may require sleeves in the 20-30 mmHg range. Mmhg stands for millimeter of mercury, a unit of measuring pressure. When it comes to compression garments, mmHg refers to how tightly the elastic medical compression stockings support the veins in the arm. The higher the mmHg number, the more firmly the sleeve will squeeze the patient’s arm. People with more severe lymphedema may need arm lymphedema sleeves in the 30 to 40mmHg or greater range. A doctor, nurse, or therapist can recommend the level of compression that is best for your situation.

These sleeves are constructed from a variety of fabrics. Nylon sleeves, available in lower compression levels, are easier to put on and provide sleek support under clothes. They’re less noticeable, so many people with lymphedema choose them.

A silk sleeve is another common type of sleeve. These sleeves are known for their durability and breathability. Although most lymphedema sleeves require replacement after six months or so because the fibers stop supporting the lymph network properly, silk arm sleeves are less likely to stretch and may last a year or more.

People with more severe cases of lymphedema or who want a more comfortable sleeve may also choose microfiber sleeves. These sleeves are available in a variety of colors, are easier to wash, and users report that they’re much more comfortable.

Brands

Some popular lymphedema arm sleeve brands and styles are:

LympheDiva 20-30 mmHg (available in White, Black, and Fuschia):

A user from Maryland writes: “If you have to wear a compression sleeve, you might as well do it in style. The ladies that own and run this company have come up with a fashionable way to handle the lymphedema that comes as a result of surgery, especially surgery related to breast cancer. Women who feel vulnerable can take special pride in wearing these sleeves. They are colorful, bold, and ask for passerbys to comment upon. Go for it ladies!”

Juzo Arm Lymphedema Sleeve (30-40mmHg):

Here’s what one user says about this sleeve: “I just went to a tighter sleeve and was worried that it would be really hard to get on. It is harder than the looser one, but goes on easily with a donning glove. It’s controlling my lymphedema better too. I really like the silicone band–it doesn’t fall down!”

Juzo Arm Lymphedema Sleeve 20-30 mmHg

A user writes: “Very comfortable. The length is just right. much better than other products I’ve purchased elsewhere in the past.”

Jobst Armsleeve 20-30 mmHg

Where to Buy

You can find lymphedema products and armsleeves at your local medical supply store or online, both through popular websites like Amazon and online medical suppliers. Make sure that when you purchase a sleeve you’re getting the compression level (in mmHg) that your doctor recommends for you. He or she may even provide you with a specific prescription and brand that would work best for your situation.

Buying Lymphedema Products

For many people with lymphedema, you may need to buy lymphedema products from a reliable source. You may hold in your hands a prescription from your health care provider, but 1) have no idea what you’re buying, 2) have no idea where to purchase it, and 3) feel unsure that you’re getting the most features or capabilities for your money.

Feeling confused and concerned about the cost of lymphedema products, patients may put off purchases or even ignore their doctor’s suggestions for buying products that could make their lives easier and their health better. Fortunately there are a few simple tips that can make selecting products easier.

1. Go with your doctor or health care provider’s advice. Usually, people with lymphedema need a few items, including compression stockings or arm sleeves, lymphedema bandages and foam padding, sequential compression devices or compression pumps, and other durable medical supplies. For stockings, your doctor may recommend a brand like Mediven, Jobst, Juzo, or Sigvaris.

For sequential compression devices, your doctor may recommend a brand like PresSion, Flexitouch, BioCompression, Wright Therapy, or Kendall. Both compression garments and compression pumps are medical devices, can be somewhat complicated to operate if you’re new to using them and may require assistance to learn how to use properly. It’s tempting to go with an off-name brand to save a few bucks, but your doctor made a recommendation for a tested product for your situation, so it’s advisable to follow the advice of someone familiar with your specific health situation.

2. Don’t purchase a used or refurbished model – you don’t know what you’re getting! Going with a used model could put your health at risk if it doesn’t work properly. The investment you make in a compression pump machine will be one of the most important investments you make because it will help you live a longer and healthier life, allowing you to succeed at work and home and spend more time with family and friends. Unauthorized dealers may purchase your sequential compression device from a middleman. They may not work properly and you will never know. In addition, you may pay a significant amount of money and not have warranty coverage. The risk isn’t worth it.

3. Avoid websites that offer cheaper brands when buying lymphedema products. Instead, look for a website that offers machines with warranties from the quality manufacturers (PresSion, Kendall, Flexitouch, BioCompression, or Wright Therapy, or Jobst, Juzo, Mediven, and Sigvaris) and offers free customer care and support. When you’re buying equipment that costs you or your insurance company hundreds to thousands of dollars, you deserve access to customer support if you need it.

4. Look for brands recommended by recognizable organizations, such as the American Cancer Society. If you’re unsure about a specific brand, contact the manufacturer for information about their product offerings, warranties, customer service, and more, so you can compare.

Sequential Compression Device: What You Need to Know about Lymphedema Pumps

Has your doctor recommended that you use a sequential compression device? These special lymphedema pumps help reduce blood pooling, clots, and fluid buildup in people who can’t move for long periods of time.

How Does This Device Work?

Like compression stockings and lymphedema sleeves, these devices help blood and fluid flow better, reducing leg lymphedema.

First, a disposable sleeve is placed around your leg. The sleeves look a bit like leg warmers, and stretch from your ankles to your knees or the tops of your legs. After you put on the sleeves, an air pump, connected to the sleeve, pushes air into the sleeve at various intervals. This creates a squeezing sensation of pressure and helps the blood in the veins circulate and flow better. There are both home and hospital-grade versions of these devices.

The more chambers a device has, the better it can help blood and fluid in the legs circulate. A hospital-grade sequential compression device may have up to 10 chambers.

Another name for these lymphedema products is intermittent pneumatic compression system.

Who Needs This Device?

People undergoing hip replacement or other surgery or with obesity, blood clotting conditions, deep vein thrombosis (DVT) or swelling in the arms and legs, called lymphedema, may be prescribed these devices. Research studies have also investigated the use of sequential compression devices for relieving restless legs syndrome. This common problem is the second most common sleep disorder and causes uncomfortable or painful sensations in the arms or legs.

How Much Does a Sequential Compression Device Cost?

Cost of these lymphedema pumps often depends on how many chambers they have. More chambers are more expensive, but also generally more effective.

Using a Pump

• Most of the sleeves you order for use with the pumps are machine washable.

• You can order sleeves in a variety of sizes to accommodate your needs.

• You may need a prescription for more powerful lymphedema pumps; usually you obtain this from your doctor’s office and then fax it when you order your item.

• You shouldn’t use these lymphedema pumps if you have an active blood clot.

• You shouldn’t use these if you have congestive heart failure.

• If your arm or leg or foot is very sensitive to pain, don’t use a lymphedema sleeve on it.

Check with your doctor before using any type of sequential compression device.

All information on AboutCompressionStockings.com is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.

Leg Lymphedema and Compression Stockings

Women undergoing treatment for vulvar cancer often experience the unpleasant side effect of lymphedema. In a December 2009 study, researchers from the United Kingdom suggest that using compression stockings can help alleviate leg lymphedema.

Lymphedema is severe swelling that occurs due to a blockage in the lymphatic system, part of the immune and circulatory system’s network of vessels that help remove fluids from the body. Because removing cancer from the vulvar area often requires removal of lymph vessels, too, fluid can’t drain properly, and accumulates in the body, causing significant swelling in an arm or leg.

A small study conducted at the University of Manchester in the United Kingdom reported that evaluated whether women who’d undergone surgery for vulvar cancer experienced less leg lymphedema if they wore compression stockings.

Compared to women who didn’t wear the stockings, women who wore stockings after vulvar surgery had less fluid volume in their legs and had fewer symptoms of leg problems. The study, published in the International Journal of Gynecological Cancer, did not find that compression stockings affected the rates of wound healing.

Because of their study findings, the researchers concluded that using compression wear may be effective for reducing leg lymphedema in women who require vulvar surgery, although they say that more studies are needed to make specific conclusions.

Compression choices for leg lymphedema:

• Sigvaris Pantyhose
• Sigvaris Thigh High Open Toe
• Jobst Relief Thigh Highs

Will you be undergoing surgery for vulvar cancer? Using support stockings as a preventive measure may be one way to reduce your risk of leg lymphedema. Talk to your doctor about what level of compression you might require. Some name brand stockings often used to alleviate lymphedema include Mediven, Sigvaris, Juzo, and Jobst.

Lymphedema Compression Stockings and You

The health condition lymphedema involves swelling in the arms and legs. When the lymphatic system in your body becomes blocked, fluid may have difficulty draining and circulating. As a result, the fluid has nowhere to go and collects, causing uncomfortable swelling. Although the condition has no cure, sometimes the swelling may be relieved with lymphedema compression stockings.

Lymphedema often develops after a person has surgery, injury, or infection. All of these situations can make it difficult for the lymphatic system to drain lymph fluid. Cancer, radiation treatment, and other diseases may also cause this lymphatic disorder.

One of the most common symptoms of lymphedema include swelling in the arm or leg (the fingers and toes may also swell). If you have this health problem, your arm or leg may feel heavy and tight and it may be difficult to move. If you have lymphedema, you may develop infections in the affected body part, and the skin in that area may become thickened and hard.

If you see a doctor about lymphedema swelling in the arm and leg, he or she may have you undergo tests such as MRI, radionuclide imaging, CT, and Doppler ultrasound.

To treat lymphedema, your doctor may recommend a variety of therapies, including exercise and massage. You may need to wrap your swollen body part with bandages to improve lymphatic drainage. Doctors also often recommend lymphedema stockings. These tight elastic stockings squeeze your arm or leg and make it easier for fluid to drain out of your body. Some common brands of stockings include Sigvaris, Mediven, Jobst, and Juzo. These stockings also help prevent swelling if you are prone to this health condition.

Lymphedema compression can make it less likely that your puffy arm or leg will become severely swollen.