Expert QuoteThere are some women with lymphedema who are going to get into trouble if they are not using some kind of compression most of the time. And then there are women who can probably just wear compression when they are flaring or having symptoms, they notice a volume change, or they are doing something with the arm that is going to cause more lymph to be produced. It really has to be adjusted based on an individual’s risk level.
There are two main types of compression sleeves: daytime sleeves and nighttime sleeves. Both come in ready-to-wear (or off-the-shelf) and custom versions. Ready-to-wear sleeves are made by the manufacturer in different sizes, and you and your therapist (or fitter from the medical supply company) choose the size that fits your needs. Custom sleeves are made to fit your specific measurements. A custom sleeve may be needed if your arm is unusually long or irregularly shaped, or if the lymphedema is particularly aggressive and/or advanced. Or it may be a good option if you try a ready-to-wear sleeve and it doesn’t seem to do the trick. As you might expect, custom sleeves are more expensive than ready-to-wear sleeves.
A daytime sleeve is a tube of strong yet somewhat flexible fabric that extends from the wrist up the arm and almost to the shoulder. Its tightness decreases gradually as it moves up the arm, and this supports the flow of lymph up the arm to the axillary (underarm) lymph nodes. Depending on the manufacturer, sleeves come in flesh-tone colors (ivory, tan, brown, etc.), neutral colors such as white and black, and more colorful styles and even prints. So you have a choice of trying to have the sleeve blend in with your skin, coordinate with your clothes, or make more of a fashion statement on its own. Some daytime sleeves come with a glove or gauntlet already attached.
Sleeves also come at different pressure levels, which are described with a numerical classification system that ranges from low pressure to high pressure, class 1 through 4. The amount of pressure is measured in terms of “mmHg,” or millimeters of mercury, based on the amount of pressure exerted by one millimeter of liquid mercury. (You’re probably familiar with this from your blood pressure readings, which are also expressed in terms of “mmHg.”)
- Class 1 sleeves exert 20-30 mmHg of pressure on the limb.
- Class 2 sleeves exert 30-40 mmHg of pressure.
- Class 3 and 4 sleeves, available as custom orders, exert even higher ranges of pressure (40-50 or 50-60 mmHg).
Sleeves of the same class can feel quite different depending upon the manufacturer. There is no system in the U.S. for ensuring that sleeves are labeled correctly according to these classes. Keep this in mind if you are trying out different sleeves or thinking about switching brands.
Sleeves manufatured in Europe use a slightly different classification system:
- Class 1 sleeves exert 18-21 mmHg of pressure on the limb.
- Class 2 sleeves exert 23-32 mmHg of pressure.
- Class 3 sleeves exert 34-46 mmHg of pressure.
- Class 4 sleeves go even a bit higher.
Generally, more severe cases of lymphedema require a higher-class sleeve, while milder cases require a lower class. Some companies make even lighter pressure sleeves — 15-20 mmHg — for the mildest cases. Your lymphedema therapist can help you determine what level of pressure is right for you. Over time, you may find that you need to move to a higher-pressure or lower-pressure sleeve, depending on how your symptoms respond.
The cost of a daytime sleeve can range from less than $100 to about $250.
If you find that daytime compression isn’t enough to control your symptoms, you may need to wear a compression sleeve at night, too. Nighttime sleeves are larger and bulkier than daytime sleeves — first, because you’re lying down while wearing it, and second, mobility is less of a concern since you’re sleeping. Typically these sleeves are made of foam and padded material, and often they have outside straps that can be adjusted to provide the right amount of compression. Examples of brands you may encounter are the ReidSleeve®, the Tribute, and the Measure-Up™ Armsleeve. Although designed for nighttime use, they can be worn during daytime rest or periods when you don’t need to use your arm that much. Your lymphedema therapist can help you figure out what’s right for you.
Nighttime sleeves are more expensive than daytime sleeves, ranging anywhere from $200 to more than $1,000. Therefore, insurance coverage may be more of a concern. Check with your lymphedema therapist or your medical supply company to see whether other patients have been successful in getting coverage.
“The good news is that we have many more compression options than in the past — and this means more ways to intensify a treatment regimen as needed,” says Andrea Cheville, MD. “So, you might start with a lower-class daytime sleeve and see how that works. If needed, you can move to a different class of sleeve, or a custom sleeve, or maybe add nighttime compression. There are many ways to ratchet up the amount of compression once you see how your body responds.”
A note about daytime vs. nighttime compression: Experts are divided on the issue of whether or not it’s OK to wear a daytime sleeve overnight. Some believe it is fine, and many people report that it works well for them. Other experts are concerned that a daytime sleeve could bunch up or otherwise shift out of place at night, without the wearer realizing it. This could pose some risk to the limb. If your lymphedema therapist recommends around-the-clock compression, ask for his or her opinion about the type of compression sleeve you should wear.