Pectus carinatum (PC) is a chest wall deformity where the sternum and rib cage protrude outward. Bracing is a common, non-surgical treatment that applies sustained, corrective pressure to reshape the chest wall over time. Successful bracing therapy requires consistent wear, typically 12 to 20 hours per day, meaning the brace must be worn while sleeping. Finding a comfortable position for a full night’s sleep can be difficult due to the constant pressure. Addressing brace fit, sleeping position, and nighttime discomfort is crucial for maintaining the long wear times necessary for correction.
Pre-Sleep Preparation and Brace Fit Checks
Preparing the brace and skin before lying down significantly reduces the chance of friction and pressure issues developing overnight. Always wear a thin, clean, and well-fitting base layer, such as a cotton or moisture-wicking synthetic t-shirt, directly against the skin underneath the brace. This layer prevents direct contact between the skin and the brace material, which helps manage perspiration and minimizes abrasive friction.
Before securing the brace, inspect the garment for any wrinkles or folds that could create pressure points on the skin as you sleep. The brace should be tightened to the pressure level recommended by the orthotist. This setting is typically firm enough to prevent sliding but should not restrict normal breathing.
Check that the brace’s padding is correctly situated, especially the sternal and posterior pads. Ensure all straps are lying flat and are not twisted or digging into the skin around the torso. Avoid applying lotions, powders, or ointments directly to the skin just before wearing the brace. These products can soften the skin and trap moisture, potentially accelerating skin breakdown under the pressure pads.
Strategies for Finding Comfortable Sleeping Positions
Finding a sleep position that minimizes direct pressure on the brace is a process of trial and error, often requiring specialized support. Back sleeping is usually the most straightforward position because it distributes the body’s weight evenly. However, the back pad of the brace can still cause discomfort.
To counter this, consider using a high-density foam or eggcrate mattress topper. This allows the back pad to sink slightly into the surface, softening the pressure point. Placing a pillow or rolled towel underneath the knees can also help maintain a neutral spinal alignment, preventing the lower back from arching uncomfortably against the brace.
Side sleeping is more challenging because it places weight onto the lateral aspects of the brace and the ribs. To alleviate this pressure, use a large body pillow or strategically placed rolled towels to create a supportive cradle for the torso. Position the padding so the body’s weight is borne by the soft tissues adjacent to the brace pads, not the pads themselves. This ensures the spine remains aligned and prevents the brace from pushing into the rib cage, which can disrupt sleep.
The pillow used for your head and neck is important when the torso is rigid from the brace. Select a pillow that adequately supports the neck and keeps the head in a neutral position. This prevents strain, which is noticeable when the torso cannot move freely. A firmer mattress is generally preferable, as a soft mattress allows the body to sink too deeply, increasing the likelihood of pressure points where the brace meets the skin.
Addressing Common Nighttime Discomfort
Even with proper preparation and positioning, some discomfort is common, especially during the initial adjustment period. Redness underneath the brace pads is a normal response to applied pressure and heat. This marking should typically resolve within 30 to 60 minutes after the brace is removed.
Persistent redness lasting longer than an hour, or the appearance of blisters, open sores, or bruised skin, indicates excessive pressure. This requires immediate contact with the orthotist. Regularly inspecting the skin, particularly over the sternum and back, is a proactive measure against developing serious pressure sores.
Managing temperature is another frequent nighttime concern, as the brace traps body heat and can lead to increased sweating. To mitigate this, ensure the bedroom is kept cool, and use lightweight, breathable bedding that does not trap excess warmth. The moisture-wicking undershirt worn beneath the brace will help draw sweat away from the skin, but persistent dampness requires removing the brace briefly to clean and dry the skin and the brace interior.
Initial, mild pain, particularly after a pressure adjustment, can often be managed with over-the-counter pain relievers, provided they are cleared by a medical professional. If the discomfort is sharp, intense, or prevents sleep, the brace fit or pressure setting is likely incorrect. Attempting to self-adjust the brace is strongly discouraged. Any structural or pressure modifications should only be performed by a certified orthotist to prevent injury and ensure effective correction.