Compression stockings are specialized garments that apply gentle pressure to the lower legs and feet to improve blood circulation and prevent blood from pooling. This mechanism supports the veins in returning blood to the heart, working against gravity during periods of standing or sitting. They are commonly recommended for managing conditions like chronic venous insufficiency, reducing swelling, and preventing deep vein thrombosis (DVT). Whether these stockings should be worn during sleep depends heavily on the type of garment and an individual’s specific medical needs.
The General Recommendation for Nighttime Wear
For the average person using standard graduated compression stockings, the general recommendation is to remove them before going to sleep. Standard compression garments, typically rated at 15-20 mmHg or higher, are designed to counteract gravitational forces when the body is upright. This graduated pressure is strongest at the ankle and gradually decreases up the leg, facilitating upward blood flow.
When a person lies down, gravity no longer challenges venous return. The legs are elevated to approximately the same level as the heart, allowing blood to circulate naturally without external assistance. Therefore, the graduated pressure provided by daytime stockings becomes unnecessary when the wearer is recumbent. Wearing a garment designed to fight gravity when gravity is not a factor can be counterproductive and may interfere with the body’s natural nocturnal circulatory regulation.
Standard graduated compression stockings differ from anti-embolism stockings, often called TED hose, which are sometimes used in hospital settings. Anti-embolism stockings provide a lower, more uniform level of compression intended for non-mobile or bedridden patients to prevent clots. However, the graduated stockings used for daily activity should be taken off at night unless a physician advises otherwise.
Safety Concerns and Risks While Sleeping
Wearing standard, graduated compression stockings unnecessarily overnight introduces several safety risks. One significant concern is the risk of a “tourniquet effect” if the stocking rolls down or bunches up while the wearer is asleep and immobile. If the material folds, it creates a band of concentrated, high pressure that can constrict circulation.
Standard high-pressure stockings (20-30 mmHg or higher) are risky for overnight use because they are too tight for a horizontal position and may impede circulation. Excessive pressure can cause skin irritation, redness, itching, or the formation of pressure sores, especially in individuals with compromised skin integrity or reduced sensation. The skin needs a break from compression to allow for proper hygiene and inspection.
Furthermore, ill-fitting compression stockings can create localized pressure points that increase the risk of nerve compression or even the formation of a deep vein thrombosis (DVT). For individuals with peripheral arterial disease (PAD), where blood flow is already restricted, wearing compression overnight without medical approval can worsen circulation. Removing the garments at night allows the skin to recover and prevents complications associated with prolonged, high-level compression.
Specific Medical Scenarios Requiring Overnight Use
Exceptions where compression is required or beneficial during sleep always involve specialized garments and medical supervision. Patients with severe lymphedema, a chronic condition causing significant fluid retention, may be instructed to wear a specialized, low-pressure garment or compression wrap overnight to prevent the rapid re-accumulation of fluid. This nocturnal compression is often part of a complex, 24-hour management regimen.
Non-healing venous ulcers require continuous wear to promote healing and reduce the pooling of blood and fluid around the wound site. Physicians may prescribe specific ulcer kits or low-pressure compression garments for this purpose. Post-surgical patients who are temporarily bedridden or have restricted mobility may also be advised to wear anti-embolism stockings (typically 8-15 mmHg) for a specific duration to prevent blood clots.
Any decision to wear compression stockings overnight must be made explicitly by a healthcare provider. The overnight garments prescribed in these scenarios differ from standard daytime stockings, featuring lower compression levels (below 15 mmHg) and softer materials designed for extended wear. Patients must adhere precisely to the medical professional’s instructions and should never attempt to use their regular, high-level daytime stockings for sleep.