A compression sleeve for lymphedema is a tube-shaped elasticized garment that a person wears on the arm. By putting pressure on the arm, it keeps lymph flowing through the lymphatic system.
Lymph is a colorless fluid containing white blood cells. It bathes tissues and flows through the lymphatic system into the bloodstream. Lymphedema is a condition in which lymph builds up in the tissues and causes swelling.
In this article, we explain when a person should wear a compression sleeve for lymphedema. We also look at the differences between daytime and nighttime sleeves, their costs, and whether insurance will pay for them.
There are several stages of lymphedema:
- Stage 1: At this stage, the condition causes the arm to swell and feel heavy. Pressing on it leaves a dent.
- Stage 2: This stage causes the arm to swell, and it may feel hard. Pressing on the arm does not leave a dent.
- Stage 3: In this stage, known as lymphostatic elephantiasis, the arm may be significantly larger than usual. Stage 3 rarely occurs in people with breast cancer.
Compression sleeves are suitable for people who have mild stage 1 lymphedema. For individuals with stage 2 or 3 lymphedema, a process called complete decongestive therapy may initially reduce swelling. A person could then use a compression sleeve.
Different compression sleeves are available for use during the day and the night. Daytime sleeves offer more compression, while nighttime sleeves are slightly looser.
Some people only need to wear a compression sleeve when they have lymphedema flare-ups, while others should wear one every day.
A 2019 study found that the use of light compression sleeves by people with breast cancer for 2 years following surgery reduced lymphedema and led to an improved quality of life.
Compression sleeves are safe to wear daily. A doctor or lymphatic specialist can advise as to the best schedule for wearing a compression sleeve and whether to wear one at night. If it is necessary to wear one overnight, experts recommend getting separate sleeves for daytime and nighttime use.
Companies sell compression sleeves as manufactured medical devices in various sizes and can also custom fit them.
Daytime compression sleeves fit snugly to the arm from the wrist to the shoulder and are tighter at the bottom than the top. This fitting helps lymph flow up the arm to the lymph nodes in the armpit. Compression sleeves come in a range of colors, which include different skin tones and various prints.
Sleeve measurements vary depending on the pressure, in millimeters of mercury (mm Hg), that they place on the arm. In the United States, compression sleeves for lymphedema have the following categories:
- Class 1 sleeves exert 20–30 mm Hg of pressure on the arm.
- Class 2 sleeves exert 30–40 mm Hg of pressure.
- Class 3 and 4 sleeves are custom order levels, and they exert 40–50 and 50–60 mm Hg, respectively, of pressure.
In the European Union, the classification system is different:
- Class 1 sleeves exert 18–21 mm Hg of pressure on the arm.
- Class 2 sleeves exert 23–32 mm Hg of pressure.
- Class 3 sleeves exert 34–46 mm Hg of pressure.
- Class 4 sleeves exert a bit more pressure than class 3 sleeves.
The sleeve should provide even compression and not bind at the wrist or elbow. There should not be any areas of numbness or tingling due to the sleeve.
Some compression sleeves include a glove for the hand. A doctor or lymphatic therapist can help advise on the right choice of sleeve to reduce specific symptoms.
Some people will need to wear a sleeve at night to control lymphedema symptoms. Nighttime sleeves are usually bulkier and made using foam or padding. Often, they have adjustable straps on the outside to apply or reduce pressure.
A nighttime sleeve is slightly looser than a daytime sleeve, but it still provides consistent pressure along the arm. It should not be so loose as to twist or bind up, particularly around the wrist or elbow joint.
As with daytime sleeves, the classification of nighttime sleeves is based on the pressure they place on the arm. In both the U.S. and the E.U., the categories are the same as they are for the daytime sleeves.
Compression sleeves for lymphedema need to be tight enough to encourage the flow of lymph up toward the shoulder but not so tight that they cause numbness or tingling.
A lymphedema therapist or durable medical equipment company can ensure that a person gets a sleeve that fits them correctly. These professionals can also measure a person for a custom sleeve if necessary.
Researchers have not yet conducted studies on the safety of wearing daytime sleeves at night. As daytime sleeves are tighter, some experts believe that they are not safe to wear at night. Concerns include the sleeve moving when a person tosses and turns during sleep, which could cause further swelling or inhibit blood flow.
If a doctor or lymphatic therapist recommends a round-the-clock compression garment, a person can discuss daytime versus nighttime sleeves with them.
Many private insurance plans do not cover the costs of compression sleeves for lymphedema. Medicare does not include compression sleeves for lymphedema on its list of durable medical equipment or provide coverage for them. Medicaid provides some coverage, although this varies by state.
The costs of compression sleeves for lymphedema may be too significant for some people, especially since doctors recommend having at least two sleeves. Several organizations assist with the costs of compression sleeves:
- CancerCare may offer a one-time grant for the purchase of lymphedema supplies. A person can call 800-813-4673 to speak with an oncology social worker.
- The Cancer1Source and LympheDIVAs partnership provides free or reduced-cost supplies for a limited number of people each month.
- The National Lymphedema Network offers a garment program for people with significant financial needs whose physical therapists are members of the network.
- Sisters Network: Breast Cancer Assistance Program provides financial help for medical accessories and utilities.
Compression sleeves cover the arm from the wrist to the shoulder with a snug elasticized cloth. It is tighter at the bottom than the top to promote lymph flow up the arm toward the upper arm and armpit lymph nodes.
Many people will need to wear compression sleeves around the clock, and there are different sleeves for daytime and nighttime.
Daytime sleeves are tighter and allow for more freedom of movement. Nighttime sleeves are bulkier and usually include some foam or padding. There may be straps on the outside that enable the wearer to tighten and loosen the sleeve.
Compression sleeves can be expensive, ranging in price from $50 to more than $1,000. Some organizations offer financial assistance to those who need it.