Would you rather wear a strange-looking and uncomfortable mask while you sleep… or tight stockings during the day?
The obvious answer is “um, neither”… but it is entirely possible that people who have a certain type of chronic obstructive sleep apnea may be presented with exactly this choice, based on new European research. A study just published in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine reports that wearing compression stockings can reduce sleep apnea episodes significantly for one-third of the people whose apnea is caused by chronic venous insufficiency — a pretty dramatic difference for such an easy treatment. Since it was a small, brief and preliminary study focused on just this one cause of obstructive sleep apnea, it’s entirely possible that longer treatment may yield even more impressive results that are helpful to even more patients.
OUT FROM BEHIND THE MASK
I don’t know if you have ever seen a continuous positive airway pressure (CPAP) mask, but — even though the designers have done their best and there now are quite a few different models to choose from — there’s not a single one that is truly comfortable. They are bulky and uncomfortable on the face and force many wearers to sleep in positions they’d rather not sleep in. Many people who need them refuse to wear them. That’s why the news that there is a safe, easy-to-use and inexpensive treatment option for a good portion of people with sleep apnea is quite welcome!
I contacted Stefania Redolfi, MD, of the University of Brescia in Italy, lead researcher of this practical and surprisingly promising study. She explained that chronic venous insufficiency is a vascular problem in which veins (primarily in the legs) can’t efficiently pump blood back to the heart. Fluid builds up in the legs during the day and then shifts at night to the neck, bloating tissue there. This causes the person to experience the partial collapse of the pharynx in between breaths during sleep — and so begins the loud, unpleasant “gasp and snore” pattern that characterizes obstructive sleep apnea in these patients.
What does wearing tight stockings during the day have to do with insufficient oxygen at night? It is actually quite ingenious. “Wearing compression stockings during the day helps to reduce the daytime fluid accumulation in the legs,” Dr. Redolfi explained, “which in turn reduces the amount of fluid flowing into the neck at night.” Absent the pressure created by that fluid, the respiratory system does not narrow as much and, for many people, this intervention is enough to allow them to get adequate oxygen into their lungs by breathing — and sleeping — normally. This is a wonderful thing, because sleep apnea and the constantly interrupted sleep that goes with it can severely undermine a person’s health.
WHAT THE RIGHT SOCKS CAN DO
The study was small, involving 12 patients — half randomly assigned to wear compression stockings during the day (putting them on as soon as they awakened and taking them off only after getting into bed for the night) for a week, while the other half served as the control, with the two groups switching places after the first week. Subjects spent their nights at a sleep center, where their physiological signs (including brain waves, respiration and eye movements) were measured continuously. Researchers also measured each person’s overnight changes in leg fluid volume and neck circumference at the start of the study and at the end of both the compression-stocking and control periods.
Dr. Redolfi told me that the researchers expected the compression stockings would help — but they were somewhat surprised by the degree to which they helped! Wearing the stockings resulted in:
- An average of a 62% reduction in overnight leg fluid volume change, as compared with when subjects did not wear the stockings.
- A 60% reduction in neck circumference increase (used as a proxy measurement to estimate fluid shift into the neck).
- A 36% reduction in the number of apnea episodes.
EFFECTIVE AND INEXPENSIVE
This is a very basic intervention that has the potential to make a big difference for patients who are struggling with obstructive sleep apnea. The stockings cost less than $50 and, though they aren’t exactly cute or comfortable, Dr. Redolfi told me that all the study participants preferred them to the CPAP mask. As simple as it sounds, though, she told me that people with sleep apnea shouldn’t try this on their own — she said it is important to have a sleep study done to measure whether the stockings are making a difference and if so, how much. Talk to your doctor about this. Dr. Redolfi plans further research to ascertain whether wearing the stockings for longer than a week shows more significant results… to learn whether other measures, such as using diuretics or exercises to reduce fluid volume, are useful… and also to examine whether wearing compression stockings can help people with sleep apnea due to other causes, such as obesity. I’ll keep a watch for further findings and keep you apprised of the results.