Dear Dr. Roach: I’m 70 years old, and my whole family is prone to edema, varicose veins and deep vein thrombosis due to venous insufficiency. I’ve been wearing support pantyhose for 45 years whenever I get dressed, and I recently increased the compression. While I’m sitting, I elevate my legs. I am otherwise healthy and not overweight, and I have no cardiac issues, just the edema. Usually I’m OK except when I’m traveling (especially in airplanes) or when I’m dining in restaurants as I must avoid salt intake, so it’s easier to stay home.

My question is whether it’s OK to wear the support hose all the time, even while I’m sleeping? I usually take them off to change or take a shower and put them right back on afterward. The other night I took them off before bed as I was going to shower first thing in the morning, but my husband said that I shouldn’t do this. He is a retired physician and feels that I need to wear them at all times. Do you have any suggestions? — P.H.

Answer: The most common reason to develop edema (swelling) in the legs is venous insufficiency, which is caused by the failure of the valve structures in the veins. Without these valves, blood tends to pool in the legs, raising the venous blood pressure and driving fluid out of the blood into the tissues. The legs are affected because gravity pulls the blood and fluid down.

I’m sorry to disagree with your husband, but I agree with the usual recommendation to remove support stockings at bedtime. The reason for support stockings is to try to counteract gravity, and when you’re laying flat in bed, you don’t need to do this anymore.

Research from way back in 1993 showed that oxygen levels in the skin fall when support stockings are worn at night. For most people, this is tolerated well, but people with poor circulation (from blockages in the arteries to the leg, for example) can develop damage to the skin, which can potentially lead to skin ulcers.

Only people who have been recommended for 24-hour compression (such as people with lymphedema) should be wearing them while in bed. Taking them off is more comfortable and allows the skin to recover. Wound care nurses are the experts in managing venous insufficiency.

Finally, regular exercise is good for edema! The muscle action helps bring the fluid back into the circulation. Sitting with your legs down is bad, which is why traveling can be so problematic.