Sleeping with a leg or pressure wound: positioning and comfort.

Why nights are hard when you have a wound

Sleeping with a leg or pressure wound takes some planning. The position that feels natural may press on the wound, a wrap or dressing can feel bulky, and pain seems louder when the house is quiet.

Rest is part of recovery, so the problem is worth solving. These ideas are general. Your treating clinician’s instructions about how to lie, what to raise and what to wear overnight always come first.

Positioning questions to ask your clinician

Bring these to your next visit and write down the answers.

• Which positions should I avoid, and how long may I stay in one position?
• Should I raise my legs at night? Is there any reason I should not?
• Do my compression wraps or stockings stay on overnight?
• Should my heels be lifted off the mattress?
• What should I do if pain wakes me?

Sleeping with a leg wound

For many people with venous leg ulcers or swollen legs, clinicians recommend raising the legs during rest so fluid can drain back toward the body. Pillows placed lengthwise under the calf, supporting the whole lower leg, are a common way to do it.

Raising the legs is not right for everyone. When the arteries are not delivering enough blood, lifting the legs can make pain worse. Foot or toe pain that starts when you lie flat and eases when you hang the leg over the side of the bed should be reported promptly, because it can be a sign of reduced circulation.

Whether a wrap stays on overnight depends on the type. Many multi-layer wraps are worn day and night, while some stockings come off at bedtime, so ask. Our guide to keeping compression wraps comfortable covers slipping, bunching and tightness.

Sleeping with a pressure wound

The main rule with a pressure injury is to keep your weight off it. A wound on the tailbone, for example, means time on your sides. Within that rule, these general practices are common:

• Use a partial side tilt. Lying fully on your side puts weight straight onto the hip bone. Many care teams prefer a tilt of about 30 degrees, held with pillows behind the back.
• Separate bony areas. A pillow between the knees and ankles keeps them from pressing on each other.
• Float the heels. If your clinician advises it, a pillow under the calves lets the heels hang clear of the mattress.
• Keep the head of the bed low when you can. Sitting propped up for hours makes the body slide, which drags skin over the tailbone. If you were told to sleep raised for breathing, reflux or swallowing, keep doing so and tell the wound care team.
• Change position on a schedule. Our guide to a repositioning schedule at home shows how to set one up with your clinician.
• Skip ring cushions. Donut-shaped cushions are generally not recommended, because they can concentrate pressure around the ring.

If you cannot turn yourself, or you wake in the position you fell asleep in, tell your clinician. A pressure-relieving cushion or mattress is something they can assess and order.

Easing pain and protecting dressings overnight

Tell your clinician if pain regularly wakes you or keeps you from changing position. Do not add, skip or reschedule medicines on your own. Help with pain and comfort is part of primary care, and it works best when coordinated with the wound plan.

A few habits make nights easier:

• Wear loose, smooth nightclothes that slide over the sheets instead of dragging on a dressing.
• If a dressing leaks through at night, tell the wound care team. The dressing plan may need a change.
• Before a bathroom trip, sit on the edge of the bed for a moment and turn on a light.

Night-time changes to report

Call the clinician or team managing your wound about:

• A new red, purple or dark patch over a bony area that does not fade after you change position.
• Pain that is new, worse, or relieved only by dangling the leg.
• Numbness, tingling, or cold or discolored toes below a wrap. Follow the instructions you were given for a tight wrap, and call right away.
• More drainage, a new odor, spreading redness, fever or chills.

Call 911 for chest pain, trouble breathing, sudden confusion or any other emergency.

Gateway arranges wound care visits and pressure injury prevention support with partner clinicians across Greater St. Louis and the Metro East. To ask about a visit, request care or call 314-325-0126.

Common questions

Related pages

• Repositioning schedule at home
• Cushions and mattresses for pressure relief
• Pressure injuries and bed sores
• Venous leg ulcers
• Pain and comfort
• Keeping compression wraps comfortable
• Eating for wound healing
• Staying hydrated and wound healing