Compression Socks for POTS

Read This Before You Buy Compression Socks for POTS: The Ultimate Guide

Most POTS patients waste money on the wrong compression garments, making symptoms worse instead of better. If you’ve been struggling with Postural Orthostatic Tachycardia Syndrome (POTS), you know the frustration of trying remedy after remedy with limited success.

Compression socks for POTS are frequently recommended by doctors, but rarely do they explain exactly what to buy or how to use them properly. This guide will save you time, money, and prevent the discouragement of investing in products that don’t help your symptoms.

Understanding POTS and Blood Pooling

Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia (link article) that affects the body’s ability to properly regulate blood flow when changing positions. When you stand up, gravity naturally pulls blood downward. In people without POTS, the autonomic nervous system automatically tightens blood vessels in the lower body to help push that blood back up to the heart and brain.

For POTS patients, this automatic response doesn’t work properly. Instead, blood pools in the legs, abdomen, and lower extremities. This pooling means less blood reaches your heart, causing it to beat faster to compensate.

The result?

Racing heart, dizziness, lightheadedness, and even fainting when standing.

This blood pooling cycle creates many POTS symptoms:

Tachycardia (rapid heart rate upon standing)
Dizziness and lightheadedness
Fatigue and exercise intolerance
Brain fog and difficulty concentrating
Visible blood pooling (purple/red discoloration in feet and legs)

Understanding this mechanism is crucial because it explains exactly why compression socks for POTS can be so helpful, when used correctly.

How Compression Socks Help POTS Symptoms

Compression garments, including socks and tights, can help alleviate symptoms of Postural Orthostatic Tachycardia Syndrome (POTS) by providing external pressure that counteracts blood pooling in the lower extremities. This gentle, graduated pressure helps push blood upward, combating the gravitational pull that causes pooling.

Recent research supports the effectiveness of compression therapy for POTS patients. A 2021 study published in the Journal of the American College of Cardiology found that abdominal and lower body compression reduced heart rate and improved symptoms during head-up tilt tests in adult POTS patients. The study demonstrated that compression garments work through several mechanisms:

Reducing heart rate increase upon standing
Improving stroke volume
Better maintaining systolic blood pressure
Decreasing symptom severity

The study showed a dose-dependent effect, with full abdominal and leg compression (FULL) providing the most significant benefits, followed by abdominal/thigh compression (ABDO), and then lower leg compression (LEG).

It’s important to note that not all compression garments are equally effective. The level of compression and the area covered both play crucial roles in managing POTS symptoms. Most dysautonomia experts recommend 20-30mmHg or 30-40mmHg waist-high stockings for optimal results.

A community-based trial conducted in 2024 further confirmed the effectiveness of commercially available waist-high compression (WHC) tights in reducing heart rate and improving symptoms both acutely and after several hours of use. This study is particularly valuable as it demonstrates the real-world applicability of compression therapy for POTS patients.

However, it’s crucial to understand that compression therapy is most effective when properly fitted and consistently used and there is a need here for an individualized approach, Patients should work with their healthcare providers to determine the most appropriate type and strength of compression garments for their specific needs.

5 Critical Mistakes When Buying Compression Socks for POTS

Mistake #1: Choosing the Wrong Compression Level

Compression strength is measured in millimeters of mercury (mmHg), and this number makes all the difference for POTS patients.

What on earth is mmHg?

Imagine you have a big straw and you’re trying to drink a milkshake through it. The milkshake is thick, so it’s kind of hard to suck it up, right? Now, mmHg (millimeters of mercury) is like measuring how strong you can suck on that straw. But instead of a milkshake, we’re talking about how tight socks or leggings squeeze your legs.

For people with POTS, their bodies have a tough time moving blood around properly when they stand up. It’s like the milkshake doesn’t want to move easily through the straw.

Compression socks or leggings that squeeze with a certain strength, measured in mmHg, help push the blood up from their legs back to their heart, just like squeezing the bottom of the straw helps move the milkshake up easier.

Higher numbers of mmHg mean the socks squeeze tighter, helping more with moving the blood where it needs to go, so they don’t feel dizzy or too tired when they stand up. That’s why knowing about mmHg is really important for people with POTS, it helps them choose the right socks to feel better.

Now, what about compression?

Many people buy compression socks labeled as “compression” at regular stores, not realizing these often provide only 8-15 mmHg of pressure, usually not enough for POTS. Most autonomic specialists recommend a minimum of 20-30 mmHg for POTS patients, with many requiring 30-40 mmHg for significant symptom relief.

Compression Level	Typical Use	Effectiveness for POTS
8-15 mmHg	Mild support, travel	Minimal benefit
15-20 mmHg	Everyday support	Limited benefit
20-30 mmHg	Medical grade	Good for mild POTS
30-40 mmHg	Medical grade	Best for moderate-severe POTS
40+ mmHg	Prescription only	For severe cases only

Why stronger isn’t always better: While most POTS patients need higher compression levels, compression that’s too strong can be counterproductive. If you can’t put them on or they’re so uncomfortable that you won’t wear them, they won’t help. Start with 20-30 mmHg if you’re new to compression, then increase if needed.

A 2021 study published in the Journal of the American College of Cardiology found that compression garments providing 30-40 mmHg of pressure were most effective in reducing orthostatic tachycardia in POTS patients.

Mistake #2: Getting the Wrong Garment Height

This might be the biggest mistake POTS patients make. Knee-high compression socks are the most common and affordable, but they create a problematic effect for many with POTS.

Here’s why: if you only compress the lower leg, blood can still pool in the thighs and abdomen. This can actually make symptoms worse by creating a “squeezing toothpaste tube” effect, pushing blood just above the compression zone.

A 2020 study in the American Heart Association journal demonstrated that abdominal compression, when combined with lower body compression, provided significant symptom relief for POTS patients.

For most POTS patients, thigh-high or waist-high compression stockings provide significantly better symptom relief because they prevent blood from pooling in the upper legs and pelvic area.

Mistake #3: Poor Material and Construction Choices

Compression garments for POTS are not all created equal:

Breathability vs. compression strength: Some materials provide better compression but trap heat, which can trigger POTS flares in heat-sensitive patients.

Durability factors: Quality compression stockings typically last 3-6 months with regular wear. Less expensive options may lose their elasticity within weeks, no longer providing the necessary compression. This makes them a poor investment despite the lower upfront cost.

Seasonal considerations: Many POTS patients need different compression options for different seasons. Lighter, more breathable fabrics for summer and warmer, opaque options for winter can help manage both symptoms and comfort.

Mistake #4: Incorrect Sizing

Unlike regular socks that stretch to fit, compression stockings must be precisely sized to provide the correct pressure. An estimated 70% of people wear incorrectly sized compression garments.

A 2024 review in Wirecutter emphasized the importance of accurate measurements for compression sock fitting.

How to measure properly:

Measure first thing in the morning before swelling increases
For thigh-highs and pantyhose, measure at ankle, calf, thigh, and hip
For knee-highs, measure at ankle and calf
Always check the manufacturer’s sizing chart (they vary significantly)

Signs your compression socks don’t fit correctly:

They roll down or bunch up
They leave deep indentations in your skin
The heel pocket doesn’t align with your actual heel
They feel painfully tight or suspiciously loose
You experience numbness or tingling while wearing them

Mistake #5: Overlooking Important Features

Small details can make a huge difference in comfort and effectiveness:

Open vs. closed toe design: Open toe designs are easier to put on and better for hot weather but can bunch in shoes. Closed toe designs provide complete coverage but can be hotter and harder to don.

Silicone grippers vs. non-grip options: Silicone bands at the top help thigh-highs stay in place but can cause skin irritation in sensitive individuals. Alternative securing methods include garter belts or compression pantyhose.

Zipper vs. non-zipper styles: Zippers make donning and doffing much easier, especially at higher compression levels, but add bulk and can be uncomfortable when sitting. They’re worth considering if you struggle with hand strength.

Material sensitivities: Many POTS patients have comorbid conditions like Ehlers-Danlos Syndrome or Mast Cell Activation Syndrome, making them sensitive to certain fabrics and elastics. Seamless options, cotton blends, and latex-free materials may be necessary.

A 2025 article from a compression sock manufacturer highlights the importance of these features for POTS patients, emphasizing comfort and ease of use, so it is important to choose wisely!

Choosing the Right Compression Level for POTS

Finding the optimal compression level is crucial for managing POTS symptoms effectively. Here’s a more detailed breakdown:

15-20 mmHg: Entry-Level (Often Insufficient)

This level is rarely strong enough for significant POTS symptom relief but can be a starting point if you’re very sensitive or new to compression. It’s better than no compression but consider it a temporary solution while building tolerance.

20-30 mmHg: Standard Recommendation

This is the minimum level recommended by most POTS specialists. It provides meaningful support without being too difficult to put on. Studies show this level can reduce standing heart rate by an average of 8-12 beats per minute in POTS patients.

A 2021 study published in the Journal of the American College of Cardiology found that this level of compression can reduce standing heart rate and improve symptoms in POTS patients.

30-40 mmHg: Optimal for Most POTS Patients

Research shows this strength provides the most significant benefit for moderate to severe POTS. The same 2021 study referenced above demonstrated that full abdominal and leg compression (FULL) at this level was most effective in reducing orthostatic tachycardia and improving symptoms.

40+ mmHg: Medical Supervision Required

These highest compression levels require a prescription and are typically used for severe cases or those with additional venous insufficiency. They can be extremely difficult to put on without assistance or donning aids.

Different POTS subtypes may benefit from different approaches:

Hypovolemic POTS (low blood volume): Often responds well to 30-40 mmHg compression combined with abdominal compression
Hyperadrenergic POTS: May benefit from moderate compression (20-30 mmHg) that doesn’t trigger an adrenaline response
Neuropathic POTS: Typically requires higher compression (30-40 mmHg) focused on both legs and abdomen

Beyond Socks: Other Compression Options for POTS

Abdominal Compression for POTS

The venous capacity of the abdomen is actually larger than that of the legs, making abdominal compression extremely important for many POTS patients. In fact, a 2020 study in the American Heart Association journal highlighted the importance of abdominal compression in POTS management.

Benefits of abdominal binders:

Prevents blood pooling in the abdominal/pelvic region
Can reduce heart rate increases upon standing by 10-15 BPM
Helps maintain blood pressure when upright
Improves symptom tolerance during activities

The best abdominal compression for POTS comes in several forms:

Elastic abdominal binders – Wrap-around compression that fastens with velcro
Compression tanks/vests – Less visible under clothing but may provide less targeted pressure
High-waisted compression shorts/leggings – Combine leg and abdominal compression

Full Body Compression Options

For those with severe symptoms or who need compression for prolonged standing/activities, more comprehensive options exist:

Full body compression suits provide graduated pressure from ankles to chest. These medical-grade garments are custom-fitted and more expensive but offer the most comprehensive support.

Compression leggings with built-in shorts provide thigh and abdominal compression in a more fashionable, less medical-looking package. Brands like Solidea and Jobst offer these hybrid options.

Compression clothing for POTS has expanded beyond medical suppliers. Athletic brands now offer compression tights, shirts, and sleeves that, while not as strong as medical-grade options, can be more comfortable and stylish for daily wear.

Special Compression Needs

Heat intolerance solutions:

Compression garments with moisture-wicking, cooling fabrics
Open-toe or open-foot designs
Summer-weight options (still providing adequate mmHg)

Sensitive skin options:

Seamless construction
Cotton-blend fabrics
Latex-free materials
Silicone-free top bands

Activity-specific compression:

Extra-durable footbeds for walking/standing jobs
Reinforced knees for bending activities
Quick-drying fabrics for those who sweat heavily

Dr. Satish Raj, a leading POTS researcher, notes: “Compression therapy is one of the few non-pharmacological treatments with solid scientific evidence supporting its use in POTS. However, the level needs to be tailored to the individual patient’s symptoms and tolerance.”

A 2024 study published in the Journal of Clinical Medicine found that leg compression garments were used more frequently than abdominal compression garments among POTS patients, despite the potential benefits of abdominal compression.

This suggests that there may be room for improvement in prescribing practices and patient education regarding optimal compression strategies.

When selecting compression garments, it’s crucial to consult with a healthcare provider to determine the most appropriate type and level of compression for individual needs. It’s also important to consider that while compression garments can provide a source of comfort or temporary pain relief, the root cause of POTS and the need to understand this is much more important.

Why Compression Socks Aren’t The Only Answer

FAQs About Compression Socks for POTS

How long should I wear compression socks with POTS?

Most specialists recommend putting compression on first thing in the morning before getting out of bed, when blood hasn’t had a chance to pool. Wear them throughout the day when upright. Most patients remove compression for sleeping, though some with severe POTS find benefits from wearing lighter compression (15-20 mmHg) at night.

Can I sleep in compression socks?

You can, but it’s generally not recommended for most POTS patients. Nighttime is when your body performs much of its fluid redistribution. Exceptions include patients with significant overnight fluid shifts or those who experience early morning symptoms. If you do sleep in compression, choose a lower strength (15-20 mmHg) than your daytime compression.

Will insurance cover compression stockings for POTS syndrome?

Coverage varies widely. Some insurance plans cover prescription-strength compression garments with a diagnosis of POTS or orthostatic hypotension and a prescription from your doctor. Medicare typically doesn’t cover compression stockings. Check with your insurance provider about specific requirements, which may include:

A prescription specifying exact compression strength
Purchase from a medical supply company
Prior authorization
Limits on how many pairs per year

How many pairs of compression socks do I need?

Most POTS patients need at least 2-3 pairs to rotate while washing. Quality compression stockings need gentle handwashing and air drying to maintain their elasticity, which means you can’t wear the same pair daily. Many patients find having 3-4 pairs optimal, replacing them every 4-6 months as they lose elasticity.

How do I put on tight compression stockings?

Putting on high-compression stockings can be challenging. Helpful techniques include:

Using rubber gloves for better grip
Special donning aids like frames or slides
Turning the stocking inside-out to the heel, then right-side out as you pull it up
Applying while seated with legs elevated to reduce initial swelling

Can compression make POTS symptoms worse?

Yes, in some cases. Improperly fitted compression, particularly compression that stops at the knee, can create a “tourniquet effect” that worsens blood pooling above the compression zone. Additionally, if compression triggers sensory issues or causes skin reactions, the stress response may exacerbate POTS symptoms. This is why proper fitting and gradually increasing compression levels are important.

Conclusion: Finding Your Compression Solution

Compression socks for POTS can be life-changing when used correctly. The key takeaways from this guide:

Strength matters – Look for 20-30 mmHg minimum, with many patients needing 30-40 mmHg
Height is crucial – Thigh-high or waist-high compression prevents the “toothpaste tube” effect
Don’t overlook abdominal compression – It’s often the missing piece in symptom management
Proper sizing is essential – Take careful measurements and check manufacturer guidelines
Quality equals effectiveness – Medical-grade compression maintains its pressure longer
Combination approaches often work best – Many patients layer different compression garments

Remember that compression is just one tool in managing POTS. While it helps address the blood pooling symptom, a comprehensive approach addressing hydration, salt intake, conditioning, and possibly medication may be necessary for optimal management.

Ready to better understand your POTS symptoms and create a personalized recovery plan? Take our Symptoms Evaluation Assessment to learn more about your specific dysautonomia pattern and receive customized recommendations.

Evaluate Your Symptoms: Do You Have Dysautonomia?

Take our quick and comprehensive symptom assessment to find out if your symptoms align with dysautonomia and receive personalized insights.