Sleep Tight: Pressure-Free and Adaptive Beds

On average, we spend close to one-third of our lives in bed. If you’re newly injured, just out of rehab, or recovering from a serious illness, the proportion is likely to be higher than that — and if you’re prone to skin breakdown, respiratory problems, or any other issues that can be exacerbated by lying immobile, it’s important that your bed setup help to prevent them.

With the advent of new high-tech adaptive beds — from mattresses filled with air, sand or silicon beads, to motorized turning systems that allow you to change position without needing a caregiver to wake you constantly during the night — people with disabilities have more options than ever before in battling pressure sores and other issues. But having so many options can be very confusing. Not everyone needs the most high-tech bed on the market — and many of us prefer being able to cuddle with a partner to being stuck behind siderails in a hospital bed. What factors go into deciding which kind of setup is right for you? What are the options available? And how does having the right bed affect not just your health but your quality of life?

Clearly, there’s more involved than just catching a few more Zs.

Options and Compromises
For most of his 46 years as a C3 quadriplegic, Donald Dawkins of Sarasota, Fla., has slept in a waterbed. “I went to a waterbed in the ’70s, back in my hippie period,” he says, laughing. “But I also liked the fact that it was conducive to good skin care.” While he has battled pressure sores off and on over the years, until very recently he had gone for more than 20 years without a flare-up.

Then, a bout of osteomyelitis put Dawkins in the hospital for multiple surgeries — and onto a downward spiral of pressure sores that eventually became life-threatening. “I was in really bad shape,” says Dawkins, 65. “I had wounds on my feet, I had them all over my legs, on my buttocks, my hips — there was no way they could heal.” His condition became so dire that at one point he was transferred to hospice care. “My own doctors didn’t think I would make it.”

What saved his life, he says, was a Clinitron bed — a state-of-the-art bed from Hill-Rom which utilizes what is called “air fluidized therapy.” With the Clinitron, warm air is pumped through a mattress filled with microscopic silicone beads, simulating a fluid surface. After eight months on the Clinitron, Dawkins’ condition went from grave to near-normal. “It really was effective,” he says.

Dawkins’ story illustrates an important principle — that the needs of a person with skin-care issues can change with time (especially related to aging), sometimes drastically. Nevertheless, it’s important when determining your own sleeping needs — presumably working with an occupational therapist and other rehab professionals — to consider all the variables methodically.

According to Marilyn Pires, RN, rehabilitation clinical nurse specialist at Rancho Los Amigos National Rehabilitation Center in Los Angeles, the first question to ask is: Do you really need a hospital bed to start with? “Do you really need anything other than a conventional bed? That would depend on whether you are ambulatory, whether you can do independent transfers, whether you need a hospital bed to assist with activities of daily living,” Pires says.

Dawkins is not alone in using a conventional waterbed for pressure-sore control. Many people prefer them over hospital beds — for the simplicity, the low cost, and the ability to sleep in the same bed with a partner. “There are a lot of people with spinal injuries who swear by water mattresses,” Pires says. Many others select the widely available Tempur-Pedic mattress for the same reasons, while also providing a measure of pressure control, she adds.

Some hospital-style beds don’t come in larger than single sizes, so if that kind of intimacy is important to you, that factor is going to weigh heavily on what kind of sleeping arrangements you want. “First you make the decision [between a conventional or hospital bed] based on mobility and function,” Pires says. “But then you have to think about your personal preference.”

If, at this, point, you’ve determined that you need an adaptive bed, there are additional factors to consider:

• What are your positioning needs? Do you require an adjustable head or foot to sit up or to elevate your feet, or can you achieve the same results with pillows, wedges or other low-tech adaptive aids? “You might consider using other adaptive devices that might approximate what you can do in a hospital bed, but in a conventional bed,” Pires says. She has also seen cases where individuals and their partners have paired an adaptive mattress with a conventional single mattress on a double-sized frame, combining needed pressure relief with the extra space of a larger bed.

• Do you do your own transfers, and/or have a caregiver assist you with dressing or other tasks while in the bed? You might want a bed that is height-adjustable — that can be lowered to make transferring easier, and raised to ease the physical strain on the caregiver.

• What compromises will you have to make in order to achieve the level of pressure-sore prevention you need? After eight months in the Clinitron, Dawkins has since transitioned to a lower-level air mattress — but his ultimate goal is to get back into his waterbed. “I like being next to my wife,” he says.

Support Surfaces

Don Dawkins credits the Clinitron bed with healing his life-threatening pressure sores.

Don Dawkins credits the Clinitron bed with healing his life-threatening pressure sores.

Although Dawkins credits the Clinitron with starting him down the road to recovery, he says the bed does have drawbacks. For one thing, the motor that generates the air flow through the mattress is very loud. “It’s running constantly, so there’s always a noise,” he says. Also, the mechanism of the bed generates quite a bit of heat. “You’re sweating constantly. Or I was, anyway. But be that as it may, it really was effective.”

Which is what high-end beds like the Clinitron are designed for: treatment for sores that have already developed, for example — typically stage 3 or higher, according to Pires — or for recovery from flap surgery. “It’s not a bed that you would select for prevention,” Pires says.

Another system, the Dolphin Bed, claims to be as good or better than the Clinitron, with less noise and better heat dispersion. The Dolphin system got its name because it was originally developed by the United States Navy to transport the trained dolphins it employs in mine sweeping and rescue operations. The Dolphin Bed’s “fluid immersion simulation” system suspends the occupant on a cushion of air and uses specialized software to detect and compensate for pressure points on the body, creating the same effect as being immersed in water.

For everyday prevention, or for less serious conditions, there are still a wide variety of beds available — from full mattresses to overlays, employing various kinds of foams, gels, fluids or air-flow systems. Many of the air beds — like the Flexicare, also from Hill-Rom — use some form of air suspension technology, also known as “low air loss,” which in addition to pressure relief helps to manage the heat and humidity of the skin. Still others utilize alternating pressure to redistribute the weight at intervals on various parts of the body prone to skin breakdown. One advantage of air mattresses over other systems is that they can be deflated and transported — a point in their favor for someone with an active lifestyle who doesn’t want to be stuck at home. “Some people have mattresses they use at home, and some have mattresses that they travel with,” Pires says. “Obviously, air mattresses would be easier for travel.”

In addition to providing a pressure-free support surface, many adaptive beds include features for repositioning the occupant throughout the night. The Völkner Turning System, for example, consists of a double row of air cells running the length of the mattress. At intervals, one row deflates while the other inflates, turning the bed’s occupant from side to side. Another, the Freedom Bed, does the same thing mechanically, by rotating the mattress lengthwise. By contrast, “With static mattresses, the person still needs to be awakened and turned during the night,” Pires says. Systems like these, by working automatically, can allow uninterrupted sleep for caregivers as well as bed users.

Clearly, the days of simply laying down a piece of egg-crate foam on a regular store-bought mattress are over.

Return to Normalcy
Of course, as with anything medical, none of this innovation comes cheap. The cost of many adaptive beds can run well into four figures, and insurers tend to balk at paying for the higher-end ones. “HMOs hardly even cover rehab, let alone the products that are associated with it,” Pires says. At Rancho, a public rehabilitation center funded by the County of Los Angeles, they are also limited by their contracts with vendors in the kinds of equipment they can prescribe to patients, she adds. “We don’t get a chance to just try different products.” People who receive coverage through the VA or workman’s comp, or who are on Medicare or Medicaid, “actually have a better chance of getting these items funded than those with private insurers. … It really depends on the individual insurance policy.”

Although he receives Medicare now, Dawkins was covered by private insurance when he had his osteomyelitis attack and was first prescribed the Clinitron. Getting approval from his insurance company was “a living, unmitigated nightmare,” he says. “I submitted a three-inch stack of documentation, five letters from different physicians stating that if I did not have this bed, I was toast.” A rehab counselor by profession, Dawkins is a strong believer in self-advocacy. Even so, out of the eight months he spent with the Clinitron, “I wound up paying for the last five months out of pocket, which really depleted my savings.”

Still, in terms of his own survival, the cost was worth it. “I had wounds that had to heal, and there was only one way to do it,” he says. “Certainly I did not want the expense, but there are things that you have to do.”

His goal now, he says, is to get back into his waterbed. “I want to get my life back to a degree of normalcy,” he says. “In a way, the waterbed represents that.”


Everyday Adaptive Beds
There are several models of adaptive beds, each with unique features to fit individual needs (not necessarily for pressure relief). Here are a few that come in larger sizes for couples. (See “Resources” below for contact info.)

SleepSafe BedAssured Comfort’s SleepSafe beds are designed to eliminate entrapment and falls, meeting or exceeding FDA guidelines on the seven zones of entrapment. The American-made beds feature a remotely controlled, “whisper quiet” electric motor and NeoComfort memory foam mattresses.

Transfer Master BedAvailable in sizes ranging from twin to queen, Transfer Master’s Valiant HD is designed to meet and exceed hospital codes and yet be affordable. The Valiant is head, foot and hi-low adjustable, and also features a cardio chair position. Its weight capacity is 600 pounds and it has an innerspring coiled cloth mattress, 5-inch swivel lock casters and a powder coat finish on deck and trim.

Volkner BedVölker beds are designed to look like high-end furniture and yet function like electrically-adjustable hospital beds. The company says its focus is to provide comfortable beds with a nice, homelike appearance as well as technologies to make life easier. Motors, casters, lifting mechanisms and assist rail aren’t visible and the lying surface is designed to protect skin. Beds are available in a variety of styles and colors.

 

Resources
• Hill-Rom (makers of the Clinitron and Flexicare beds), 812/934-7777; www.hill-rom.com
• Dolphin Bed, 770/399-9988; info@woundsystems.com, www.woundsystems.com/dolphinbed.html
• Freedom Bed, 713/433-9155 or 800/635-0098; info@qualitymattress.net, www.pro-care.com
• Assured Comfort/SleepSafe Beds, 866-852-2337; www.assuredcomfortbed.com
• Völker Turning System, 925/691-5117 or 800/884-3317; www.volker.com
• Transfer Master, 877/445-6233; www.transfermaster.com
• Hertz Supply (some models of Völker beds), 800/321-4240; info@hertzsupply.com, www.hertzsupply.com

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