chapped lips and chapped nares

[robysue]

Have to rant before I go do the weekly cleaning of all the CPAP stuff which I absolutely loathe doing since it takes away time on a Saturday because it was another rough night with a migraine headache, the insomnia monster, and its ally du jour (or perhaps more appropriately its ally de la nuit): CHAPPED LIPS.

Of all the low-level on-going comfort issues I've had dealing with CPAP therapy since September 23, the ones that keep on going like the Energizer Bunny are CHAPPED LIPS AND CHAPPED NARES. The level of discomfort waxes and wanes, but never disappears completely. When the chapping is at its worst (which today at least it is not), I look like I've got some kind of freaking disease around my mouth and below my nose it gets so red.

I would estimate that I am now spending up to an hour or two every day (mostly in 10-60 second increments---you can do the math) on LIP CARE. Vaseline, lip balm, lip ointment, lip moisturizer, chapstick repeatedly ALL DAY LONG and ALL NIGHT LONG. And I've got to be super careful about which products I use because most skin care products contain various assorted stuff that makes my skin itch like crazy. And the flavored stuff winds up making me lick it off the lips, which INCREASES the chapping---so no flavored stuff. *sigh* Stuff that's "guaranteed" to last for hours, lasts for 30 minutes if I'm lucky.

I even sleep with a chapstick in my hand to slather on the lips every time I wake up.

The lip chapping is being triggered by the turbulence created by the exhaust flow from the mask bouncing off the covers, the pillows, my pjs, and my husband's body. I have ALWAYS been sensitive to sleeping under moving air: I simply loathe sleeping under an AC vent (it will chap the lips) and in the summer in our un-airconditioned bedroom, I cannot tolerate a fan blowing directly on me all night long. Turning up the humidifier increased the chapping (as counter-intuitive as that sounds), but then again, when ever I've had to sleep with a room humidifier blowing all night long due to severe congestion---guess what? Always got chapped lips too. So I turned the humidifier setting back down to 1 and that's marginally helped.

The nare chapping I think is being triggered directly by the air being blown directly into my nose and the inevitable very small leaking that occurs right around the seal of the cones of the pillows when you adjust them or when you move around or when you reseat them. [Yes---those are SHORT LIVED LEAKS, but it does NOT take much air to chap my tender skin.] And once the chapping starts, there's no way I can soothe that area at night without turning the machine completely off, unmasking and slathering the whole area with vaseline-based chapstick, which is a no-no for the silicone-based pillows since the lanolin just doesn't do the job---I have tried it, and while it helps some, the vaseline is better once the chapping is severe.

At this point, I've just about decided that the physical damage to my lips and nose caused by NOT using vaseline at NIGHT is far GREATER in cost to my psyche than the physical damage to the nasal pillows caused by using vaseline at night is to my pocketbook.

[msradar65]

I have two suggestions. Lanolin ointment. Lanosih or you can try preparation H ointment. It must the be the one that looks like yellow Vaseline when it comes out the tube.

I was told about the preparation H cure by a friend that does a lot of snow skiing. I have used both. Both work well. Just make sure if you go the preparation H option...that no one else in the home uses for what is designed for...cause that would be rather gross! lol

[HoseCrusher]

Robysue, Digging way down to the bottom of the "bag of tricks..."

Take 1 gallon of distilled water and add 1/8 teaspoon of salt to it. Drink 1 quart of this each day.

(In my most reassuring voice)

In 5 days your lips will be healed!

OK, on the serious side, chapped lips can be caused by dehydration. The type and amount of water you drink can either hydrate you, or dehydrate you. The distilled water is pure, but adding a very small amount of salt to it will add some electrolytes to it. If you don't like the idea of adding salt, pick up some Emergen-C or Pedialyte for the electrolytes.

[dtsm]

Lanolin will provide short term relief but the problem, IMO, isn't the air from cpap. It's [as HC posted] probably more dehydration or 'lack of sufficient hydration'.

I suspect your home is also fairly warm in winter? A bedroom humidifier, rather than cpap humidifier also might provide better night-time relief.

[Janknitz]

Back in the day I loved putting Carmex lip stuff on my lips--it felt really good (now I can't stand anything so aromatic). So I used it a little, and then my lips seemed chapped, so I used it more, and then my lips seemed chapped, and I used it more and more. I finally figured out that using lip stuff was MAKING my lips chapped. When I stopped using all this stuff, the problem went away. I don't even wear lipstick. I have a lot of skin and fragrance allergies, so I stay away from makeup in general, anyway.

I do use an unscented chapstick ONCE before bed, simply to give my lips a little bit of tackiness to help keep them sealed. But that's it. And I have been having nice, comfy lips since I no longer mouthbreathe with CPAP.

Sometimes my nose gets dry, especially in winter and after a cold. I use a little lanolin during the day--far from bedtime because for me, personally, the lanolin seems to make the nasal pillows more slippery and more prone to leaking.

And I second the suggestion to keep your body well-hydrated. I had to use CPAP for about 1 month without the humidifier during my titration period, and drinking plenty of fluid was the ONLY thing that kept me comfortable. I'm not big on drinking fluids, so it was challenging for me.

[Muse-Inc]

Try one of the Badger lip balm RobySue, these are the ones I use. They really work and, more importantly, last throughout the night even when congestion has me mouth breathing the entire night and that's saying something! http://www.badgerbalm.com/p-427-cocoa-b ... -balm.aspx
I had really dry & peeling cuticles with hangnails that I found unsightly; they caught on everytning and then bled ugh ugh ugh. In frustration one day, when applying the balm to chapped lips in winter cold, I thought what the heck and put it on my cuticles...voila, they smoothed right away for at least a few hrs, so I continued using the balm and they began to heal! These balms do not have the slimy, sticky, get on everything texture that glosses and such have.

I used to buy a Clinique lipstick-shaped product called Wrinkle Stick that had vitamin E which I used as a lip balm but it;'s texture wasn't as nice.

After looking up this site, I'm about to buy this and try it for the rest of winter at least: http://www.badgerbalm.com/p-379-cuticle-care.aspx

[Auricula]

robysue, Have you tried a different mask? I also use the FX and find that other than by adjusting slightly at the nares I can't change the direction of air. I also have a Swift II and am able to aim the outflow somewhat. Another advantage of the Swift II is that I can lightly wipe water droplets off the slidey bar and reduce the built-up water that sits there and is broadcast. And I can align that bar when it is askew and cut down on escaping air that way.

You could also evaluate what you are using to wash your face in case it is drying your skin. For the first three winters I was on CPAP I developed unsightly rosacea, which I thought was caused by an allergic reaction to the plastics in the mask, and was going back and forth between recommendations of my ophthalmologist (who said it was actually blepharitis, an inflammation of the eyelashes) and my dermatologist (who said rosacea). My face got very red and I developed chains of abrasions. I stopped using soaps and conventional cleansers and went to a facial cleansing gel for sensitive skin that contains no soap, artificial colors, or paraben (a chemical used as a preservative for its bactericidal and fungicidal properties). I also started washing my eyelids with baby shampoo diluted with water and used an eyelid scrub every other day. The rosacea/blepharitis condition is gone as is the itchy/stinging/crusty stuff I used to have in the corners of my eyes, as well as the chronic tearing. Just thought of one other change this winter and that is that I am not using a heated hose; I adopted the technique of taking the 6’ hose under the covers with me; the air that is exhausted is not as warm as with the HH, which sometimes made my face too hot, and I am not experiencing any rainout.

I also concur with the other posters who suggested better hydration and possible rebound effect from overuse of “balms.”

Hope you find some relief. I am very happy not to have a red face and itchy eyes this winter. Let us know what works. Pat

[gac914]

Turning up the humidifier increased the chapping (as counter-intuitive as that sounds), but then again, when ever I've had to sleep with a room humidifier blowing all night long due to severe congestion---guess what? Always got chapped lips too. So I turned the humidifier setting back down to 1 and that's marginally helped.

From my understanding of how the humidifier setting works on your (and my) machine, there is a common mis-understanding that turning up the dial turns up the amount of humidity. It was explained to me by my doctor that the only thing you're turning up is the heater to make the air blowing through the mask warmer. If this is so, it would explain getting chapped worse when turning up the humidity control as the warmer air might exaggerate the problem.

[Cindy Lou Who]

The lip chapping is being triggered by the turbulence created by the exhaust flow from the mask bouncing off the covers, the pillows, my pjs, and my husband's body.

robysue, I also loved my Swift FX but had to switch to another nasal pillow (Opus 360) because I couldn't stand the air bouncing into my face from all the surfaces you mentioned! I didn't have your troubles but got very dry eyes from it. Sometimes couldn't open my eyes as they were stuck shut they were so dry. Had to grope my way to the bathroom and splash water on them!
Have you tried the Opus 360?
https://www.cpap.com/productpage/fisher ... -Mask.html
It's nearly as light as the Swift but more stable. I get a 0.0L/min leak rate some nights. The exhaust port directs the air straight out from the 'elbow' where the headgear's hose connects to the pillow (look at the headgear in silhouette to see what I mean). I can lay in almost any position and not have air 'bouncing' back into my face. The Opus pillow doesn't touch the upper lip either, only where it seals against the nares. I do get chapped in that area only if the humidity is up too high. Another thought.... have you changed the settings on your humidifier? Has the humidity in your bedroom changed?
Sure hope this info helps you get comfortable and find relief real soon!!!!
Cindy

[robysue]

Just got back from skiing in single digit temps. Yeah, I know what that does for my chapping problem too, but skiing is at least FUN for the kid in me. I even do the black diamonds at Holiday Valley in Ellicottville, NY for those of you who are interested in such things. And while it was cold today and tonight, there was some fresh powder as well.

As for the numerous suggestions. I thank you very much.

The dehydration suggestions are likely on the right track---in spite of the copious amounts of water that I typically consume. Particularly in light of the topiramate I'm now taking. So I'll look at them much more closely.

When I woke this morning, the lips were quite a bit better than yesterday. I attribute this to the fact that last night the migraine was more or less under control and I was able to tighten the FX's backstrap back to where I usually wear it, which is appropriately loose.

The night before---the night the migraine struck---even the appropriate loose fitting of the FX's backstrap combined with the conducted noise through the hose from the PR S1 proved to magnify the migraine pain something awful (noise IS a migraine trigger for me). And so I eventually loosed the backstrap well beyond "appropriately loose" all the way to "ridiculously loose" by adding a good inch or two of additional slack. Finally took a gander a the leak graph this morning. Boy did that extra slack show up in the leak rates. No wonder the lips were super sore yesterday. But in spite of some serious leaking (at least in my opinion and my sore lips' opinion), Encore Viewer was happy as a lark about my leak rate: Solid light green "normal mask fit" line across the whole night---even the stretch where the leak rate was double what I usually get with this mask for a while. And the S1's LCD also said 0% time in Large Leaks for the night, of course. What the heck do you have to do to trigger that nasty Black LARGE LEAK line in Encore Viewer anyway? A whole lot of this night would have poked up over the Red Line in ResScan. But my guess is that enough of the night would still have been below the Red Line so that I would have seen Mr. Green Smiley Face the next morning.

What about the leak rate for last night with the straps back in their usual appropriately loose place? Back to a nice flat horizontal line somewhere around 20 L/min in Encore. (For those of you using ResMed S9's, please keep in mind that PR shows both the intentional leak rate and the unintended leak rate in the leak data. At my pressures, the FX has an intended leak rate of around 25--29 L/min, so my leak rate is exceptionally good most of the time. Back when I used the S9, I'd often get 95% leak rates of 0.0 with the FX and I'd occasionally have what I'd call jackpot days: median, 95%, and maximum leak rates in ResScan all reported as 0.0 L/min. Leaking with the FX has never been a really big problem for me.)

Others in no particular order than what caught my eye:

The lip chapping is being triggered by the turbulence created by the exhaust flow from the mask bouncing off the covers, the pillows, my pjs, and my husband's body.

robysue, I also loved my Swift FX but had to switch to another nasal pillow (Opus 360) because I couldn't stand the air bouncing into my face from all the surfaces you mentioned! I didn't have your troubles but got very dry eyes from it. Sometimes couldn't open my eyes as they were stuck shut they were so dry. Had to grope my way to the bathroom and splash water on them!
Have you tried the Opus 360?
https://www.cpap.com/productpage/fisher ... -Mask.html
It's nearly as light as the Swift but more stable. I get a 0.0L/min leak rate some nights. The exhaust port directs the air straight out from the 'elbow' where the headgear's hose connects to the pillow (look at the headgear in silhouette to see what I mean). I can lay in almost any position and not have air 'bouncing' back into my face. The Opus pillow doesn't touch the upper lip either, only where it seals against the nares. I do get chapped in that area only if the humidity is up too high. Another thought.... have you changed the settings on your humidifier? Has the humidity in your bedroom changed?

I have seriously considered the Opus 360. But there's a hard piece of plastic in the frame that is a bit irritating and (cheapstake that I am), my insurance company won't pay for another mask for another 2 months and I really don't want to throw money at the Opus 360 (yet). When trying the Opus back when I was originally choosing my first mask, it felt almost as comfortable as the FX---except for that rigid hard bit of plastic mentioned before. And that is worrisome since I already find the FX's softer frame uncomfortable enough when I'm in my favorite sleeping position because of a sensation of lying on a hard, unyielding stick. Both masks have a tendancy to cut across my temple area, and since I'm a side sleeper, this means that I'm lying on top of the mask in a fairly tender spot. And it sometimes hurts. Fortunately with the FX that unstability that bugs many people is exactly what allows me to yank it around and get it into a more comfortable spot when it's bugging me. I'm not quite sure I'd be able to do that with the Opus.

Turning up the humidifier increased the chapping (as counter-intuitive as that sounds), but then again, when ever I've had to sleep with a room humidifier blowing all night long due to severe congestion---guess what? Always got chapped lips too. So I turned the humidifier setting back down to 1 and that's marginally helped.

From my understanding of how the humidifier setting works on your (and my) machine, there is a common mis-understanding that turning up the dial turns up the amount of humidity. It was explained to me by my doctor that the only thing you're turning up is the heater to make the air blowing through the mask warmer. If this is so, it would explain getting chapped worse when turning up the humidity control as the warmer air might exaggerate the problem.

You'd think this would be documented somewhere in the user manual? Or the clinical manual? Or the PR webpages? I've been looking ever since I got the PR for details on how the system works. At any rate, all I can say is that at setting 1, the PR is using a lot more water than the S9 did at 3.5 and 4. But I don't see how warmer air would make the problem worse exactly. Explain?

I suspect your home is also fairly warm in winter? A bedroom humidifier, rather than cpap humidifier also might provide better night-time relief.

If you consider a night time temperature of 62 degrees F fairly warm, then I guess so. But most folks who visit our house complain about how cold we keep it. Daytime temp is set to 66 when we are actually in the house and 60 when we're not. Bedroom humidifiers in the past have typically bothered me in two ways: (1) noise and (2) chapping. (Yes, I know that's counter intuitive and I know that humidifiers don't really create much of a forceful breeze, but nonetheless, if a humidifier blows on me, I get chapping.)

You could also evaluate what you are using to wash your face in case it is drying your skin. ... I stopped using soaps and conventional cleansers and went to a facial cleansing gel for sensitive skin that contains no soap, artificial colors, or paraben (a chemical used as a preservative for its bactericidal and fungicidal properties).

Sounds like you had to discover what I had to learn back in my teens since I was born with chronically dry skin. I have NEVER been able to use anything except a handful of products with very few ingredients: I even have to be careful with those that are designed for super sensitive skin. I always use fragrance-free, anti-bacterial agent-free, dye-free, etc. products Going on CPAP? I didn't change my facial soap. Still doing what I've done for years: Neutrogena fragrence-free facial cleansing bar every other day or Aveeno Oatmeal Soap every other day. [Ok, I've had to increase washing my face from every third day or so up to every other day because of the CPAP.] But one of the first things I rejected was the nightly washing of my face: It's just way to drying. I tried that right at the start and decided that even with finally finding a moisturizer that doesn't make my face itch, my face just isn't oily enough to warrant worrying about facial oils building up fast enough to subject to being washed every single evening;

Just thought of one other change this winter and that is that I am not using a heated hose; I adopted the technique of taking the 6’ hose under the covers with me; the air that is exhausted is not as warm as with the HH, which sometimes made my face too hot, and I am not experiencing any rainout.

Never used a heated hose---insurance sure would not have paid for it, and I wouldn't either. I do route the hose under the cover and it's in a hose cozy as well. Makes it feel less medicinal and more comforting---like a giant stuffed toy snake to cuddle.

[BlackSpinner]

Turning up the humidifier increased the chapping (as counter-intuitive as that sounds), but then again, when ever I've had to sleep with a room humidifier blowing all night long due to severe congestion---guess what? Always got chapped lips too. So I turned the humidifier setting back down to 1 and that's marginally helped.

From my understanding of how the humidifier setting works on your (and my) machine, there is a common mis-understanding that turning up the dial turns up the amount of humidity. It was explained to me by my doctor that the only thing you're turning up is the heater to make the air blowing through the mask warmer. If this is so, it would explain getting chapped worse when turning up the humidity control as the warmer air might exaggerate the problem.

Wrong. Warm air holds more moisture. This is physics. Elementary physics at that.

[jbn3boys]

I do route the hose under the cover and it's in a hose cozy as well. Makes it feel less medicinal and more comforting---like a giant stuffed toy snake to cuddle.

Now THAT might be the best reason yet for a hose cozy!

[robysue]

And the hose/machine's name is Kaa (the snake from The Jungle Book) as a result.

[Big S]

If you don't have your machine in a classic mode it should be since you're in Buffalo. Before you do this though, get Kaa a winter coat.

[Cindy Lou Who]

It could be that you've had the chapped lips and nose long enough that something else is going on.... Some wee beasts have taken up residence in you skin and begun to infect. If that's true, a week of antibiotic cream could clear that up. Apply it during the day time, and use what you've been using at night to further protect your lips and nose. When the irritation calms down then you know you have the answer.

I'm jealous too! Ski bum indeed If you get that prescription PLEASE let us know
Cindy