Silicone Sensitivities

Hi, all!

I just started my BiPAP therapy and I'm on the struggle bus. I tried a nasal mask, but my skin is sensitive to silicone, and the first night it caused a serious reaction (there was lots of pus involved, guys. It was gross...and painful). This happened after my sleep study as well, so I knew it was a possibility. To be fair, my skin is sensitive to EVERYTHING (certain scented products, some water, new bras, certain detergents, you name it). I switched over to a nasal pillows mask, which I was nervous about, because when I was getting fitted for the nasal pillows, we found out that my nostrils are basically alien nostrils according to PAP mask manufacturers. Even the extra-small angles in so that it hits my septum and no air comes out. We went with a mask that only came in small because it had fabric straps instead of silicone, and I wore it last night. It took a lot of adjusting to get it so that it allowed any airflow, and I loosened it as much as I could while still keeping it in place. At 3:30am, I woke up to discover that the nasal pillows had shifted a bit as I moved around, and now not much air was coming out and I'd been breathing through my mouth. I spent another little while trying to adjust, and then just gave up for the night. When I looked at my data this morning, my apneas per hour was 1.6, versus 0.2 with the nasal mask. I also have a killer headache, even after my daily dose of caffeine. Questions:

• 1. Has anyone else had a similar issue with nasal pillows? Were you able to make it work?
  2. If nasal pillows aren't a viable option, do you have any suggestions for masks with a minimum amount of silicon having direct contact with my face?

Exactly which nasal pillow mask did you try last night?

There are mask liners available to limit silicone to skin contact. Do you know about them?
There are even nasal pillow liners of sorts.
https://www.padacheek.com/

Mask liners, like those sold by Padacheek.com prevent silicone from touching the face.
Sleepweaver masks are made entirely of fabric--I prefer the Elan nasal mask.

Another vote for the sleepweaver masks, also agree with trying the elan model first. The only problem that I had with them was that they didn't just unclip or pull off without releasing, you had to get into the rhythm of small re-adjustment every time that you put it on. But they work well, and if you're sensitive to silicone, provide a great alternative. It may take a little work initially getting them fitted and comfortable, but once you're there it's well worth it.

This is all super helpful, thank you!
And I tried the Swift FX nasal pillows at the vendor's office, ended up going home with the Respironics Nuance Pro.

I use the Nuance Pro nasal pillow mask. Started out with a Resmed nasal pillow, and got sores and pimples under my nostrils (though I don't have a sensitivity to silicone as you do). The Nuance Pro was much softer and "squishier", much better for me.

I also use RemZzz's liners for nasal masks. They are thin cotton knit, like T-shirt material. They are GREAT! No more sores or even red skin!

They can be a little fiddly, especially until you get used to them! Push the large holes over the nares (nose cones) and all the way down to the bottom over the widest part of the cones. Then grasp the liner by the sides beside the small holes and stretch it. Try the fit. If it's still too small, stretch it again. The directions do say to stretch it. I was too timid about stretching at first, but that is the key!

Then hold the liner in place with both hands and push it up to your nose. Continue holding it there with one hand while using the other hand to pull the back strap of the mask headgear over your head. Once it's on, you can adjust the liner a bit by pulling gently on the edges of the liner that stick out if you need to.

Once you practice a bit, you'll get the hang of it! The little bit of fiddling is well worth the comfort to me! The liner covers the entire area under the nose, just the tips of the nasal mask are not covered.

The package says to only use the liner once, but I use it for three nights (unless I have a cold or bad allergies). Then I throw it out and get a new one. I tried washing them gently by hand, but the edges curl up and even ironing doesn't straighten them out, so that didn't work.

I hope you find a solution. Nose sores with a CPAP are miserable.

Best,
Robin

@readingteacher, this is somewhat helpful, but I think the biggest issues for me with the Nuance Pro is the nasal pillows only come in small, and I'm really an extra small. So not only is it a slightly uncomfortable fit, but getting it angled to where there is air coming out is difficult. So far the insides of my nose seem to be less fussy than the rest of my skin, so at least there's that!

But I'll check out the liners for regular nasal masks (not the nasal pillows), or the all-fabric nasal mask, because it's really the skin near where the sides of my nose and cheeks meet, and the bridge of my nose that get sores/breakouts/whatever is going on, and that's uh...pretty conspicuous in addition to being very uncomfortable. The day after I stopped using the original mask that broke me out, I couldn't even wear my sunglasses because they hurt resting on my nose/cheeks, and there was about a half inch area on the right side of my nose/cheek that was so angry (it looked like I had a staph infection!). Not a great time!

XtraSpicyQuesadilla wrote: ↑

Sat Sep 18, 2021 10:30 am

do you have any suggestions for masks with a minimum amount of silicon having direct contact with my face?

I second chunkyfrog's suggestion of Sleepweaver masks.

Some older post mention they leak often and need fair amount of adjusting.
I don't experience this problem. YMMV.
My pressure range is 5.6 - 15 cm. OSCAR shows low leakage.

Although I am not sensitive to silicone, the P10 pillows does cause inflamation after about a week's use. So I switch to other masks for a few days until the redness goes away.

Both the 3D and Elan applies minimal pressure to the face.
You wear them fairly loose and rely on cushion inflation for sealing.

The cloth conforms to surfaces when you sleep on your side.
So it also likely solves your pillow problem you mentioned in the other thread.

The part I really dislike is the headgear. But like Pugsy says, you pick your battles.

GrumpyHere wrote: ↑

Sun Sep 19, 2021 1:29 am

My pressure range is 5.6 - 15 cm. OSCAR shows low leakage.

...

Both the 3D and Elan applies minimal pressure to the face.
You wear them fairly loose and rely on cushion inflation for sealing.

...

The part I really dislike is the headgear. But like Pugsy says, you pick your battles.

I'm not sure how the pressure ranges work yet, does yours mean you do Bi-Level as well? That's what I'm on now, and your description of the Elan would make me nervous that it would require a lot of adjusting when going from low to high pressure. If you're doing Bi-Level, do you have that issue?

I actually don't mind headgear at all! It makes me feel more secure.

@Xtra . . . Grumpyhere lists a pressure range, indicating a bilevel machine,
So, bilevel is entirely possible.

chunkyfrog wrote: ↑

Sun Sep 19, 2021 9:31 am

@Xtra . . . Grumpyhere lists a pressure range, indicating a bilevel machin,
So, bilevel is entirely possible.

Thank you! Still getting the lay of the land here. I thought that might be the case, but didn't want to assume and be wrong!

Which AirCurve 10 model?

S

or

VAuto

or some other...there are about a half a dozen various "bilevel" AirCurve 10 machine models

Exact model name is on the face of the machine lower right.

XtraSpicyQuesadilla wrote: ↑

Sun Sep 19, 2021 9:10 am

your description of the Elan would make me nervous that it would require a lot of adjusting when going from low to high pressure. If you're doing Bi-Level, do you have that issue?

TLDR: The Elan and the 3D don't leak in a significant way at a max PS of 7.6 for me YMMV.

Even though I don't use its full capabilities, I have a ResMed S9 VPAP Adapt, a specialized bi-level meant to treat complex apneas (CSA + OSA). It is the older brother to AirCurve 10 ASV. It can adjust the pressure from 5 cm to 25 cm in a single breath.

The machine auto adjusts both EPAP and PS.
My PS ranges between 2.6 to 7.6 during the night.
I limit the max IPAP to 15 because of aerophagia.

I have both the Elan and the 3D. So they don't leak in a significant way at a max PS of 7.6. There are some minor leaks (below 24L/min) that do not wake me. Again YMMV as with all masks.

When I used an AirSense AutoSet for Her, my AHI was 5-7 with min pressure of 9 cm and EPR of 2. Probably needed optimization.

I had read about Pugsy's positive experience with the older 36007 VPAP Adapt. So when I had an opportunity to buy a low hour Adapt, I went for it.

It took a while to adjust to it but I am more than happy with it. My typical AHI is between 0-2.