Allergy to CPAP silicone - suggestions ?

Welcome @roosterfish, You mentioned most of the posts related to your issue are dated. I'm assuming you have seen the 2017 discussion here that contains a few responses from this year - CPAP silicone allergy: Anyone know of other options? Solutions?: https://connect.mayoclinic.org/discussion/cpap-silicone-allergy/.

I don't actually have a silicone allergy but I do find that I can't use a silicone CPAP mask against my face/nose just due to the discomfort. I've tried many different masks including the ResMed AirTouch F20 foam masks but even they didn't work for me without a cloth cover of some sort. My sleep medicine PA introduced me to some comfort covers that are made for most CPAP masks and I've been using them since being diagnosed with obstructive sleep apnea back in 2018 - https://cpapcomfortcover.com/. I haven't tried one of the all cloth CPAP masks but they may be another option if you haven't seen them - https://www.circadiance.com/sleepweaver/.

Have you tried any of the cloth covers for CPAP masks?

It might be the silicone, but there are other factors in the pipeline from machine to your face. There's the hose and its materials, there is the filter, or lack of one in the machine, there's the condition of the humidifier vessel's interior and cleanliness, there's the way you clean them...or don't...and what you use for a detergent or cleaning agent and how much of it is left behind after you have rinsed.

The silicone itself is inert for our purposes, so it can only affect you if it makes direct contact AND you are indeed sensitive to that contact. You can purchase or fashion terrycloth or other material covers for almost any cushion being used currently, or you can use 'Barriere Cream' made by Wellspring Pharmaceuticals in Canada, probably available on line.

There might also be something in the water if you use a humidifier and heat. I use the local tap water because it is of high quality and low in mineralization (drops 4000' from a glacier just 18 miles away, so it's all surface run-off, not well or spring water that typically has more dissolved materials in it). Most become satisfied with bottles of distilled/demineralized water available by the gallon at WalMart for a coupla dollars.

Or, there's something in the humidifier tray. I used mine successfully for about 8 months, and then one day noticed a very light pinkish tinge on the surface of the interior. It was a biofilm that had begun to sprout, and was probably only a few days from growing legs. I used peroxide to swish out the interior, rinsed well, refilled, and I was back in business. This has happened only once more in the seven years I have been on PAP therapy. But there's always a chance something is growing, a fungus, a bacterium....something the water treatment didn't....you know....treat? Maybe your system is just sufficiently sensitive that you can't deal with any amount of it. Happens to the best of us.

How often do you clean the interior of your mask and the hose elements connected to it? I don't seem to have to clean mine more than once a week, but some don't feel right unless they clean their systems daily. Whatever floats their boats and lets them sleep securely at night, more power to them.

I hear you... had lots of trouble with a silicone mask and facial rash. I need my mask to be fairly tight since my pressures are relatively high.

Sleep doc suggested a light application of 10% hydrocortisone cream which is not recommended to do more than a few days - it didn't help me. I did try a half dose of Benedryl which helped some, but had other side effects. Was tempted to try something with aloe in it.

I swapped to a memory foam mask which solved the allergic reaction, but it still causes redness where it makes contact and dents where the straps dig in. I couldn't find a cloth cover for that and tried making my own which ended up being impractical. Have tried adjusting the tightness to have the minimum tightness while ensuring minimal large leaks.

I use reverse osmosis purified water in the tank and clean the tank periodically - I use my electric toothbrush. The CPAP appears be inhaling dirt through the filter. The use of hydrogen peroxide to sanitize the tank sounds like a good idea, may also be worthwhile to flush the hose with it.

That said, I'm looking for a better fitting mask, a better CPAP intake air filter if they make them, an inline filter for the hose and will take another try to find a mask cover.

I have low and steady pressure, with a max inspiration of 8.5 mm/H2O. So, I can afford to leave my strapping looser, but it does mean more leaks when deeply asleep. So, I learned to sleep on my side, almost exclusively, and to fold my arms, and my wrists, and tuck my hands on either side of my face, close to the mask. This might sound weird, but it actually prevents all but the most egregious of leaks. Most importantly, if you get little puffs and noises that alert you as you're trying to fall asleep at bedtime, this is detrimental as it tends to go on until you fall asleep out of plumb good luck. The bent wrists, with the backs of my fingers against my cheeks and chin, is something you'd have to get used to, but it works really well. It provides a bumping post of sorts against whichever side of your face the pillow is supporting, and prevents displacement or distortion of the seal by the pillow material. Might be worth trying it. If it works, you can loosen them straps a smidge.

Try the Barriere Cream. It works very well for pressure/contact sores and welts, and for 'contact dermatitis.' My wife steals my tube all the time because she learned that it works well for her needs, and she's very finicky about stuff.

As for better filters, the ones they provide are good, but they're not 'HEPA' variety. I think you can find them, but I have no links as I seem to be fine and have never sought them. Or, look for a material of that nature, with about the same thickness, and simply cut out from a sheet of that material what will fit properly and do the job.

Wow. Thank you. Talk about a comprehensive response. So much more to think about and rule in/rule out. I tried using distilled water in the pan initially but found it did not really contribute or deter from my experience so just stopped. When the sneezing began - so explosive I pulled my rib muscles - and the drainage, I began washing my tubes, mask, and pillow every morning with a mild dish detergent (which the instructions recommended) and then hanging to dry during the day. I did use the filters supplied with the machine and started changing them weekly but they were quite porous and I didn't really think they accomplished much. I was not aware of any material covers or nosepieces at the time which is something I do need to research and revisit. The memory foam and comfort covers could be worthwhile. So thank everyone for the input and opening my eyes to other possible causes.

Thanks for the suggestions.

Yesterday, I found an old unused 3M Covid mask, cut it up to make a filter to see if it helps and did the entire cleaning ritual as well.

Working on getting the cream. It's doesn't appear to be available in the US, although there are lots of other barrier creams available.