ALS Respiratory Support: Essential Tools and Strategies for Better Breathing

When ALS respiratory support, the medical interventions used to help people with amyotrophic lateral sclerosis maintain breathing as muscles weaken. Also known as respiratory assistance for ALS, it becomes critical as the disease progresses and the diaphragm and intercostal muscles lose strength. Without support, breathing becomes shallow and inefficient—leading to fatigue, poor sleep, and higher risk of pneumonia. This isn’t about extending life at all costs; it’s about keeping people comfortable, alert, and able to talk, eat, and connect with loved ones for as long as possible.

Non-invasive ventilation, a breathing support method that delivers air through a mask without requiring a tube in the throat. Also known as NIV, it’s often the first line of defense for ALS patients. Devices like BiPAP, a type of non-invasive ventilator that adjusts pressure during inhalation and exhalation. Also known as bilevel positive airway pressure are common because they’re easy to use at home, don’t require surgery, and can dramatically improve sleep and daytime energy. Many patients report feeling like they’re getting their breath back after just a few nights of use. But timing matters—waiting until you’re gasping for air means you’ve already lost too much lung function. The best results come when support starts early, before symptoms become severe.

When NIV isn’t enough, tracheostomy, a surgical opening in the windpipe to connect directly to a ventilator. Also known as trach becomes an option. It’s a major decision—not just medically, but emotionally and practically. A trach means 24/7 care, cleaning, and maintenance, but for some, it means being able to speak again with a speaking valve or even eat normally. It’s not for everyone, but for those who choose it, it can restore a sense of control. What’s often overlooked is that respiratory muscle weakness, the gradual loss of strength in the muscles that control breathing. Also known as diaphragmatic weakness doesn’t just affect lungs—it impacts cough strength, swallowing, and even speech. That’s why cough assist devices and suction machines are often part of the same support plan.

You won’t find one-size-fits-all answers here. What works for one person might feel overwhelming to another. Some rely on BiPAP only at night. Others use it all day. Some choose trach and live for years with quality. Others prefer to let the disease take its course without mechanical help. All are valid. The goal isn’t to push toward the most aggressive option—it’s to match the support to the person’s values, lifestyle, and goals. That’s why this collection of posts dives into real-world experiences, safety checks, device comparisons, and how to talk to your care team about what matters most. You’ll find guides on when to upgrade equipment, how to avoid infections, what to do when masks leak, and why some patients stop using their ventilators—not because they gave up, but because they chose to live differently. These aren’t theoretical discussions. They’re stories from people who’ve been there, with practical advice that actually helps.