 The data card records critical features of NIPPV acceptance hours and timing of use and adherence apneahypopnea index, mask leak, minute ventilation; but to date data card monitoring has not yet been incorporated fully into ALS clinic practice. We will limit our focus to patients who meet Medicare-reimbursement criteria or AAN-recommended practice parameters for initiating NIPPV. The larger question guiding this research is whether data card monitoring and communication of these results to clinicians and patient families promotes optimal use of NIPPV. We define optimal use as i high acceptance, as indicated by daily night time use greater than 4 hours, and ii high adherence, as indicated by apneahypopnea index, mask leak, and minute ventilation. We will test whether timely reporting of acceptance and adherence values to patients and clinicians increases the likelihood of i changes in orofacial masks and settings on devices and continued use of devices, and ii positive patient mood and sleep quality and lower caregiver burden over follow-up. 