Gary also has the Phillips Respironics cough assist. He uses it faithfully as ordered - twice a day 3 sets of 5 coughs. Only occasionally brings up phlegm. Doesn't mind it at all, when compared to the bipap! He struggled to get used to that - 5 months now. Getting a trilogy tomorrow in preparation for an elective tracheotomy. As I understand, it will be used on bipap settings for a while. The cough assist doesn't seem to tire him.