OK, first, Neil, how can I call you Neil if you don't call me Laurie?
I don't want to sound repetitive w/ all the BiPAP settings stuff, but some of what we did...YMMV, I think you were bulbar onset so it is different...
1) Reconsider the CoughAssist and/or suction machine. Note whether they really end a coughing ep or prolong it. We never had a CA and stopped using suction the last year or so. We did use the papaya as mentioned on your recent thread. Sometimes cough syrup (not decongestant type).
2) A thousand (not) times a day or so, Larry "spit" excess saliva into a folded half paper towel we held for him. Especially after waking up, before and after meals, and before sleep.
3)He was also on BP meds for his aneurysms and some prob helped somewhat w/ mucus as a side effect. I would track your BP and if it trends up, certainly consider antihypertensives because your system is stressed enough already.
4)ClimateLine tubing/ResMed machines (had its own thread)
5)Increased minimum Ti (inspiration time) when he coughed. Cranked it back down when he wasn't to avoid air trapping, esp. at night.
Cranked down settings overall in the last year -- like I say, IPAP 15 max/10 min/5 EPAP is a place to start. But volume-based ventilation unless you have major pre-existing apnea (and maybe even then) is better (the S9 ST-A or the Astral, the latter just being a souped up more portable ST-A that can handle a trach). So then you just set a Vt target (I lowered that as we went along; permissive hypoventilation to reduce cough reflex/for comfort; may not work as well for others, poss greater risk of pneumonia if food is getting stuck) along with a range and the settings adjust to target. Like the AVAPS mode on the Trilogy but one that works better.
Also -- no shortcut I can give -- have to make sure trigger setting is "very high," probably and cycle depends on your pattern. Not sure Trilogy has cycle setting anyway.
6) Circadiance Sleepweaver cloth nasal mask -- I don't believe your fragile facial/glottal musculature needs heavy plastic on top. And heat is more a factor w/ a heavier mask, too.
7)Nasal steroid (Nasacort) morning and night. Sometimes Nasalcrom. Sometimes an herbal inhaler (Olbas). We used steamed essential oils early, then stopped. We avoided decongestants totally bc of heart issues. YMMV but they can dry secretions that then coat the tubes/nose anyway. I don't use them myself.
8) Tried not to use central heat. Used heated mattress pad (bed) or blanket (in w/c) instead. Always had fan on during sleep. Used A/C consistently in spring/summer. Good to go outside/open window after rain for fresh air!
9)Fast melt loratadine tab in am.
10) Is this a top 10 list? Never lie flat. Even for medical procedures, bring real pillow. Head, feet always somewhat elevated in bed, alternate w/c positions as frequently as you can.
11) No, top 11 --- baby nasal aspirator (blue, long tip) for mucus, morning/night
12) Only air freshener/spray we used around Larry was pure orange oil, no chemicals, never at face level, always below. No disinfectant or other irritating sprays. No vacuuming w/ him in room, etc.
I'll post whatever I forgot later. And once again...you have to do what works for you. Which means you have to ask, so to speak.