Noninvasive ventilation has become standard-of-care management for patients with amyotrophic lateral sclerosis (ALS) but remains a challenging intervention for patients with bulbar weakness. Noninvasive ventilation can itself trigger sleep-disordered breathing events in the form of glottic closure, which can limit success of the intervention. Complexity arises from impaired airway clearance, secretion management, and positive pressure related airway collapse. This review highlights the approach to identification and management of glottic closure and airway complications associated with noninvasive ventilation in patients with bulbar weakness secondary to ALS.