Inclusion Criteria:  Age greater than or equal to 18 years Currently hospitalized Awake and able to attempt communication Respiratory failure requiring non-invasive ventilatory support Positive Inspiratory Pressure (PIP) less than or equal to 20 cm H2O Positive End Expiratory Pressure (PEEP) less than or equal to 10 cm H2O FiO2 less than or equal to 0.60 Clinical attending physician believes it is safe for the patient to participate Able to consent o If patient cannot consent on the basis of difficulty in being heard and asking questions (as in fact may occur with NIV, a key assumption of this study), then assent will be obtained from the patient with informed consent obtained from a legally authorized representative.  Exclusion Criteria:  Tachypnea with RR > 35 Increase in PIP, PEEP or FiO2 over the last 2 hours Known to be delirious (clinically obtained CAM score that is positive) Prisoner