support, wrote two letters to the electric company in an effort to keep the utility connected, cleaned the device and eventually replaced it due to malfunction. One month after the end of the study, the patient requested a third letter to the electric company confirming her use of the machine and resulting medical need for electricity. At the conclusion of the study, the participant's utilization was infrequent, illustrating how conditions related to personal context can impede successful adaptation to CPAP therapy.

Patient E

Patient E was a 47-year-old African-American woman had a history of TIA, hypertension, hyperlipidemia, depression, morbid obesity, myocardial infarction, and prior tobacco use. She was enrolled in the study after a left middle cerebral artery stroke that resulted in right upper and lower extremity weakness. Based upon the initial assessment, staff predicted thatshe had a high probability of successfully using CPAP. Salient positives included the ability to identify several motivators for CPAP adherence including significant tiredness that limited her ability to participate in daily activities such as shopping or walking. She had an AHI of 16, consistent with moderately severe OSA. 

She was immediately optimistic about using CPAP and reported no initial barriers to use or adverse effects within the first week of therapy. She reported a reduction in sleepiness after just the first night's use. On subsequent visits, she frequently demonstrated enthusiasm about CPAP ("I'm so glad you found this \[OSA\]") and expressed her gratitude to study staff on each visit. She used CPAP for over four hours per night. 

She stated that the only time she did not use her CPAP machine was when she