that she was feeling extremely tired, pointed to bags under her eyes, and perceived CPAP as a means to improve her energy. The one potential negative was that she was not interested in having anything cover her face. She was highly motivated and told study staff that she was going to be their "best user".

During her first week with CPAP, she was a very good user of the device (at least four hours per night) and she described feeling quite positive about CPAP. However, as she continued to use it, she began experiencing issues with abdominal bloating that caused her to discontinue use. She had a vacation planned, and, although she originally reported an intention to take the machine with her, aerophagia ultimately resulted in her decision to leave the device athome. After her vacation, study staff addressed the issue by changing from a full-face mask interface to a nasal cannula.

Initially, these changes resulted in improved use, but she then experienced the sensation of increased pressure, which caused her to awaken in the middle of the night. She expressed to study staff a frustration that she was not the "best user". Study staff responded by re-educating her about the ramp button to reduce the pressure and offered her encouragement. Her CPAP adherence improved, but she still experienced difficulties with nocturnal awakenings and a sensation of uncomfortably high pressures. By the end of her participation in the study, she was using CPAP for at least four hours per night for three-quarters of nights but was still "ashamed" that she was not a "better" user.

Patient