Insert the blue handled key into the activation screw head and try to have the butt-end of the blue handle pointed up towards the patients nose. (This is called the 12 o’clock position and is a good starting point.) From the operator’s perspective (not the patient), the key is turned in a clockwise direction to initiate the expansion. There are 2 sides on the key, one has a target and the other side does not. Make sure you are pushing on the target to insure the key is being turned the proper direction. Turn the key (like a car key) until the butt-end reaches the 12 o’clock position again. This is 1 full activation.