Brown the sausage in a large, deep pan. Break apart thoroughly as it cooks. About 8 minutes

Once Sausage is browned, add in the peppers and onions, stir to combine and saute til vegetable begin to soften- about 3-5 minutes.

Add macaroni, sauce, water and seasoning. Stir to combine.

Cover the pan and bring to a boil, then reduce to medium heat and simmer 15-20 minutes. Stir every 5 minutes or so and check macaroni for desired doneness.

When the macaroni is al dente, remove the pan from the heat. Stir in the cream and then slowly stir in the cheese one handful at a time.