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During CPAP you wear a nasal mask attached to a machine that pumps air and provides a constant degree of background pressure in the airway. This pressure keeps the passage between the mouth and the lower pharynx open. CPAP is widely available commercially, reasonably inexpensive (compared to surgery), and relatively simple to operate. But, as one sleep researcher put it, “you have to sleep with a machine that sounds like a vacuum cleaner for the rest of your life.” CPAP can be uncomfortable and irritating; in some cases eye complications, stemming from the presence of the mask, have been reported. The most important drawback, however, is psychosocial. For many of my patients, especially the younger ones and their spouses, the thought of sleeping with a nasal mask and an air compressor every night can be disheartening. In those cases where CPAP is appropriate, the patients must possess the proper mental attitude to use the technique correctly and faithfully.*146\226\8*

A person experiencing anxiety symptoms should say to himself: ‘I’m feeling anxious. This means my nervous system is telling me it can’t cope with the work I’m giving it to do. I have to ask myself two questions to do with the input side of the anxiety equation, and three questions to do with the processing side.’
1. Am I asking my nervous system to do too much? Am I overloading myself with tasks?
2. Is what I am asking my nervous system to do, too difficult for it?
3. Have I had enough sleep? If I am lacking in sleep, my brain will not be functioning efficiently.
4. What is the state of my nutrition, in particular, my blood glucose level? The brain uses only glucose as fuel. If my blood glucose is too low, my brain will not be functioning properly.
5. Am I suffering from an abnormal physiological state? Such as:
• Alcohol or drug withdrawal,
• Excessive amount of stimulants, e.g. coffee, tea.
• Am I sick?
The person experiencing anxiety symptoms, who stops, thinks and asks himself these five questions will, in all probability, be able to decide what the problem is.
For example: ‘Am I trying to do too much? No, this is my usual work load. Is what I am asking my nervous system to do too difficult for it? No, just the usual. Have I had enough sleep? Come to think of it, I only had five hours sleep last night after getting home late from the party. And I didn’t have breakfast either. In fact I forgot to have lunch, and it’s 3 o’clock in the afternoon. I think I’d better take half an hour off and go and have some lunch. My blood sugar is probably too low.’
When it comes to asking about abnormal physiological states, it is quite possible that the person experiencing anxiety will not be able to answer this question fully. After all, if a person is ill the diagnosis may need to be made by a doctor.

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The feeling of unease or dread which we experience as part of the anxiety alarm reaction, is actually a feeling image of danger. The unconscious mind provides an image of what danger feels like. We are all more or less aware of how the unconscious mind operates in images, because we experience some of the image logic of the unconscious mind in our dreams. The feeling of anxiety is like an image provided by the unconscious mind, of what being in danger would feel like, if one were in danger. It is equivalent to the feeling of guilt as a feeling image of what punishment would feel like, if the person were being condemned by others.

The physical symptoms of anxiety
As well as experiencing a feeling of dread in the alarm reaction known as anxiety, we experience as well, various body feelings due to the actions of adrenaline and noradrenalin, released by the sympathetic nervous system. These messenger substances prepare the body for possible physical action, in case there is a necessity to fight or run away.
Thus the design of the anxiety alarm system includes the double function of warning, and preparing for the possibility of danger. The body’s systems are designed to regard the possible threat as a danger that one could run away from, or defend oneself physically, against. However, preparation for physical action may be quite inappropriate. It is a fact that most of the dangers we face in our lives now, are not things we can physically sprint from, or punch our way out of. Preparation for ‘fight or flight’ is of no practical use to us if the threats we face are things like the possibility of being sued, or being financially ruined by a stock market crash.
Preparation for fight or flight in those circumstances just makes us physically uncomfortable. On the other hand, the discovery that we are sharing a paddock with a savage bull would be a danger in which our preparation for rapid physical flight would be highly appropriate and useful.
As you might imagine, preparing the body for possible urgent physical action involves a number of changes to the functional state of a number of different systems of the body. To remember what all these changes are and the symptoms we might expect from them, all we need to do is picture what changes in the body are required to prepare us to run away as fast as possible, or hold ourselves ready to fight, tense and vigilant.
• The state of tension of the muscle fibres increases, making them contract more efficiently and quickly.
• Blood supply is re-directed to decrease blood flow to skin, internal digestive organs and kidneys, and increase blood flow to brain, heart, and muscles.
• The pulse rate increases, pushing nutrients faster around the body, providing more oxygen, and carrying away more carbon dioxide. The rate of breathing increases.
• The nervous system’s automatic reflexes are sharpened; the person becomes vigilant and able to react faster to stimuli.
• Glycogen in the liver breaks down into glucose, increasing the available nutrient supply to heart, brain, and muscle.
The symptoms of anxiety therefore, include feelings of muscle tension and fatigue, particularly in the chest muscles, neck and back. In order to fight one needs to stand stiffly up, bracing oneself for attack. Muscle stiffness as a result of being in a continual state of preparation, can cause soreness, spasm, and pain in back, neck, and chest muscles. Increased tension of agonist and antagonist muscle groups causes tremor, or shakes, seen most easily in the hands.
This tense state of muscular preparedness feels very uncomfortable unless the tension is put to some use. Physical exercise, by giving the prepared muscles some work to do, can alleviate some of the physical discomfort.
The sharpening of nervous system reflexes, with the increased vigilance, tends to interfere with the person’s ability to sleep. Stimulation of the heart by the sympathetic nervous system may produce an awareness of rapid heart rate, flutters and palpitations. The changes in blood supply and motility of the internal digestive organs can produce unpleasant feelings in the abdomen, and variable effects on bladder and bowel function.

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