As far as I can tell, I don't know what causes the out-breaks. I don't have sleep apnea, but getting a good night's sleep is supposed to be important--but then that is when I have had three outbreaks in one month. I drink 1/2 caf coffee and no alcohol, I exercise every day and faithfully take all the meds and supplements. I try to eat a reasonable diet. I think dehydration at some point might be my issue but if I drink a lot of fluid during the evening, then I am up half the night going to the bathroom! I feel like it is a crap shoot! My doc says that "super controllers" like me are the kind that are most bothered by A-fib. The ones who are relaxed and more sedentary don't seem that upset about it! From all I have read, the sooner the problem is addressed, the better the chances of living a more normal existence. And that is what I want! Sorry I can't offer a better answer but thank you for your support.