Julia - Professor Hindmarsh is going to publish his paper very soon, on the pump. I am sure it will be feasible for it to be used in the USA too.  If we did not have the pump, I would certainly do as you do, dose following the circadian rhythm and I admire you and others on this board that do this. I know many doctors, like Prof Hindmarsh are all working on hard to improve the treatment in CAH. Kathy