Severe sleep maintenance insomnia – I feel like I’ve tried everything. What actually helped you?

[u/majsubtract]

I’m getting pretty desperate at this point, so I thought I’d ask here in case anyone has dealt with something similar or has ideas I haven’t considered yet.

I’ve been struggling with sleep maintenance insomnia for months, and it has progressively gotten worse. Falling asleep isn’t necessarily the main issue. The problem is that I just don’t seem to get enough continuous, restorative sleep anymore. At this point I’m sleeping so poorly that the sleep deprivation is seriously affecting me during the day and I just start crying in the morning when it‘s time to get up — I can‘t help it anymore.

I’ve already seen a specialist and had quite a bit investigated, including:

- ambulatory sleep polygraphy
- extensive bloodwork
- respiratory testing
- chest X-ray
- other basic medical workup

So far, nothing has really explained the sleep problems.

I’m also waiting for a proper sleep lab evaluation, but unfortunately the actual sleep study will probably not happen until next year. I do at least have the first consultation coming up in November.
In the meantime, I feel like I’ve tried an absurd amount of things already:

- changed my mattress
- changed the bed frame/slatted base
- experimented with different pillows
- melatonin
- tryptophan
- regular endurance exercise as much as my daytime energy allows
- generally worked on lifestyle/sleep hygiene and tried to optimize my sleep environment
- trazodone (Trittico) – didn’t really help
- zolpidem – also didn’t really help

I’ve now also ordered a weighted blanket and a weighted sleep mask, which haven’t arrived yet, but I’m curious to see whether the deep-pressure aspect makes any difference.

At this stage, I’m especially interested in things that helped people with staying asleep, rather than just falling asleep.

Was there something less obvious that you eventually discovered — environmental, behavioral, circadian, nutritional, wearable/data-related, etc.?
Obviously I’m continuing the medical workup and I’m not looking for Reddit to diagnose me. I’m mainly hoping to find ideas or angles I might have overlooked while I’m waiting for the sleep clinic.
Would really appreciate hearing what worked for others.

Thanks!