terminal insominia - the rare and unwanted, yet constant companion in my life

Dear forum,

I am a 32 year old ambitious, very giving and usually quite energetic and positive girl. I am in desperate need of advice on my terminal insomnia.

I’m struggling with a form of insomnia that has been affecting me in phases for years, and I’m looking for advice on how to manage it better.

Current situation:
It’s 5:45 AM as I write this. I’m on a business trip and spent 13 hours with clients and colleagues yesterday. I like my job and don’t mind business trips, but I’m exhausted. Despite that, I find myself awake again, unable to fully rest.

History:
I’ve always been an early bird and naturally wake up very early without an alarm. Sometimes, though, my sleep gets really short – averaging 5–5.5 hours for weeks at a time. This happens in phases. My last severe phase was three years ago, when my doctor prescribed zolpidem because I couldn’t sleep more than four hours at a stretch.

How it unfolds:
I fall asleep easily, usually within 5–10 minutes of going to bed around 11 PM (sometimes midnight). I wake up around 3 AM, go to the bathroom, and can sometimes fall back asleep until 4–5 AM. After that, I can’t get comfortable or relaxed. I’m restless in bed – the state between wakefulness and sleep feels physically stressful, and I often have uncomfortable dreams. I end up getting out of bed, not fully rested, and start my day.

During the morning, I stay active for 3–4 hours but become extremely sleepy, sometimes needing a power nap. By the afternoon, fatigue becomes unbearable, and it’s worse in the two weeks leading up to my period, when I suspect I have strong PMS – extra anxiety, low confidence, fatigue, and mild depression.

Impact on life:

I feel like I can only give 60–70% at work.

I struggle to keep in touch with friends and notice increased forgetfulness.

I’ve cried a lot recently.

I crave chocolate or extra food, even though I’m normally health-conscious.

I sometimes need to take days off due to exhaustion.
Frustration comes from knowing my mind and body need rest but can’t get it – not from lack of time, but from inability.

Routines and lifestyle:

I stopped drinking completely 5 weeks ago (used to have 1–2 glasses of wine occasionally).

I exercise 5–6 times per week, mostly in the mornings, never after 6 PM.

I walk my dog twice a day.

My bedroom is comfortable, dark, and quiet.

I get plenty of sunlight.

I reduce screen time an hour before bed.

I eat a healthy, balanced diet, including protein, vegetables, carbs, and daily treats.

Work is mentally challenging but not overly stressful.

Supplementation:

Vitamin D3, omega-3, vitamin B6, ashwagandha, magnesium glycinate 400 mg.

Escitalopram 10 mg for mood (started 8 months ago).

Treatments tried:

Treated iron deficiency (four months ago – now at 92%).

Sleep center evaluation 10 years ago: mild sleep apnea, not needing treatment.

Zolpidem 10 mg helped temporarily, but not sustainable and sometimes increases next-day fatigue.

Melatonin had little effect.

Nidra yoga and reading at night help relax but haven’t improved sleep.

Three years ago, insomnia coincided with boredom and loneliness at work, but the last two years were better. I feel happy in my relationship and surrounded by family and friends, so I believe psychological causes are minimal.

Consequences now:

I look visibly tired and aged despite not drinking.

I feel restless and low on energy, never at my usual 100%.

I sometimes need time off or reduced workload due to exhaustion.

I crave wine in the evenings just to relax.