Treatment resistant insomnia—can the ER even help me?

I don’t think the ER will be of much benefit. Unisom is only recommended for occasional insomnia, not every bight use. The sleep melt version contains diphenhydramine which is addictive, so if you’re using sleep melts at least switch to the pills form which contains doxylamine succinate.adults over 65 should not take it as they are more sensitive to side effects including drowsiness, dizziness, confusion, dry mouth, constipation, blurry vision, and urinary retention. These effects can be more pronounced due to slower metabolism and reduced clearance in older individuals, which may lead to prolonged sedation and an increased risk of falls and related injuries.

It sounds to me like you would benefit from a sleep doctor, usually a specialist from neurology.

What do u mean when you say you don’t have the PTO to keep seeing your doctor? I don’t know this term.

I’ve been reading studies (don’t have them at my fingertips) that conclude melatonin should be for occasional use only.

Gotta go, more later

@laura1970 PTO is paid time off from work. I accrue some every paycheck but I need PTO to take off work for doctors appointments. I’m taking the pill form of unisom, and I agree I should see a sleep doctor, but that requires a visit to my doctor that I don’t have PTO for. I thought maybe I could get a referral from the ER for a sleep doctor but I’m not sure if they’ll do that for me.

I think an MRI of your brain/head would be indicated (I have no medical training) to see if there is any obvious deformation or tumour growth. Tumours can secrete their own hormones which can alter bodily functions, including sleep.
https://neuroendocrine.org.au/hormonal-imbalances-in-neuroendocrine-tumours/
I don't want to alarm you or feed you 'information' which will cause you to spiral (you already have enough on your plate!), but if it were me, I'd press this until I got help from an internist or someone capable of interpreting an MRI of the brain. Maybe it would have to be a CT scan....I dunno....but 'something' is amiss, and there has been a sudden change per the date you cite. From then forward you have lost a lot of sleep. To me, as inexpert as I am, this sounds distinctly hormonal, or maybe something mechanical about your brain. An endocrinologist might help with the hormone shift, or hormone added, and a neurosurgeon might be the one to call for a head MRI and rule out any tumours.

@gloaming that’s what I was thinking. I need a brain MRI anyway for my MS treatment but haven’t been able to get one. It’s been over a year. Something has clearly changed with me suddenly and significantly, I just haven’t had the time off from work to get the MRI. I think I’ll pop by the hospital to see if they’ll do one for me—or at least refer to me to a sleep specialist in neurology.

The ER would be a waste of time - I speak from personal experience. Chronic insomnia since age 12, and I usually only get 3 to 4 hours of sleep per night. I might get an occasional night where I’ll get 6 to 8 hours, but that doesn’t happen more than twice a month. What had been working for me, to increase those 6 hour nights were gummies made of all natural ingredients and NO melatonin. They are called NUMO Sleep gummies, and they were working great - until I had a hip replacement a month ago, and am now back to 3 to 4 hours. Hoping this is only a temporary situation that will improve as I heal? They may not work for you, but it might be worth trying a bottle of them. I’ve recommended them to several people and they have gotten improved sleep. Good luck!

Update: I went and they said there isn’t much they can do for me, but they said they’ll refer me to a sleep doctor which is really mostly what I need anyway. Glad I went.

@oodlesofeep
Have you had a sleep study to see if you have sleep apnea waking you up constantly due to breathing interruptions?

Have you had anything happen leading up to the end of October that caused this to start happening (did you fall/get injured/have an illness right before)? Have you changed diet, medications, activities, products?

@oodlesofeep

Have you looked into taking a short leave of absence to get to the bottom of your sleep issue? If you don’t have any PTO, you may be able to take a FMLA leave or use vacation time. Check with your HR department. Depending on state, you may be able to take short term disability benefits for your condition and to get diagnosed and properly treated. Going without sleep can be dangerous for you at home, on the job, driving, etc. because accidents are more likely to happen if majorly sleep deprived. You could also have job performance issues and lose your job depending on the type of work you do if you are not able to adequately cover your essential work functions (I used to work in HR for many years and recall someone have performance and attendance issues because of untreated sleep apnea).

You have 2 severe diseases. MS and epilepsy. Could that be causing some kind of deep-down subconscious anxiety reaction? Perhaps a psychologist or therapist might be helpful. I know how much suffering insomnia can cause one. I have been there & am still working on it.

Mindfulness might help. Look it up. There are many good websites. It is not a cure. Is more like a coping mechanism. Mindfulness is the practice of paying full, non‑judgmental attention to the present moment. It works by training your awareness to observe thoughts, emotions, and sensations without automatically reacting, which helps reduce stress and improve clarity. It is like standing outside of yourself & watching your thoughts, feelings & emotions rise to the surface without responding. It takes practice, won't come right away. Involves watching the breath. There is more to this. Try to find out as much as you can. May you be free from your suffering.

Ask your doctor about adding Ltryptophan. It's a natural amino acid we get from the food we eat. I have horrible insomnia but I tried 1,500 mg of ltryptophan 1 hour b4 bedtime and 30 mg of melatonin 1/2 hour after that. It worked the few times I tried it. Don't just do it, ask your doctor first. I have a compromised liver from a horrible bout of sepsis which nearly killed me so my situation is much different. I have a compromised liver right now and I'm doing things to make her healthy again. My hematologist said I can use lorazepam, I tried one 1/2 mg last night. What a great feeling to sleep like a baby and wake up refreshed instead of groggy and unsteady. The ltryptophan/melatonin mix sometimes makes you feel groggy and unsteady. The lirazepam works great. But see your doctor before trying anything new. And stay away from using otc pills a lot. Try a benedryl, but again ask your doctor first. How this can help you. Let me know.