Brief Answer:
Recommendations

Detailed Answer:
Hello and welcome,

I've experienced severe sleep problems at times and have patients who also have experienced this.

I think, from what you described, your sleep problems need more than melatonin and Benadryl. There is hope though. The thing to address is the anxiety and hypervigiliance. Then sleep will come and once sleep is restored, your memory, concentration, and ability to function well will improve as well.

I recommend that you see a psychiatrist for medications for the anxiety, and if that is not possible, then to see your primary care doctor.

Medications that can help would be an SSRI antidepressant/antianxiety medicine such as Lexapro (escitalopram). But that can take several weeks to kick in. So in addition, since Trazadone did not work for you, you can talk with your doctor about one of the atypical antipsychotic medications such as Seroquel or Zyprexa. These work quickly, are sedating, and also give the SSRI medication a boost.

Now I know what people think when they hear "antidepressant" and "atypical antipsychotic" medications. You may think "but I'm not depressed or psychotic". I am not assuming you are. That is just the name of the class of these meds because that is what they were first used for. But the SSRI antidepressants also work for anxiety and hypervigilance (where a person keeps worrying about getting something done, etc). And the atypical antipsychotics are used for a number of things other than psychoses, including severe insomnia.

A 3rd medication, to have on hand for episodes of panic attacks, is either alprazolam or lorazepam. But, after a couple of weeks on escitalopram and either seroquel or olanzapine, you may no longer need to take the benzodiazepine (alprazolam or lorazepam).

In addition to these medications, I recommend you also see a psychologist/counselor to help you with skills to control the anxiety too.

Now about the hypertension. If you never had that before, it may be related to the anxiety. But if it is a regular problem, then you should see your primary doctor for a medication to control this on a daily basis.

So - there is hope that you will recover from the sleep problems, but the way to address it is to treat the anxiety.

In summary:
See your doctor and start
1. An SSRI (escitalopram works faster than some of the others but still takes about 2 weeks to really start seeing effects).
2. An atypical antipsychotic (Seroquel is often used for insomnia, so is olanzapine).
3. A benzodiazepine for break thru episodes of panic (alprazolam or lorazepam).

In addition, see a counselor for help with training your mind to not go off on anxious thoughts.

Please let me know if I can help further.

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