Hi, You seem very distressed with the issue of insomnia after your major surgery last year. To begin with, i would want to tell you that taking sleeping pills (like ambien or alprazolam) will not be a fool-proof treatment for insomnia in the long run. As a Psychiatrist i do not advise my patients to take these medicines for more than a few weeks (2-3), mostly because they lose their effect over time and need to be taken in higher doses. Also, they are only a temporary relief for the person, not the remedy for the complete problem. The better way is to treat the underlying problem which has apparently caused your insomnia. Based on your information, i gather that you have had worry, headaches, sleepless nights and hence a constant tiredness, inability to work and anxious/low mood for almost a year. It prompts me towards a diagnosis of moderate Depression, which is very common in middle aged women (near menopause), especially in a post-surgical period. The hormone replacement therapy that you are taking will definitely help in allaying your stress. In addition, i would want to suggest you to consult a Psychiatrist near you in person and get this cluster of complaints formally assessed and treated. You may need a short course of anti-depressant medication. There is also a need to run a short battery of blood investigation, especially the complete blood count and the organ function tests, especially thyroid functioning. I believe that a course of proper medication without prolonged use of sleeping pills will be of much benefit to you. Hope this addresses your concern.Wish you sooner recovery. Happy to help for any more questions.