I take five medications. OTC melatonin is the only one that is actually a sleep medication. One is an old-school ADHD med, one is a tricyclic (old-school) antidepressant, one is an antipsychotic, and one is an anticonvulsant. The second two are pretty new. I take very low doses of them-- in fact, except for the anticonvulsant, none of them would be very effective for the conditions they are first-line drugs for at the doses I take.
The ADHD drug keeps me from “micronapping” during the day, where you can sleep for less than a minute and not even be aware of it, several times during the day (this is something that happens to hardcore insomniacs who are running on four days with a total of ten hours of sleep). The tricyclic keeps my mind from racing when I’m trying to relax and fall asleep-- it also keeps me from worrying so much about not sleeping that I worry myself into wakefulness, and tricyclics have drowsiness as a side effect, but they are not habit-forming in the way that sedatives and narcotics are-- they also make you drowsy, but don’t interfere with you actually sleeping-- you aren’t just sleeping off the drug, in other words. The anticonvulsant partially suppresses my startle reflex, because I startle several times during the night, particularly when I go into REM sleep. Sometimes I startle into full wakefulness, and sometimes just out of REM, which is the really restful part of sleep. The antipsychotic somehow seems to promote REM sleep and make my sleep more efficient and effective, so I feel very rested when I wake up.
The melatonin helps push me over the edge into actually falling asleep.
That’s how I get to sleep.
It took several years of experimenting to get the right mix of drugs, and the right dosages, but it’s been working for 15 years. I had to take a break when I was pregnant, and ended up having to quit work early because my sleep got so screwed up-- but then in the last trimester just being pregnant made me tired, and I slept a lot.
I have two PRNs, Ambien and clonazepam. I rarely take them-- mostly when I’m jet-lagged, if I have to get up very early, so I need to get to sleep at say, 7pm (if I have to drive safely in the wee hours the next morning, say), or if my sleep gets screwed up by an illness-- like two months ago when I had a stomach bug and was taking phenergan which made me sleep a lot, and then I couldn’t get to sleep when I stopped taking it, or once years ago when I had to take steroids, and they kept me awake.
I get 30 5mg Ambien a month (most people get 10mg), and I can take one or two. I think I last filled it last November. I need to check and see when the Rx expires and fill it once just before that. I have 60 .5mg clonazepam a month, and can take 1-4. It also says “as needed for sleep or anxiety” on the bottle, because I’m allowed to take it before I go to the dentist, as long as I have a ride home. The last time I took more than one was to sleep on an airplane two years ago.
I’m not cured, but I’m “effectively treated,” like a diabetic whose blood sugar is well under control with diet, insulin, medication, or whatever combination works.
All the meds are pretty cheap. They all cost just a couple of dollars a month, except the antipsychotic, which just became available generic last year, and still costs 16 dollars a month. I think my insurance pays a lot more.
So yes, it is possible to control even really difficult, hardwired insomnia. But you need to see a psychiatrist or neurologist who knows about sleep. You need a sleep study to ferret out unusual patterns in your nocturnal brain waves, and start there.