Brief Answer:
Check the dosage of the Melatonin, please.

Detailed Answer:
Hello and welcome,

I have had severe insomnia in the past and know how miserable it can be.

You can try melatonin, but first check the dosage as 500 mg would be a toxic dosage. Is it 500 micrograms (abbreviated mcg or ug)? Because the usual dose is 3-5 mg.

I think it is important to determine the cause of your insomnia. Since this is an ongoing problem, you should have your thyroid function checked. Also, consider chronic anxiety and depression. The sleep medications such as Belsomra or Sonata do not work if there is underlying depression or anxiety disorder, and can even make the anxiety or agitation worse. An SSRI such as Lexapro, combined with a continuous anxiolytic such as clonazepam might work better for this situation. It can take a couple weeks for the Lexapro to kick in well, but a continuous dose of benzodiazepine can calm you down enough that sleep will come more easily at bedtime. The lorazepam and temazepam that you have been taking I imagine have just been given for sleep - at bedtime - rather than dosed throughout the day. Kind of like trying to stop a moving train.

I hope this information helps. Please let me know if I can provide further information or clarification.

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Brief Answer:
I can understand about not wanting to go on continuous benzodiazepines.

Detailed Answer:
Yes, I can understand not wanting to go on benzodiazepines because of the concern about discontinuation. If you are quite shy of these, another possibility for anxiety and hyper alert state is buspirone. It is a different class of anxiolytic than the benzodiazepines and has been around a long time. It is not often used for immediate treatment because, like the SSRIs, it does not work immediately. But it is easier to discontinue.

If the anxiety symptoms are very severe, sometimes psychiatrists will add a sedating atypical antipsychotic in a tiny dose. These have significant risks of side effects in the standard therapeutic doses for schizophrenia or bipolar but not in the tiny amount for relaxation and sleep. For example with the medication olanzapine, therapeutic dose for schizophrenia or bipolar mania is 15 - 20 mg and for anxiety/sleep it can be effective at 1.25 - 2.5 mg. But I would defer to a psychiatrist for medical management if you use something like this.

While scheduled use of benzodiazepines can be somewhat difficult to discontinue, it is not impossible if done slowly and carefully.

I'd also like to suggest counseling, if you think it appropriate for your situation, to discuss issues that may be keeping you up.

And mindful focused breathing practices. For example, one technique called 4 x 4 breathing is easy to learn and practice. If done regularly, your body can go into a more relaxed state more quickly from it too. In this technique, you sit, or recline, comfortably and take a few deep breaths. Then breath in in a relaxed way, counting to 4 as you breath in, and breath out counting to 4 as you breath out. Do this for 4 breaths, focusing on your breath. Then start over, doing 4 breath cycles. For duration, you can do this for 4 breaths. As you get more used to it, try to extend the time up to 10 minutes.

Your mind will wander, and when you become aware of it wandering, acknowledge it and gently return your focus to your breaths again.

I hope you soon have good restful sleep.

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