So sorry you are struggling with sleep issues. I do, too.

Your therapist and/or psychiatrist can help you find additional tools to cope and help you with sleep. But if you are struggling with healthcare, the tips below are what I received from multiple providers. You have to find what works best for you, and to also consult a professional to make sure that nothing interacts with any other medication or treatments you're receiving.

I was weaned off of Ambien years ago since it was losing its effect. If you want more holistic approaches that involve over-the-counter meds, you can try Melatonin 6mg or 10mg two hours before bedtime along with sleepy time tea or chamomile tea. Also, try to unwind two hours before bedtime (not just 30 minutes prior). The way Melatonin works is when taken two hours before bedtime; it has a delayed effect, and it's also good practice to self-care and relax two hours before bedtime anyway. The other supplemental drinks mentioned could be sipped on for the first hour before bedtime.

What also helps when you have anxiety or panic or heart palpitations is a powdered drink called CALM, which a nurse at the VA recommended to me a while back. You can take CALM with chamomile and Melatonin, and the nurse said to me that it is all safe. However, what might be safe for me might not be safe for you, so I'd check with your providers first.

Creating a good nighttime routine helps, too, if that is possible. For some people living in noisy situations or tough roommate situations, or who deal with swing shifts, that might not be possible. But whatever you can do to minimize the noise, the light, the stimuli keeping you awake, try to do. For example, you can maybe set up room dividers if you share space with a roommate. You can also set boundaries about sleep time. There are also noise reducers (like sponges) you can put on your walls. Having light blockers for the windows could help, too, especially if you're sleeping during unconventional (daytime) hours. Some people elect to shower or bathe before bed, or do something very soothing like listening to calm music while sipping on tea, and after taking Melatonin.

Another problem is if you have incontinence or frequent urination, then a different approach might be needed. You might want to sip on only half a cup of the tea or CALM, for instance, and you might want to do that two hours before bedtime, so that you can empty your bladder well ahead of time.

Additionally, some people experience GERD/acid reflux, body pain, or other physiological issues at bedtime or while lying down. You might want to ask your primary care physician what will help in these situations, so that you can get a better night's sleep. My doctor suggested I elevate my legs when I'm feeling leg pain or swelling, so I purchased a special wedge for that. I haven't purchased the wedge for GERD/acid reflux, but I simply prop my pillows up a certain way or sleep on my side.

Other issues might include the way your lighting is (if you have to sleep with the light on due to fear of sleeping in the dark, or if there's natural light coming in if you sleep during the daytime), or the room temperature setting is too hot or too cold, or the way the bedroom is set up (with too many distractions). If you have a bunch of electronics or other things competing for attention in your bedroom, then you could try to find a way to shut off electronics (or move them out of the room, if you have room to do so). You can also cover up distracting things with sheets, etc. It's whatever works for you at night to create a very soothing atmosphere. For roommates, state boundaries and consider investing in room dividers. For temperature, try adjusting it in some way - whether it be through machines or natural cooling or heating sources. For lighting issues, consider getting a dimmer light if you have to sleep with the light on, or consider getting a thicker curtain to block out natural light if sleeping during the daytime.

Also, consider avoiding news reading, difficult conversations, certain triggers, and other negative stimuli before bedtime. Save these for your afternoon - many hours before you're scheduled to sleep. This will help make it easier to relax and fall asleep, and will also mean that you're not waking up to anything negative either.

Sleep is more than a night routine. It involves your daily routine and functioning as well. Gastrointestinal issues could interfere with sleep, so eating and drinking many hours before bedtime might help. Eating well, spacing time for negative items in the middle of your day (whenever that is, depending on your work schedule) helps so that you can wake to a good morning and sleep to a good night, and have those good associations of self-care upon waking and sleeping. All of these suggestions I found through the VA's apps as well as through various suggestions from many different healthcare providers (primary care physicians, psychiatrists, psychotherapists, psychologists, etc.).

I hope some of these tips help.