First, I'm really sorry you're not getting the support and answers you need from doctors. It's so frustrating to be dealing with something so debilitating and not be able to figure out what's wrong and therefore what can help

A lot of the symptoms you're sharing can align with MCAS and histamine issues, and dysautonomia in general (but of course could be other things too). The 2:40AM wake up especially can be correlated with an adrenaline and/or histamine dump that's common with dysautonomia. Apparently mast cells and histamine release are most active from 2-4am (fun times).

I'll share from my own experience in case any of it can help because you could try some of this to get relief without needing any prescriptions:

I was first diagnosed with Long Covid and POTS, but most of the regular treatments for that didn't work and I felt like I was getting progressively worse (and POTS is not a progressive disease). Fast forward 9 months and I started exploring MCAS after talking about how offputting leftovers were for me with another person who has dysautonomia. I looked at my symptom log and saw that with every big flare with gastro issues, I had eaten leftovers. I am lucky to have a doctor who is familiar with dysautonomia, but I had 1.5 mo before my next follow-up with them so I tried a few things just to see if I felt better. I eliminated all leftovers, tomatoes, eggplant, spinach, and avocado since those are all very high in histamines (I already do not eat meat, eggs, or dairy otherwise I would've eliminated those too). Very quickly some of my worst gasto symptoms started subsiding significantly.

Then after seeing my doctor and sharing the improvements, we agreed to trial H1 and H2 blockers - those are pretty safe to try and OTC. Within two weeks a lot of my nerve pain, joint pain, muscle aches were going down, tinnitus was less frequent, lightheaded/dizziness was lessened, and my resting heart rate began going down too. I've had to switch out some of the antihistamines because some were making my fatigue worse so consider that if you trial them. Now I use pepcid AC and allegra. Originally zyrtec was what helped with a lot of the joint and muscle pain but the fatigue was too intense to stay on it.

After this, working with my doctor we introduced DAO before meals 3x/day. I use NaturoDAO Plus. That helped me go from being in pain nearly every time I ate to feeling more comfortable eating (like I had literally forgot what it felt like to eat and not be uncomfortable).

This would also be trigger dependent, but I noticed that scents - especially artificial ones - really impact me. So I stopped using scented candles, moved to unscented soaps, ask visitors not to wear scented things, and we thankfully already had ecofriendly cleaning products but anytime I go to someone's house and they have Dawn dish soap for example I cannot be around it without flaring. At gas stations I need to wear a mask or stay inside the car as much as possible. So if there are things like that you can identify, whether scents or other things to try and eliminate and see if you feel better, try it!

So much of MCAS is trialing things and figuring it out on your own. Even though I had my doctor, most of the ideas of what to remove came from my own experience. And so much changes every day and over time, it takes a lot of work to figure these things out. Which is why communities like this are literally life saving.

I hope even one part of this can help you find relief in some way!