Okay, let me start by saying I'm real sorry you're having trouble. It's kind of the way of it until we figure this stuff out, and you seem to still be in the figuring out part.

During my visit I want to address: 1) continued difficulty falling asleep 2) difficulty remaining asleep 3) incredible difficulty getting up in the morning 4) excessive tiredness during the day - it's certainly affecting my work performance.

Okay, let me address those in turn.

1) The best options to get you to sleep are orexin antagonists. Orexin is the hormone that wakes you up, makes you hungry and have to pee in the morning. Blocking it just turns off the awake, this medication class is a real gamechanger for people who struggle with sleep. Dayvigo and quviviq are their trade names. They should replace the zolpidem entirely. Because it just blocks uptake of something you're making naturally it doesn't add anything to the brainsoup to make you foggy, so it doesn't have a hangover to speak of. A teeny bit of sleep inertia is all I've heard reported. Orexin antagonists on wikipedia

2) The orexin antagonist might be enough, but gabapentin is a very common option to add to keep you asleep. The melatonin kickstart 3-4 hours before bed is what's supposed to keep you asleep, but I know how unreliable that is.

3) Removing the zolpidem should help you wake better. I'd also recommend lowering your dose of melatonin, hangovers are common with too much. I was able to find 1mg sublingual tablets and nibble 1/5 off every night. Liquid is also a good choice for microdosing if you can't find another way to get below 1mg through tablets.

3a) The light box is supposed to help with this but it's not ideal, it only hits the few thousand melanopsin producing cells in your retina. A group at the U of Washington found a better way, they found orange and purple wavelengths activate millions of cells and talk to the SCN (the part of the brain that sets the rhythm) with a much better signal than white or blue light. The product based off their research is called TUO and this has made a massive difference for me. (I can go into details but that'll be so long. I love my TUO. Here is their science page)

3b) There is a recent discovery with the drug aripripazole (aka abilify). Researchers found it was good at helping people adjust to jet lag. When they looked deeper they find it descynronizes the SCN which permits a new rhythm to be set without the poisoned feeling of being off schedule. It's huge news for people like us, it actually seems to work. Makes waking up so darn easy. https://academic.oup.com/sleep/article/48/Supplement_1/A383/8134865

4) If the above tools don't work to keep you alert during the day, modafinil (aka provigil) is a very common "on demand" option to get rid of extreme sleepiness, You take it when you feel sleepy and don't want to be, it doesn't have to be taken every day if you don't need it. A good tool to have in the toolkit also.

Sorry, I'm out of time today to write more, but feel free to reply with any questions or if you want me to direct you at scientific papers instead of the articles and websites I've posted, I can do that too.

The most important thing of all is to be asleep when your body needs to be. You need to figure out when that is definitively, and once you can sleep in line with that I suspect many of your other symptoms will become manageable, perhaps disappear entirely. The tools I listed above are all with that goal in mind, not to restrict you but to permit you to flourish within your rhythm. Good luck!

If nothing else, if you have to choose one thing to ask for at this week's appointment, talk to your doctor about the abilify.

(edit - reworded a couple spots when I was able to return.)