New and worsening sleep maintenance insomnia. What should I do?

Before I begin, everything I say I do so through personal experience and I am not in any way connected to medical practice. If you are practicing good sleep hygiene, not too hot, not too cold, no clocks, no distracting lights or radio sounds or television sounds, then it would be best if you contacted your GP to discuss the problem. One fact that you mentioned, laying in bed sometimes for an hour plus once you wake, could be one way to approach your problem. Instead of laying there for such a length of time, get out of bed, leave the bedroom, sit and have a drink of something warm and milky then when you feel ready go back to bed. If the problem remains the same then continue with this regime irrespective of how exhausted you may feel until it becomes a matter of habit. The more you worry about sleeping, the worse your sleeping pattern will become. This is called anticipatory anxiety and if you suffer from any kind of anxiety to begin with then the more you will worry about not getting to sleep when you think you need to do. This is a process designed to reset your circadian rhythms which are the body (and mind's) way of telling your body when you are tired enough to sleep and when you ought not to be in a phase of wanting to sleep. If that doesn't do the trick then the next step is to visit your GP for medical advice. Having said all of that, although it is advice I have been given from numerous sources including my current GP, countless Consultant Psychiatrists and other health care professionals, I have had since my teenage years until now at the age of sixty two only two nights of natural sleep. I rely on medication and am quite happy to continue to do so. Everyone is different and not many people would feel comfortable being reliant on medication as I am yet, as I said, I am happy not to compound the anxiety I endure by adding to it from anxiety over sleep. I wish you well.

John