anxiety, insomnia, and depression

Hi all. I've finally made an appointment with my doctor. A few years ago I talked to my primary about the fact that I have horrible issues with sleeping. She told me to try melatonin, sleepy time tea, keeping the room dark ect. I tried those things for a few years with minimal relief. My insurance has changed so I've switched primary care drs. The sleeplessness has caused me to have horrible anxiety. I've always been very high strung so it makes sense that the lack of sleep causes me anxiety. I've also felt down lately. Just mostly sad, not down right depressed just funky sometimes. But I think everything stems to the lack of sleep. I'll go days with just getting a few hours of sleep. I worry that this appointment will go like the last one even though I've tried over the counter medications with no relief. I'm also a nightshift nurse. So I'm sure that plays into it. Switching shifts is not an option. Does anyone have any advice or similar situations?