my meta-experience here is that with issues this unique (where you *should* be doing great by any reasonable metric, but are not at all), it is a long and oft hellish journey, but also very hard to outsource since everything can be so n=1, you have to do all the tests on yourself. so for me i start by each broad category and try something 'strong' intervention-wise, to see if i can hone in on things, but the answer can be basically anything, maybe a single nutrient in your diet that causes inflammation or maybe your circadian rhythm is a little broken due to some random hormonal offset or maybe you are secretly subtly allergic to some type of mold near your bedroom or maybe actually you have this rare combo of two genetic variants and- but this all takes a long time to test and is really tedious. in general i've found it much more useful to do almost everything myself because it's really hard to find the perfect person to put an absurd amount of hours into *fixing you specifically* rather than just going through the usual checklist (for myself im still searching for someone i can pay very generously to deeply and commitedly help figure out why my sleep architecture is often broken, but it turns out no one knows anything about sleep to begin with so this is hard) of course, the usual checklists exist for a reason! they solve most normal problems. but if your problem is not normal they can be a silly distraction also a lot of alpha in going through way too many obscure tweets and reddit comments of people that have similar issues, but you'll probably find the same thing which is that what works for one person doesn't apply to most others, etc etc. such is biology. anyway, good luck with it, i'm sure at least one of the responses to this thread is really helpful, just not particularly pleasant to run through the playbook of finding out *which* response