I am on 40mg of pristiq (desvenlafaxine) and 5mg of cymbalta and i cannot sleep a wink. what should i do?

Prevention: Not being able to sleep may indicated sleep problems that can be life shortening or life threatening. The only way to know if there are serious problems is with an overnight sleep test. I encourage you to seek help.

Tell prescribing Dr: In the meantime consider improving sleep hygiene. Retire & rise same time each day. Bedroom should be dark & cool - used only for sex & sleep. Turn off tv. No naps. Exercise regularly but not in late evening. No caffeine for 6 hrs & no alcohol or tobacco w/i 2 hrs of sleep. Dinner should be moderate sized & finished at least 2 to 3 hours before sleep. Can try warm milk, chamomile tea or melatonin

INSOMNIA: There are excellent medications for insomnia. A Psychiatrist can guide you to the best one. Insomnia might be due to several different reasons. First have a complete physical exam by a Dr. to rule out underlying biological problem. If no problem consult with a Clinical Psychologist for psychotherapy help & possible referral to a sleep study.