Hey Eric!!
Yeah, figuring out the puzzle sucks. And even when you have (you think) a handle on it, something breaks, or has a side-effect, or is prohibited by your insurance... You get the pic.
Are all of your meds prescription? I take a lot of pills (lots of different conditions), but many of them are natural. The aforementioned Vit D, fish Oil, Niacin, Echinacea, mushroom complexes, and garlic (I cannot afford to get sick this winter!). I used to do the Co-Enzyme Q10, but it didn't do so much for me, so I stopped.
Are you otherwise happy with the doctor? Remember, you can switch and/or get another opinion. I usually see a rheumie, but in my new location I do not feel the need to, since I dig my PCP.
How well do you eat? Do you exercise? I swear by both of these, especially the exercise. It helps with pain management and energy levels.
I, too, sleep badly and need my sleep to function (still working fulltime in a professional capacity). So, I take sleep meds.... specifically rozerem, which not only works but has a great ad campaign with the groundhog and Abe Lincoln.
Stay sane and moving forward!