My cat yowls and paces all night and I haven't slept properly in months.

What you are describing, the yowling, the disorientation, not always recognizing you, all happening in the night, is a recognizable pattern in older cats and it points strongly toward feline cognitive dysfunction, which is essentially the cat equivalent of dementia. The fact that bloodwork came back relatively clear does not rule this out because cognitive changes do not show up in standard blood panels. This is a clinical assessment, not a blood result.

I want to be honest with you: this is one of the harder things to manage in senior cats because there is no cure, but there is a lot that can be done to reduce the episodes and make him more comfortable. Night lights can help with the disorientation significantly because cats with cognitive dysfunction are more affected when visual cues are reduced. Keeping his environment very predictable, same feeding time, same sleeping spots, minimal rearranging, also helps. There are also supplements and medications that your vet can discuss, and I would encourage you to go back and specifically ask about cognitive dysfunction by name if it has not been raised.

The exhaustion you are feeling after months of this is real and it matters too. If you want to talk through what a practical management plan could look like for your specific situation, the Work With Me assessment gives me the detail I need to give you something genuinely useful rather than general advice.