How do you know that your wife needs to be in assisted living care facility?

It would be a gift to both you and your wife for you to look into memory care for her. If you feel you need care for yourself look into that as well. Your wife needs a well rested caregiver advocating for her and you need time to heal and care for your needs. I wish you both the best during such a hard time. She’s blessed to have you looking out for her

You just explained perfectly how you know it's time to place your wife in Memory Care Assisted Living: "Im completely burnout and haven’t had a full night sleep in those 5 years. I feel isolated and have no energy left for the next few years." Please realize that YOU are important here too and need to take your life and your health back.

Best of luck to you

I'd say that AL would be a good fit for both of you. 24/7 caregiving for 5 years is more than enough. You need sleep! And time for yourself! AL will want to evaluate her to see if that is the best fit for her. I would start looking into it and not tell your wife until it's VERY close to being a reality.