I have nothing left. How do you recover from burnout when you cannot take a break?

I have been running on empty for months. I am a manager at a small company. I am responsible for everything. Deadlines, budgets, team morale, client complaints. It never stops. I work late every night. I answer emails on weekends. I have not taken a real vacation in two years.

My body is giving up. I have headaches, insomnia, and a constant knot in my stomach. I feel completely numb. I cannot muster any enthusiasm for anything. I am just going through the motions. I have lost interest in hobbies. I avoid friends and family. I feel like I am failing at everything.

I know this is burnout. I have read all the articles. I know I need to set boundaries and take a break. But I cannot just stop. I have a mortgage and a family. My job is demanding and there is no one else to do it. I feel trapped.

Has anyone been through this? How do you recover when you cannot step away? Did therapy help you figure out how to manage it? I need real advice.