I've been taking Belsomra twice a week since it became available in the US. I had been anxiously awaiting it's approval for over two years. For me, it does not work well at all. I get about 4 or 5 hours of poor sleep. That is of course better than ZERO sleep which I get when I don't take anything. I take 20 mg pills. Any less and it's absolutely ineffective.
So, about sleeping pills for a severe insomniac - I think it's best to cycle meds with different mechanisms of action. I do this because I build up a tolerance to a medication within just a couple of weeks of taking it regularly. And tolerance means having to go through withdrawals. And that's no fun.
Here's my schedule:
Monday night - Trazodone - 50 mg or Mirtazepine 15 mg. I alternate between them.
Tuesday night - Ambien - 10 mg
Wednesday - Trazodone
Thursday - Belsomra 20 mg
Friday - Ambien
Saturday - Trazodone
Sunday - Belsomra
Ambien works on GABAa receptors
Trazodone - they don't know how it works but it's not on GABA
Mirtazepine - antihistamine (works but causes massive weight gain for me)
Belsomra - Orexin blocker
I may try Xyrem (aka GHB or Sodium Oxybate or the "date rape drug") once a week. It works on GABAb receptors.
I know that 5htp and L-Tryptophan work via seratonin and melatonin. They aren't strong enough for me. Valerian, Magnolia Bark and sun-theanine work on GABAa. Whatever you do, DO NOT TAKE BENZODIAZEPINES. They may seem like the answer to your prayers, but they are incredibly addictive and are hell to withdraw from. I nearly died from withdrawal from a small dosage of Valium. It ruined me, and I attribute the horrific withdrawal as one of the main causes of my CFS and Fibromyalgia. I justify taking Ambien 2 times a week because it isn't as powerful as benzos.
I don't want to take any of these meds, as I feel they are contributing to my severe CFS. But, it's hard to take nothing because taking nothing means LITERALLY no sleep. I imagine after months of no or very little sleep my body would learn to produce GABA and melatonin on its own. But, getting through those months would be excruciating.
Anyway, I don't know if this helps.