Clinical recommendation	Evidence rating	Comments
Cognitive behavior therapy for insomnia should be used as first-line treatment for chronic insomnia because it improves the quality of sleep, insomnia severity, daytime fatigue, total sleep time, and beliefs and attitudes about sleep.3,6,10,11,13,17	B	Systematic review with meta-analysis of moderate- to low-quality clinical trials with risk of bias and low sample sizes
Mindfulness-based stress reduction can be used to treat insomnia.6,11	B	Systematic review of moderate- and lower-quality clinical trials with inconsistent findings
Medications are effective for treating insomnia, but long-term use (i.e., more than three months) is discouraged.25	A	Systematic review and meta-analysis of randomized controlled trials
Benzodiazepines and Z-drugs should be avoided when treating insomnia, if possible, due to significant long- and short-term safety concerns.25,28	A	Systematic review and meta-analysis of randomized controlled trials