American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the initial focus for treating insomnia?

1. Prescription sleeping pills

2. Behavior modification therapy

3. Good sleep hygiene

4. Cognitive behavioral therapy

The correct answer is: Good sleep hygiene

The initial focus for treating insomnia is centered on promoting good sleep hygiene. This approach emphasizes lifestyle and environmental factors that can significantly impact sleep quality. Good sleep hygiene includes recommending practices such as maintaining a consistent sleep schedule, creating a comfortable sleep environment, limiting exposure to screens before bed, avoiding caffeine and heavy meals close to bedtime, and engaging in relaxing pre-sleep activities. This strategy is often preferred as a first line of intervention because it is non-invasive, easily implementable, and can lead to sustainable improvements in sleep without the potential side effects or dependency issues associated with prescription medications. It also serves as a foundational step that can complement other treatments if needed in the future. Behavior modification therapy and cognitive behavioral therapy are both effective approaches as well, but typically, they are implemented after identifying that traditional sleep hygiene practices alone are insufficient. Meanwhile, prescription sleeping pills are generally reserved for more severe cases or when other interventions have failed, as they can carry risks of dependence and adverse effects. Thus, focusing on good sleep hygiene first is a practical and holistic approach to managing insomnia.