American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line therapy recommended for chronic insomnia disorder?

1. Cognitive behavioral therapy for insomnia

2. Pharmacologic therapy

3. Sleep medications only

4. Relaxation techniques

The correct answer is: Cognitive behavioral therapy for insomnia

Cognitive behavioral therapy for insomnia (CBT-I) is recognized as the first-line therapy for chronic insomnia disorder. This approach focuses on addressing the underlying thoughts and behaviors that perpetuate insomnia, rather than merely treating the symptoms. CBT-I includes components such as cognitive restructuring, sleep restriction, stimulus control, and hygiene education, which help individuals develop healthier sleep patterns and improve overall sleep quality. Research has demonstrated that CBT-I not only improves sleep outcomes but also has lasting benefits compared to pharmacologic therapies, which may have side effects and lead to dependency. While pharmacologic therapy can be beneficial in certain scenarios, it is usually recommended as a secondary option when behavioral interventions are insufficient. Relaxation techniques may be helpful as adjuncts but do not address the specific cognitive and behavioral factors that contribute to chronic insomnia as effectively as CBT-I. Therefore, CBT-I is the preferred initial treatment for those experiencing this sleep disorder.