American Board of Internal Medicine (ABIM) Certification Practice Exam

Which treatment may be beneficial for patients with insomnia when sleep hygiene techniques fail?

1. Cognitive behavioral therapy

2. Sleep restriction

3. Melatonin supplements

4. Antidepressants

The correct answer is: Sleep restriction

Sleep restriction therapy is a therapeutic approach designed to improve sleep efficiency by limiting the amount of time spent in bed to the actual amount of time a person sleeps. This technique involves setting a specific time for going to bed and waking up, which gradually adjusts sleep patterns and encourages the body to associate the bed with sleep rather than wakefulness. When sleep hygiene techniques alone are ineffective for managing insomnia, sleep restriction can help by creating a more consistent sleep schedule and reducing the time spent awake in bed. This method helps to reset the body's internal clock and consolidate sleep, leading to improved overall sleep quality. Cognitive behavioral therapy is indeed a beneficial option, but primarily as a broader, comprehensive treatment where multiple components (such as cognitive restructuring and behavioral modifications) are employed over time, making it more of a long-term solution. Melatonin supplements may also assist some individuals with specific sleep-phase disorders but do not generally address insomnia effectively. Antidepressants can be used for comorbid conditions, yet they do not primarily target insomnia as a standalone treatment. Overall, when conventional sleep hygiene practices are unsuccessful, sleep restriction presents a structured and strategic way of addressing insomnia by helping patients cultivate a healthier sleep routine and improve their sleep endpoints effectively.