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Chronic insomnia — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareChronic insomniaUSMLE Step 3

A 54-year-old has difficulty initiating sleep for eight months without restless legs, sleep-apnea symptoms, depression, alcohol use, or shift work. She wants durable treatment rather than a short sedative course. What is the best next step?

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Correct answer: B — Offer cognitive behavioral therapy for insomnia

CBT-I is first-line treatment for chronic insomnia. Medication can be considered after shared discussion when CBT-I is insufficient, but long-term sedatives and off-label antipsychotics are not the durable first approach.

Reference: American College of Physicians, Chronic Insomnia Guideline: https://www.acponline.org/clinical-information/guidelines