Chronic insomnia — RACGP Fellowship MCQ

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HardMental healthChronic insomniaRACGP Fellowship

A 51‑year‑old man presents with chronic insomnia. He consumes four coffees daily, uses screens in bed, and drinks three glasses of wine nightly. He requests temazepam. PHQ‑9 is 5 and there is no history of restless legs. What is the most appropriate management?

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Correct answer: C — Provide CBT‑I based advice and address caffeine, alcohol and sleep behaviours

Option C is correct. Australian (RACGP) guidelines clearly recommend cognitive behavioural therapy for insomnia (CBT‑I), encompassing sleep hygiene, stimulus control, and sleep restriction, as the first‑line management for chronic insomnia. This patient has modifiable behavioural contributors (excess caffeine, alcohol before bed, screen use) and minimal depressive symptoms, making CBT‑I appropriate. Temazepam (Option A) is only indicated short‑term (≤4 weeks) at the lowest effective dose due to risk of dependence, and six months is inappropriate. Antipsychotic sedation (Option C) is not indicated in primary insomnia without psychosis. Routine polysomnography (Option D) is not needed unless a specific comorbidity (e.g. sleep apnoea) is suspected. Daytime naps (Option E) worsen insomnia by reducing homeostatic sleep drive and are actively discouraged in behavioural management.

Reference: RACGP: Prescribing drugs of dependence in general practice, Part B – Benzodiazepines; RACGP AJGP 2019 “Insomnia management”