Sleep health practice questions for the lifestyle medicine boards
Sleep questions test assessment, lifestyle and behavioral treatment of insomnia, and recognizing disorders that need testing or a sleep specialist.
ABLM exam domain: Sleep Health Science and Interventions
8%of the ABLM exam
~12of 150 physician questions
~10of 120 health professional questions
128questions on this domain in the bank
What the exam expects you to know
ABLM builds the exam on the lifestyle medicine core competencies. For this domain they include:
Sleep's role in health and chronic disease
Assessing insufficient or poor-quality sleep
Lifestyle-based interventions that improve sleep
Risk assessment for obstructive sleep apnea, chronic insomnia and restless legs syndrome
Indications for a sleep study or sleep specialist referral
Indications for referral to cognitive behavioral therapy for insomnia
High-yield areas
Adults need at least 7 hours of sleep a night on a regular basis
CBT-I as first-line treatment for chronic insomnia: stimulus control and sleep restriction, and why sleep hygiene alone is not enough
Screening for sleep apnea, and home sleep apnea testing versus in-lab polysomnography
PAP adherence and alternatives
Restless legs: iron studies and the problem of augmentation
Circadian rhythm and shift-work sleep problems
How to study it
Know the first-line treatment for each common problem and the red flags that change the plan, such as suspected sleep apnea in a patient with insomnia or a patient at risk of mania with sleep restriction.
Free practice questions: Sleep health
4 questions from the bank, with the full rationale and source. Pick your answer, then open the rationale.
Question 1 of 4 · hardSleep Health Science and Interventions
A 29-year-old resident has slept about 6 hours a night for 2 weeks and says she has adapted because she no longer feels especially sleepy. In the laboratory dose-response experiment by Van Dongen and colleagues, 48 healthy adults were restricted to 4, 6 or 8 hours in bed for 14 days or kept awake for 3 nights. Which finding addresses her belief?
Performance at 6 hours stabilized after a few nights, matching the 8-hour group
Deficits grew to equal up to 2 nights of total deprivation, but sleepiness plateaued
Sleepiness ratings tracked the deficits and separated the 6-hour from the 4-hour group
Cumulative deficits appeared at 4 hours in bed but not at 6 hours in bed
Delta sleep power rose night by night, restoring performance by day 14
Show answer and rationale
Answer: B. Deficits grew to equal up to 2 nights of total deprivation, but sleepiness plateaued
A (incorrect): Incorrect. Restriction to 6 hours produced significant cumulative, dose-dependent deficits on every cognitive task across the 14 days.
B (correct): Correct. Restriction to 6 hours or less produced cognitive deficits equivalent to up to 2 nights of total sleep deprivation, while sleepiness ratings rose acutely and then increased little, suggesting subjects were largely unaware of their growing deficits.
C (incorrect): Incorrect. Subjective sleepiness showed small further increases after the first days and did not significantly differentiate the 6-hour and 4-hour conditions.
D (incorrect): Incorrect. Both the 4-hour and 6-hour conditions produced significant cumulative, dose-dependent deficits.
E (incorrect): Incorrect. Non-REM delta power showed an acute response with negligible further change across the 14 restricted nights, while performance deficits kept accumulating.
Source: Van Dongen HP, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep. 2003;26(2):117-126. Abstract Design and Participants (n=48; 4, 6 or 8 h time in bed for 14 days, or 0 h for 3 days), Results (cumulative dose-dependent deficits at 4 h and 6 h; sleepiness ratings showed small further increases and did not differentiate 6 h and 4 h; delta power negligible further change) and Conclusions (6 h or less equivalent to up to 2 nights of total deprivation; subjects largely unaware). https://pubmed.ncbi.nlm.nih.gov/12683469/
Question 2 of 4 · easySleep Health Science and Interventions
A 37-year-old man with BMI 23 kg/m² reports unintended dozing during meetings despite a consistent eight-hour sleep opportunity. His partner describes loud snoring, repeated pauses followed by gasping, and restless sleep. Examination shows a crowded oropharynx. He has no cataplexy, sedative use or shift work. Which diagnosis should be prioritized for objective evaluation?
Insufficient sleep syndrome
Obstructive sleep apnea
Narcolepsy type 1
Delayed sleep-wake phase disorder
Chronic insomnia disorder
Show answer and rationale
Answer: B. Obstructive sleep apnea
A (incorrect): Insufficient sleep can cause dozing, but the reported sleep opportunity and obstructive breathing history make apnea the priority rather than assuming inadequate duration. B (correct): Typical respiratory symptoms and sleepiness warrant evaluation regardless of a normal BMI; obesity is a risk factor, not a diagnostic prerequisite. C (incorrect): Narcolepsy can cause sleepiness, but this presentation supplies obstructive breathing features rather than the characteristic cataplexy evidence for type 1. D (incorrect): A delayed phase requires a sleep-timing mismatch; his consistent schedule and respiratory symptoms do not support it as the leading explanation. E (incorrect): No primary difficulty initiating or maintaining sleep is described; insomnia does not account for witnessed gasping and pauses.
Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC5337595/ | AASM OSA diagnostic guideline, Good Practice Statements and Figure 2 algorithm: sleepiness, loud snoring and witnessed apnea/gasping; Recommendation 2 on objective testing
Question 3 of 4 · easySleep Health Science and Interventions
A 34-year-old software developer drinks a 16-ounce coffee at 3:00 PM each workday. His bedtime is 10:30 PM, and he reports taking about an hour to fall asleep. Caffeine promotes wakefulness primarily through which action?
Enhancement of GABA-A receptor activity
Histamine H1 receptor antagonism
Melatonin MT1 receptor antagonism
Orexin receptor antagonism
Adenosine receptor antagonism
Show answer and rationale
Answer: E. Adenosine receptor antagonism
E is correct: caffeine antagonizes adenosine receptors, reducing adenosine-mediated sleep pressure. A, GABA-A enhancement, and B, H1 antagonism, are generally sedating mechanisms rather than caffeine's principal alerting mechanism. C is not caffeine's mechanism. D, orexin receptor antagonism, is used by sleep-promoting drugs. Caffeine exposure varies with dose and metabolism, so a 16-ounce coffee does not establish a particular caffeine dose. In Drake et al., 400 mg taken six hours before bedtime reduced objectively monitored total sleep time by roughly 1.1 hours in 12 healthy sleepers; the diary result was smaller and not statistically significant at six hours. This trial does not quantify this patient's response to coffee 7.5 hours before bed. Assess dose and consider an earlier caffeine cutoff individualized to sleep response.
Question 4 of 4 · easySleep Health Science and Interventions
A 40-year-old woman has difficulty falling and staying asleep at least three nights weekly for nine months despite adequate opportunity, with impaired daytime function. History and examination show no symptoms suggesting OSA, a movement disorder, parasomnia or hypersomnolence. Which diagnostic plan is most appropriate before starting CBT-I?
Obtain laboratory polysomnography to document reduced sleep efficiency
Use the clinical assessment and a sleep diary to guide behavioral treatment
Obtain home apnea testing to exclude an occult respiratory cause routinely
Obtain two weeks of actigraphy as a prerequisite to confirming the diagnosis
Obtain a multiple sleep latency test to establish the daytime impairment
Show answer and rationale
Answer: B. Use the clinical assessment and a sleep diary to guide behavioral treatment
A. Incorrect: Objective demonstration of poor sleep efficiency is not routinely required for uncomplicated chronic insomnia; reserve PSG for a relevant indication.
B. Correct: Insomnia is diagnosed through a comprehensive clinical assessment. A diary can guide CBT-I without mandatory objective testing when no competing disorder is suspected.
C. Incorrect: Home apnea testing is directed by suspicion of OSA, not routinely required for every insomnia diagnosis.
D. Incorrect: Actigraphy can help in selected uncertain cases but is not a diagnostic prerequisite in this well-characterized clinical presentation.
E. Incorrect: MSLT evaluates selected disorders of excessive sleepiness; fatigue or impaired daytime function from insomnia does not itself require that test.
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