Final answer:
The first step in treating a young adult with insomnia is to examine and improve sleep hygiene, such as restricting the use of the bed to sleep and intimacy only, before considering drugs or a sleep study.
Step-by-step explanation:
What is the first step toward treating a 23-year-old medical student who comes to your office with a complaint of insomnia? The initial approach should involve examining sleep hygiene before considering pharmacological interventions. According to the National Institute of Health and various studies, the adoption of good sleep practices and the use of cognitive-behavioral therapy are often the first steps in addressing sleeplessness issues. Prescribing medication such as zolpidem, benzodiazepines, or diphenhydramine, might lead to dependency and alter the sleep cycle, which can worsen insomnia over time. Therefore, it is recommended to restrict the use of the bed to sleep and intimacy only as a non-pharmacological intervention. This aligns with the understanding that spending excessive waking time in bed can interfere with the ability to fall asleep later. A sleep study could be considered if initial interventions are unsuccessful and the problem persists.