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Alpha-Blockers Relieve PTSD-Related Insomnia, Nightmares

06 Oct

A reviewer at the Michael E. DeBakey Veterans Administration Medical Center in Houston, Texas, reports on the value of pharmaceuticals for posttraumatic stress, and particularly of alpha-blockers for PTSD-related sleep disturbances. 

The article reports that an estimated 70-87% of patients who suffer from posttraumatic stress experience sleep disruption – difficulty falling asleep and staying asleep, as well as distressing nightmares in which the traumatic event is reexperienced.  Selective serotonin reuptake inhibitors (SSRI’s such as Zoloft, Prozac, Luvox, Celexa, Paxil, etc) are the pharmaceutical treatment of choice for PTSD, but with the exception of fluvoxamine (Luvox), they are often ineffective or only partially effective for sleep problems.

Sedative-hypnotics (tranquilizers, barbiturates, etc) may be helpful in the short term but are associated with tolerance and addiction potential.

In the central nervous system, alpha(1)-adrenergic receptors are known to be important in both the startle and sleep responses. Stimulation of these receptors may contribute to PTSD-related trauma-content nightmares.  The alpha blocker Prazosin, (Vasoflex e.g.), an alpha(1)-adrenergic receptor blocker traditionally used to treat hypertension, has been shown to decrease trauma nightmares in both combat veterans and patients with non-combat-related PTSD.

The available data, although mostly from open-label trials, suggest that this agent also improves sleep quality and patients' sense of wellbeing and ability to function in daily activities. The optimum dose is still unknown; however, a dose-related response appears to be evident. Clinicians should monitor for orthostatic hypotension, usually seen early in therapy, when prazosin is started in patients with PTSD. Ongoing trials stand to reveal more specific findings and dosages.

Citation: Miller LJ. Prazosin for the treatment of posttraumatic stress disorder sleep disturbances. Pharmacotherapy. 2008 May; 28 (5): Pages 656-66.

Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award