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The following may be used for the treatment of PTSD-associated nightmares: the atypical antipsychotics olanzapine, risperidone and aripiprazole, clonidine, cyproheptadine, fluvoxamine, gabapentin, nabilone, phenelzine, prazosin, topiramate, trazodone, and tricyclic antidepressants.
Your review notes that imagery rehearsal therapy (IRT) is considered the “preferred empiric treatment” for PTSD-related nightmares. What is IRT? In terms of drugs, the alpha-1 blocker prazosin has been widely used in VA to help ease PTSD nightmares.
To the Editor: Chronic sleep difficulties, including reduced total sleep time and nightmares, are often a chief complaint of combat veterans with posttraumatic stress disorder (PTSD) (1). Trazodone, doxepin, and benzodiazepines can be used to treat insomnia in these patients (2).
The bottom line
SSRI and SNRIs) have the most evidence to support their use as treatments for PTSD. Zoloft and Paxil are both FDA-approved PTSD medications. Prozac and Effexor XR are first-choice options that are prescribed off-label.
In addition to nightmares and insomnia, other sleep disorders and disruptive nocturnal behaviors are prevalent among trauma-exposed individuals, including persons with PTSD. Sleep disordered breathing, periodic leg movement disorders, and other parasomnias are common in trauma-exposed samples.
Several types of prescription medications may be used to treat nightmare disorder. Most often, these are medications that affect the nervous system such as anti-anxiety, antidepressant, or antipsychotic drugs. Different medications may be used for people who have nightmares associated with PTSD.
For veterans, this might mean re-witnessing horrific events or even deaths of people they witnessed while on combat missions. Physical abuse, violence, and other things can be triggering the nightmares and inability to sleep. When someone fears going to sleep and is not wanting to go to bed, that can be traumatic.
Imagery rehearsal therapy has four basic steps that can be taught in one day, experts say. First, people are asked to write down every detail of their nightmare. Next, each person rewrites the nightmare with a positive arch, making sure that it ends with a pleasant or empowering solution or resolution.
Moreover, having nightmares shortly following a traumatic event predicts more severe PTSD symptoms 6 weeks later. 11 Even with PTSD symptoms abating, nightmares can persist a lifetime.
The characteristics of these dreams vary based on the trauma experienced. However, they typically create feelings of dysphoria, anxiety, sudden awakening, and an increase in heart rate. PTSD dreams most often occur toward the end of the night, but they can happen in all sleep stages.
In primary care, the recommended first-line pharmacotherapy agents for treating PTSD are selective serotonin reuptake inhibitors, such as paroxetine 20–40 mg once daily for at least 10 weeks. Second-line pharmacological interventions include the use of mirtazapine or phenelzine.
You should not use prazosin if you are allergic to it. Tell your doctor if you have ever had: low blood pressure, especially if caused by taking medications.
Try Imagery Rehearsal Treatment
Working with a therapist, you can rehearse the dream and rewrite the ending to be less threatening and traumatizing. This method is one that has proved to reduce both the intensity of reoccurring nightmares as well as the frequency.
REM Sleep Disturbances in PTSD: Hallmark or Not? Nightmares are primarily a REM sleep phenomenon, but they may also occur during NREM sleep in patients with PTSD (12). These dysphoric dreams often depict themes, images, and emotions that can be related to traumatic events.
Primary outcome measures included a sleep diary and the number of distressing dreams or nightmares recalled on wakening. Although prazosin and behavioral sleep intervention were found to be more effective than placebo, the frequency of nightmares was not reduced.
Many studies show that most antidepressants including citalopram prolong REM sleep latency and suppress REM sleep time2 and are therefore expected to reduce or suppress nightmares.
Because people with PTSD may try to push away trauma memories during the day, it may cause worries to get worse at night and disrupt sleep.
Up to 96% of people living with PTSD may experience nightmares. These emotionally distressing dreams can happen several times a week or more. If you live with other mental health conditions, the occurrence of nightmares may increase.
Post-traumatic stress disorder (PTSD) is a mental health condition that's triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.
Psychotherapy. Cognitive Behavior Therapy (CBT): CBT is a type of psychotherapy that has consistently been found to be the most effective treatment of PTSD both in the short term and the long term.