![]() Trauma exposures included combat (n=17), aircraft carrier flight deck accident (n=4), and life-threatening motor vehicle accident in a combat zone (n=1). These veterans comprised a consecutive outpatient sample who were seen for initial evaluation (by author CT) between Jand August 1, 2003, and who endorsed troublesome trauma-related nightmares and sleep difficulty as presenting symptoms. For each patient, trauma nightmares, general sleep disturbance and specific NNDA had been quantified before prazosin was initiated and again after a clinically optimal dose of prazosin had been achieved.įollowing IRB approval, charts of 22 veterans who met DSM-IV ( American Psychiatric Association, 1994) criteria for PTSD were anonymously reviewed. 2008 or other prazosin for PTSD studies.Īs a first step in determining the effects of prazosin on NNDA in veterans with chronic PTSD we performed a chart review study of a consecutively treated sample of outpatients prescribed bedtime prazosin for PTSD trauma nightmares and sleep disturbance. However, NNDA were not specifically assessed in the Taylor et al. These sleep parameter data are consistent with a reduction of NNDA by prazosin having contributed to the observed increased sleep duration. These demonstrated significantly and substantially greater sleep duration (by 90 minutes) in the prazosin than the placebo condition without a hypnotic-like reduction of sleep latency (time to fall asleep) by prazosin. In the civilian PTSD study ( Taylor et al., 2008) at home measurement of physiologic sleep parameters were obtained. Prazosin has been demonstrated substantially more effective than placebo for reducing PTSD trauma nightmares and sleep disturbance and improving global clinical status in both military veteran and civilian samples ( Raskind, Peskind, Kanter, Petrie, Radant, Thompson, et al., 2003 Raskind, Peskind, Hoff, Hart, Holmes, Warren, et al., 2007 Taylor, Martin, Thompson, Williams, Mellman, Gross, et al., 2008). Prazosin is the only clinically available alpha-1 AR antagonist that crosses the blood brain barrier ( Hardman, Limbird, Milinoff & Rudden, 1996) and specifically blocks CNS responses to adrenergic stimulation when administered peripherally ( Menkes, Baraban & Aghajanian, 1981). Prazosin is a generic non-sedating alpha-1 adrenoreceptor (AR) antagonist used for many years to treat hypertension and the urinary symptoms of benign prostatic hypertrophy ( Lund-Johansen, Hjermann, Iverson & Thaulow, 1993 Hieble & Ruffolo, 1996). We use the term “non-nightmare distressed awakening” (NNDA) to describe this symptom. Although persons with PTSD often attribute distressed awakenings to frightening trauma-related nightmares (NM), distressed awakenings phenomenologically similar to those associated with NM frequently occur without dream recall ( Mellman, Kulick-Bell, Ashlock & Nolan, 1995b). Increased central nervous system (CNS) adrenergic activity during sleep time may contribute to these symptoms (Raskind, Dobie, Kanter, Petrie, Thompson, & Peskind, 2000 Mellman, Kumar, Kulick-Bell, Kumar & Nolan 1995a Mellman, Knorr, Pigeon, Leiter & Akay, 2004). ![]() ![]() Recurrent distressing dreams (or “nightmares”) related to the traumatic event(s) are the sleep complaint most specific for PTSD in Vietnam veterans, but distressed awakenings with difficulty returning to sleep are even more frequently reported ( Neylan, Marmar, Meltzer, Weiss, Zatzick, Delucchi, et al., 1998). Sleep complaints are among the most common, troublesome and treatment resistant symptoms of posttraumatic stress disorder (PTSD) ( Ross, Ball, Sullivan, & Caroff, 1989 Ohayon & Shapiro, 2000 Geuze & Vermetten, 2004).
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