Pharmacologic Interventions to Treat Nightmares

In contrast to the general lack of support for other medication classes to treat insomnia, nightmares, or PTSD-related sleep disturbances in servicemember populations, multiple studies have shown the efficacy of the alpha 1-adrenergic antagonist (alpha-blocker) prazosin in treating combat veterans for nightmares associated with PTSD (Raskind, Thompson, et al., 2002; Raskind, Peskind, Kanter, et al., 2003; Raskind, Peskind, Hoff, et al., 2007). In this group of studies, the researchers observed that veterans who were given prazosin experienced reductions in nightmare frequency and in the severity of PTSD symptoms. They also had less difficulty falling and staying asleep than patients in the control conditions. Additionally, the patients given prazosin commonly reported that the content of their dreams shifted from trauma-related to normal after beginning use of the drug. The results of a study by Calohan and colleagues (2010) suggest that prazosin may also be useful in reducing acute sleep disturbances among active servicemembers recently exposed to traumatic events while deployed.

Summary and Limitations of Pharmacologic Interventions

Except for the studies of the use of prazosin in military populations, there is little systematic research on the efficacy of pharmacologic interventions for treating other sleep disorders, such as insomnia, in military populations. Nevertheless, many physicians continue to rely on medications to treat military members and veterans with sleep problems (Schmitz, Browning, and Webb-Murphy, 2009). A particular concern in using pharmacotherapy as a first-line treatment is that some medications can have serious side effects. Although prazosin shows promise for treating nightmares, it is clearly contraindicated for individuals with low blood pressure because it can further lower blood pressure to dangerous levels. Given that all these medication approaches have some side effects that make them less than ideal or contraindicated in certain operational contexts or certain individuals, there has been increasing interest and a growing evidence base supporting the use of non-pharmacologic (i.e., behavioral) interventions to treat sleep disturbances in servicemember populations.

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