title: Pharmacology for sleep disturbance in PTSD.
abstract: Symptoms of sleep disturbance, particularly nightmares and insomnia, are a central feature of post-traumatic stress disorder (PTSD). Emerging evidence suggests that specific treatment of PTSD-related sleep disturbance improves other symptoms of the disorder, which in turn suggests that such disturbance may be fundamental to development and maintenance of the disorder. This mini-review focuses on pharmacological treatment of sleep disturbance in adult PTSD (specifically, studies testing the efficacy of antidepressants, adrenergic inhibiting agents, antipsychotics and benzodiazepine and non-benzodiazepine hypnotics). We conclude that only prazosin, an adrenergic inhibiting agent, has had its efficacy established by multiple randomised controlled trials. There is also high-level evidence supporting use of eszopiclone, as well as risperidone and olanzapine as adjunct therapy. Antidepressants such as sertraline, venlafaxine and mirtazapine, benzodiazepines such as alprazolam and clonazepam and non-benzodiazepine hypnotics such as zolpidem appear ineffective in treating PTSD-related sleep disturbance. Most studies that report reduced frequency of nightmares and insomnia also report decreases in overall symptom severity. Such findings suggest that (i) sleep disruption is central to PTSD; (ii) treating sleep disruption may be an effective way to address other symptoms of the disorder and (iii) PTSD symptoms tend to cluster together in predictable ways.
authors: ACSENT Laboratory, Department of Psychology, University of Cape Town, Rondebosch, South Africa.|South African Medical Research Council Unit on Anxiety and Stress Disorders, Cape Town, South Africa.
authors: Gosia
authors: G
authors: Lipinska
authors: Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.|Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
authors: David S
authors: DS
authors: Baldwin
authors: ACSENT Laboratory, Department of Psychology, University of Cape Town, Rondebosch, South Africa.|South African Medical Research Council Unit on Anxiety and Stress Disorders, Cape Town, South Africa.
authors: Kevin G F
authors: KG
authors: Thomas
mesh_terms: D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D012893:Sleep Wake Disorders / Q000188:drug therapy* / Q000503:physiopathology; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D006993:Hypnotics and Sedatives
keywords: insomnia; nightmares; pharmacotherapy; post-traumatic stress disorder; sleep