title: Symptom Presentation and Prescription of Sleep Medications for Veterans With Posttraumatic Stress Disorder.
abstract: This study tested whether sleep medications prescribed to veterans diagnosed with posttraumatic stress disorder (PTSD) are being targeted to patients who report more severe insomnia or nightmares. Secondary analysis of survey and pharmacy data was conducted in samples of veterans from two periods: from 2006 to 2008 and from 2009 to 2013. Logistic regression tested associations between self-reported insomnia and nightmare severity, and being prescribed trazodone, prazosin, zolpidem, and benzodiazepines, controlling for PTSD severity and other covariates. In both samples, insomnia severity independently predicted trazodone receipt, and nightmare severity independently predicted prazosin receipt. In the later study, insomnia severity predicted receipt of zolpidem. Veterans in the later sample were more likely to receive trazodone, prazosin, and non-benzodiazepine hypnotics, and less likely to receive benzodiazepines than those in the earlier sample. Further research is needed to evaluate and optimize pharmacological and psychosocial treatments for sleep problems among veterans with PTSD.
authors.affiliation: *Department of Veterans Affairs (DVA), PTSD Methods and Evaluation Core, VISN 21 Sierra Pacific MIRECC; National Center for PTSD, DVA Palo Alto Healthcare System, Menlo Park Division; †DVA, PTSD Research Core, VISN 21 Sierra Pacific MIRECC; DVA San Francisco Healthcare System; ‡University of California at San Francisco Medical School; §DVA Affairs Palo Alto Healthcare System and HSR&D Center for Implementation to Innovation, Menlo Park; and ∥Stanford University Department of Psychology and Behavioral Sciences, CA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Greenbaum
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
authors.forename: Craig S
authors.initials: CS
authors.lastname: Rosen
mesh_terms: D000328:Adult; D001569:Benzodiazepines / Q000627:therapeutic use*; D004325:Dreams; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000523:psychology; D063189:Symptom Assessment; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*
chemical_list: D006993:Hypnotics and Sedatives; D001569:Benzodiazepines