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Pharmacology for sleep disturbance in PTSD

Pharmacology for sleep disturbance in PTSD
Pharmacology for sleep disturbance in PTSD
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.
insomnia, nightmares, pharmacotherapy, post-traumatic stress disorder, sleep
0885-6222
156-163
Lipinska, G.
22de076c-99cb-4e6b-9872-e53668b8aae3
Baldwin, D.S.
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Thomas, K.G.F.
5ca4eba2-fcef-424b-9d46-06a453a7596e
Lipinska, G.
22de076c-99cb-4e6b-9872-e53668b8aae3
Baldwin, D.S.
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Thomas, K.G.F.
5ca4eba2-fcef-424b-9d46-06a453a7596e

Lipinska, G., Baldwin, D.S. and Thomas, K.G.F. (2016) Pharmacology for sleep disturbance in PTSD. Human Psychopharmacology: Clinical and Experimental, 31 (2), 156-163. (doi:10.1002/hup.2522). (PMID:26856810)

Record type: Article

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.

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PTSD sleep manuscript.pdf - Accepted Manuscript
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More information

Accepted/In Press date: 21 December 2015
e-pub ahead of print date: 8 February 2016
Published date: March 2016
Keywords: insomnia, nightmares, pharmacotherapy, post-traumatic stress disorder, sleep
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 388283
URI: https://eprints.soton.ac.uk/id/eprint/388283
ISSN: 0885-6222
PURE UUID: 1adc8df2-c6f6-4daf-bb2f-de0fc13a834b

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Date deposited: 23 Feb 2016 11:25
Last modified: 09 Dec 2019 19:44

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