Is Prazosin The Best Medication To Treat PTSD Nightmares?

Nightmares are unpleasant or frightening dreams, and people who suffer from post-traumatic stress disorder (PTSD) are more likely to experience them. Treatments such as prazosin might be an option if you’ve been struggling with nightmares alongside PTSD.

What is PTSD?

PTSD¹ is a severe anxiety disorder that can affect people who have witnessed or experienced a shocking, harmful, or unpleasant incident. As a result of such an event, a person may feel traumatized; over time, this can develop into PTSD.

What causes PTSD?

The underlying cause of PTSD is a traumatic event, for example:

• Injuries

• Accidents

• Disasters

• Violence

• Bullying

• Abuse (sexual, physical, or emotional)

• War

• Terrorism

• Health-related issues

• Separation

• Loss

• Death

Feeling distressed or anxious following any traumatic event is a normal response. However, when this feeling persists for too long, it can greatly impact a person's life. For example, it can interfere with work or disrupt relationships.

It's important to seek professional help for PTSD and ask for support from close friends or family members.

PTSD and nightmares

Many people who have PTSD experience nightmares related to the incident they experienced.

Other symptoms of PTSD can include:

• Flashbacks of the traumatic event

• Frightening or worrying thoughts

• Negative thoughts about yourself or the world

• Avoiding reminders of the incident

• Feeling tense

• Being startled easily

• Sleep problems

• Mood changes

• Feeling guilty or blaming yourself for what happened

• Feeling disinterested in previously enjoyable activities

If you suspect that you have PTSD, the best thing you can do is see your doctor for a proper diagnosis. Your doctor might offer treatment options, such as psychotherapy, or  prescribe certain medications. If PTSD nightmares bother you, your doctor could prescribe a medication called prazosin.²

Why does PTSD trigger nightmares?

Experts³ believe that PTSD triggers nightmares because they’re a component of the re-experiencing cluster of symptoms related to PTSD.

Re-experiencing symptoms is an aspect of PTSD that makes it feel like you’re reliving the traumatic incident. These symptoms arise from thoughts and feelings that are triggered by reminders of the event.

Re-experiencing symptoms are:

• Flashbacks

• Nightmares

• Frightening thoughts

• Feeling triggered by thoughts, people, or items that remind you of the event

Additionally, neuroscientists⁴ claim that dreams play a role in memory consolidation and information processing. Therefore, when a traumatic experience occurs, it will stand out in your mind. As a result, your brain will try to process the information or make sense of what happened through dreams.

Despite that, the dream can still feel traumatic, presenting many challenges to sleep. For instance, some people have difficulty falling asleep or staying asleep at night if bad dreams constantly disrupt their rest.

Why is it important to address nightmares?

If you struggle to fall asleep or stay asleep due to nightmares, you could develop sleep deprivation. This condition is known to affect one’s quality of life and can worsen PTSD symptoms.

Studies⁵ have also shown that people who suffer from sleep deprivation due to PTSD have a higher chance of developing dementia. Therefore, sleep deprivation from PTSD could also be a potential risk factor for other diseases.

Can prazosin treat PTSD nightmares?

A medication that has shown promising results for PTSD nightmares is prazosin. The results of one meta-analysis demonstrated that prazosin is a safe, effective treatment for PTSD nightmares.

What is prazosin?

Prazosin is classified as an alpha-1 antagonist. The FDA⁶ has approved prazosin for use in patients with hypertension (high blood pressure), so it can lower blood pressure.

However, off-label uses of prazosin include treating:

• PTSD-associated nightmares

• Raynaud's phenomenon

• Pheochromocytoma

• Scorpion strings

• Benign prostatic hyperplasia

How does prazosin work for PTSD-associated nightmares?

Prazosin works on several areas in your body, including the brain. When prazosin enters the brain, it blocks proteins known as alpha receptors.

These proteins induce a stress response, which is inhibited by prazosin. As a result, the drug may stop the nightmares and improve your overall sleep.

How to use prazosin

Prazosin is a prescription-only medication, so you need to see your doctor to determine whether prazosin is right for you.

Doses for prazosin generally start at 1mg and may increase to 6mg if required. For PTSD-associated nightmares, prazosin works best when it’s taken before you go to bed.

Is prazosin safe for everyone?

As with all medications, prazosin isn’t suitable for everyone. Therefore, your doctor needs to assess your health and situation before prescribing this medication.

Avoid prazosin or take it with caution if you:

• Are pregnant

• Have hypotension (low blood pressure)

• Have a history of cataracts

Additionally, people who have had reactions to medications similar to prazosin in the past need to be cautious. These medications include:

• Terazosin

• Tamsulosin

• Doxazosin

Some side effects are associated with prazosin. If these side effects bother you or become severe, you must tell your doctor to ensure that prazosin is safe.

Potential side effects of prazosin are:

• Hypotension (low blood pressure)

• Tachycardia (increased heart rate)

• Syncope (temporary loss of consciousness)

• Weakness and fatigue

• Impotence (erectile dysfunction)

• Dizziness

• Headaches

• Nausea or vomiting

• Constipation

• Diarrhea

Does prazosin work for nightmares not PTSD-related?

At this stage, no clinical evidence suggests prazosin helps with nightmares linked to something other than PTSD.

Does prazosin help with other symptoms of PTSD?

Currently, prazosin has only shown promising results in alleviating nightmares from PTSD. It may also improve sleep quality. However, it has no other known uses for managing PTSD.

What else can you try to alleviate PTSD nightmares?

Treatment for PTSD

Treating PTSD, the underlying cause of your nightmares, may help.

The main treatments that can help with PTSD are:

• Medications such as antidepressants

• Psychotherapy such as exposure therapy or cognitive restructuring

• Talk therapy

Setting up regular appointments with a healthcare professional who can help you manage your PTSD is also worth considering.

When to see a doctor

If PTSD nightmares are affecting your sleep, it's time to see your doctor. If you leave this problem for too long, it may worsen and be more challenging to overcome.

The lowdown

Many people with PTSD suffer from nightmares or unpleasant dreams. If you’re finding it difficult to sleep or cope during the day due to these dreams, see your doctor. They may be able to help by prescribing medications such as prazosin.