Medication for Sleep Problems in Posttraumatic Stress Disorder

Several reviews on the treatment of posttraumatic stress disorder (PTSD) confirm that problems with sleep are the hallmark of this condition. This is well known to patients and prescribing clinicians that there is pressure on the use of substances (e.g., alcohol, cannabis, benzodiazepines) to alleviate sleep deprivation, reduce nightmares, and overcome the “tossing and turning” or “fighting sleep loss.” Patients with PTSD are seduced by the short-acting effect of alcohol and swindle down the negative effects related to their sleep disturbances and nightmares. Without proper guidance and feedback, this can lead to serious problems. Similar to alcohol, benzodiazepines improve sleep problems only in the short term and can cause serious sleep problems when tapering. The benzodiazepine use is well reflected in the fact that 30% of veterans with PTSD received a benzodiazepine prescription for >90 days, even though this is not recommended in guidelines, and as recent reviews and meta-analysis show, it is considered a status “relatively contraindicated” for this indication. This chapter discusses the current state of research on medication for sleep disorders in PTSD. The focus of this clinically based chapter is on the effect of drugs on sleep in patients with PTSD, in patients with depressive disorders, and also in healthy persons. Finally, an algorithm is presented that is based on the extensive literature that is presented as well as clinical guidance.