![]() Given the clinical importance of sleep symptoms and the poor response to the first line pharmacological treatment for PTSD (selective serotonin reuptake inhibitors, SSRIs) prazosin has emerged as the main agent for treating PTSD-related nightmares because of its role in stopping the consolidation of fear memories and reducing the primitive response to fear. Sleep disorders (insomnia, restless sleep, and nightmares) occur in up to 70% of patients associated with a higher risk of suicide in PTSD. Furthermore, in this context, studies have shown that adrenergic hyperactivity begins at night, leading to increased responsiveness of alpha-1-adrenergic receptors, which promotes rapid eye movement (REM) sleep alteration, increases the frequency of nightmares, and intensifies feelings such as fear. Several symptoms of the disorder can be explained by this exacerbation of adrenergic activity in the central nervous system promoting greater norepinephrine release and increased responsiveness of adrenergic receptors. In the initial neurobiological studies, there was an increase in the basal heart rate and systolic blood pressure values in combat veterans, which led to the hypothesis that peripheral autonomic hyperactivation could be related to central noradrenergic hyperexcitation, an impression that was reinforced with findings of increased activity in the locus coeruleus, increased urinary excretion of norepinephrine metabolites, and increased monoamine concentrations in the cerebrospinal fluid of these patients. ![]() US studies reported a higher prevalence in the general population, 8.3% in the US and 9.2% in Canada, with even higher estimates (10-40%) among at-risk populations as victims of disasters, kidnappings, and military veterans. A study based on data from the World Health Organization stated that the lifetime prevalence of PTSD in the general population is 3.9% and may reach 5.6% in populations exposed to trauma. Studies on the epidemiological relevance differ regarding the prevalence of the disorder. It is characterized by intrusive thoughts, nightmares, and flashbacks involving the traumatic event, avoidant behaviors, hypervigilance, and sleep disorders, causing a functional impact in the social, occupational, and interpersonal spheres, with significant loss of quality of life for patients. She desperately needed help with her Nightmare Disorder.Posttraumatic stress disorder (PTSD) can be defined by symptomatic cognitive, behavioral, somatic, and affective perpetuation resulting from a psychologically traumatic event. She had a vague sense of fear that something bad could happen to her or to her friend and she was often troubled by memories of terrifying images from her nightmares. During the day her fatigue blended into a toxic emotional experience of low mood with a constant edge of anxiety. After that, despite exhaustion she wouldn’t be able to get back to sleep for a very long time. Nicky had become afraid to go to sleep, and then when she finally fell asleep, she’d at some point wake up terrified from the nightmares. This was because for several months she had been having nightly, terrible nightmares that woke her and left her feeling anxious and distressed. Nicky not only could not sleep through the night she was also increasingly fearful of even going to bed. She found these visits to be very tiring and stressful but felt she had to help her friend any way she could. She had been helping her friend out by providing some coverage in the care of her ill and elderly mother. She noted that she had been under a great deal of stress at work and was concerned about her best friend who was going through a divorce. She had presented to the sleep clinic with disturbed sleep and daytime fatigue that included drowsiness while driving, a very alarming symptom. She seemed to have some difficulty concentrating on my questions. Nicky appeared fatigued and out of sorts. Source: Wikimedia Commons - 'The Nightmare', by M.Z.D. ![]()
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