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Medication for PTSD Nightmares

Lori Colbo's personal experiences, research, and writing on mental illness have given hope and understanding to those affected by it.

PTSD Nightmares and Flashbacks

For those who suffer from post-traumatic stress disorder (PTSD), nightmares can be a reign of terror, disturbing one's sleep and pushing one into a downward spiral, suicidal ideation, and fear of sleeping.

PTSD nightmares are so vivid, it's as though the actual experience is happening in the here and now. According to the National Center for PTSD, nightmares may be a reliving of the trauma or have similar elements to the trauma.1 What adds to this is that those who have them are helpless and powerless to stop them while they are happening.

I have an acquaintance who is a veteran with PTSD and clinical depression. Several years ago, he was in a VA mental health unit for his disorder. His roommate was a Viet Nam vet who had a wicked case of PTSD. When they went to bed at night, soon after this unfortunate gentleman went to sleep, he began tossing and turning and thrashing around. He started mumbling in a fearful way, this escalated into yelling and screaming, pretending he was shooting, and actually got out of bed, still in the nightmare, and reliving his war traumas. He would slug and beat things and show intense terror, then aggression. You can imagine my friend was quite frightened to have this roommate, yet at the same time, he felt great sympathy and empathy for him. It is an extreme example of how torturous and vivid the nightmares can be.

Flashbacks occur while one is awake. During a flashback, the person is reliving the trauma. Dr. Frank Orchberg explains flashbacks this way, "The flashback is a traumatic memory that takes place while you're awake and that has the sensation and the feeling that it's happening now. You don't have a time sense with a flashback...The difference between a flashback and a hallucination is that the flashback is the recreation of something that actually happened. The hallucination would be a voice that wasn't in your past and that tells you things or a smell that doesn't go back to a certain memory." 2

PTSD nightmares are so vivid, it's as though the actual experience is happening in the here and now

PTSD nightmares are so vivid, it's as though the actual experience is happening in the here and now

The Good News

There is good news for those suffering from PTSD nightmares.

First, PTSD nightmares tend to lessen as the years go by.

Second, there is a medication that can intercept those nightmares before they happen. The brand name of the medication is Minipress. The pharmaceutical name is Prazosin. Prazosin is actually a blood pressure medication but has been found to effectively stop or reduce nightmares associated with PTSD.

A few years ago I shared with a mental health professional about the horrors of my frequent nightmares. She said to me, "You know, there is medication to help with that." I was stunned. I had been suffering from PTSD for about ten years and not one doctor or psychiatrist ever told me about this or prescribed it. The next time I saw my doctor he put me on it right away. I found tremendous relief. I went back on it last year, unfortunately, after a long season of reprieve. It has greatly reduced my nightmares.

How Prazosin Works

It is a curiosity as to how a blood pressure medication can work to prevent nightmares associated with PTSD. Brandon Peters MD explains:

Prazosin blocks norepinephrine, a stress hormone that affects your brain, at specialized chemical receptors called alpha-1 receptors. Receptors are the sites where cells transmit messages to each other. It is not clear how this specifically impacts sleep or dreams.3

Possible Side Effects of Prazosin

Some people have side effects that prevent them from benefitting from this medication. As a blood pressure medication, it can create negative reactions. The most common side effects are:

  • Orthostatic Hypotension (postural of low blood pressure)
  • Weakness
  • Dizziness
  • Headache
  • Sleepiness
  • Palpitations
  • Lack of energy
  • Nausea

More serious side effects are:

  • First dose hypotension
  • Orthostatic hypotension postural hypotension)
  • Intraoperative Floppy iris syndrome
  • Priapism (prolonged erection)
  • Syncope (fainting) 4

How Effective Is Prazosin With PTSD Nightmares?

Prazosin has worked wonders for me personally and it is a very effective treatment overall. However, there are many that have not found success with it.

Side effects occur with some people quite significantly.

Prazosin is not a cure PTSD. It will allow you an easier time in your healing journey if you use it in combination with therapy and any other prescribed medications.

Sources | Veterans Affairs. (2014).

2Nightmares Versus Flashbacks. (n.d.). Retrieved December 11, 2021, from

‌3 Verywellhealth. Prazosin Treats Nightmares in Post-Traumatic Stress Disorder (PTSD).

4 Basquez, R., & Pippin, M. M. (2020). Prazosin. PubMed; StatPearls Publishing.

Additional Resources About PTSD and Treatments

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2011 Lori Colbo


fucsia on August 08, 2011:

Interesting argument that I did not know. Thank for this great Hub.

Lori Colbo (author) from United States on July 28, 2011:

Thanks again Dr. Bill for your feedback. It's good to hear that after all these years, I just may know a thing or two and can pass them on as they were passed on to me.

Bill Tollefson from Southwest Florida on July 28, 2011:

Good HUB! You give a good description of PTSD nightmares. The information you give is very much needed. As our soldiers return from the wars we will see an increase in PTSD in this country. I take my hat off to you for convey your views. I have worked with PTSD in abused women for almost 2 decades and nightmares and flashback can turn someone's life upside down. Thanks.