Medication Adjustments for Sleep Disturbances and Nightmares in Schizoaffective Disorder with PTSD

Primary Recommendations

• The American Academy of Sleep Medicine recommends increasing prazosin from 1 mg to a target dose of 10-16 mg at bedtime, and adding trazodone 50-100 mg at bedtime for persistent insomnia and PTSD-related nightmares 1, 2, 3

Medication Management

• The American Academy of Sleep Medicine suggests that prazosin reduces nightmare frequency from approximately 4 nights/week to 1-2 nights/week when adequately dosed, with a target dose of 10-16 mg at bedtime 1, 2
• Trazodone reduced nightmare frequency from 3.3 nights/week to 1.3 nights/week in PTSD patients, with a recommended starting dose of 25-50 mg and titration to 100-200 mg based on response 1, 2, 3
• Topiramate reduced nightmare prevalence from 100% to 60% and frequency from 4 nights/week to 2 nights/week, with a target dose of 200 mg/day 1, 2, 3, 4

Medications to Avoid

• The American Academy of Sleep Medicine recommends avoiding benzodiazepines, such as clonazepam, which showed no benefit for PTSD nightmares in controlled trials 3