Study focuses on combat nightmares
May 8, 2009
FORT LEWIS, Wash. -- Madigan Army Medical Center is conducting a first-of-its-kind study on reducing combat-related nightmares among returning Soldiers from Iraq and Afghanistan. Researchers are looking into an inexpensive, generic drug called Prazosin to help Soldiers get better restorative sleep.
The study, which is funded by the Department of Defense, began in 2006 and recently received additional funding through 2012.
Only active-duty servicemembers can participate in the study at Madigan. A separate study is being conducted at VA Puget Sound for Operation Iraqi Freedom and Operation Enduring Freedom veterans who are no longer on active duty.
Col. Kris Peterson, chief of outpatient psychiatry at Madigan, and Dr. Murray Raskind, director of mental health service, VA Puget Sound, are the principal investigators of the study.
Prazosin was introduced in 1973 to treat high blood pressure and is also effective in treating an enlarged prostate. But in the mid 1990s, Raskind was able to show in a study of Vietnam War veterans who had combat-related nightmares that Prazosin was effective in getting rid of nightmares.
"A great concern is that a lot of Soldiers coming back from theater having had combat experience have recurring nightmares, along with other symptoms," Peterson said. "Consequently, we wanted to take a look at active-duty Soldiers and see whether or not this would be helpful," Peterson said.
"We believe these nightmares are due to brain adrenaline surges at night, which shouldn't happen," Raskind said. "In a combat situation, your brain does adaptive things, and one of them is to keep you responsive to anything that goes on during the night. Your brain administers adrenaline and gets you aroused."
Raskind explained, however, that when a Soldier leaves the combat environment, the arousal is no longer necessary, but the brain has been trained to keep the Soldier hyper-vigilant.
"If this comes during normal sleep, we think that this is a set up for developing trauma nightmares," Raskind said. "What the Prazosin does is block the adrenaline rush to the brain, so that you can sleep normally."
In a May 2008 information paper, Peterson wrote that, most important, Prazosin is not a sedative, and its use has been increasingly adopted in VA facilities and at Madigan.
"We are finding in our clinical practice, just treating Soldiers on an outpatient basis, that it is working," Peterson said.
Raskind and Peterson both assert that Prazosin has very few side effects in most people, and can be taken for as long as necessary. Raskind has been following two Vietnam veterans who have been taking the drug for 12 years.
"These men were heavy alcoholics who used alcohol as "self-medication" to suppress combat trauma nightmares and get a few hours of fitful sleep. They were both suicidal and taking five different anti-depressants, mood stabilizers and anti-anxiety drugs," Raskind said. "With a moderate bedtime dose of Prazosin and a smaller dose of Prazosin during the day, the nightmares went away, restorative sleep resumed and suicidal ideation disappeared. Both veterans have been abstinent from alcohol since being stabilized on Prazosin."
The current study at Madigan is coming to the same conclusion for the active-duty population. According to Peterson, there have been indications that the use of Prazosin reduces alcohol and drug abuse and other symptoms of post-traumatic stress disorder.
"If you're not getting sleep that's restorative, you are going to look for other ways to put yourself to sleep. Perhaps you will drink alcohol or take other substances," Peterson said. "Sleep really is a common pathway for a lot of other problems."
The study does not demand that Soldiers have a PTSD diagnosis, but does require that subjects have traumatic deployment-related nightmares at least twice a week that interrupt their sleep.
The study lasts 14 weeks and is conducted in the outpatient psychiatry clinic at Madigan. The first three or four visits are a minimum of one-hour long, but all other visits take about 15 minutes. Each visit is scheduled on Thursday, but some visits can also be conducted over the phone to accommodate Soldiers' work schedules. At the end of the study, all Soldiers receive medication management as needed.
For Soldiers stationed on Fort Lewis who would like more information or to participate in the study, call Tammy Williams at 968-4735.
Julie Calohan works in the Madigan Army Medical Center Public Affairs Office; her story appeared in Fort Lewis' Northwest Guardian.