From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For an 18-year-old experiencing nightmares and insomnia, I strongly recommend starting with non-medication approaches first, such as practicing good sleep hygiene, cognitive behavioral therapy for insomnia (CBT-I), and relaxation techniques, and if medication becomes necessary, using low-dose prazosin (1-3mg at bedtime) for nightmares and melatonin (0.5-5mg, 1-2 hours before bedtime) for insomnia, as supported by the most recent and highest quality study 1.
When considering medication, it's essential to prioritize the treatment of sleep disturbances, as they are a critical aspect of posttraumatic stress disorder (PTSD) and can significantly impact quality of life.
- Prazosin, an anti-adrenergic agent, is effective in reducing nightmares, particularly those related to trauma, by blocking norepinephrine's effects during REM sleep 2, 3, 4.
- Melatonin helps regulate sleep-wake cycles and is a reasonable first option for insomnia with minimal side effects 1.
- If these are insufficient, short-term use of trazodone (25-100mg at bedtime) may help with sleep initiation, but it's crucial to avoid benzodiazepines and Z-drugs (like zolpidem) in young adults due to dependency risks.
Addressing underlying causes such as anxiety, depression, or PTSD is crucial for long-term improvement, so consultation with a healthcare provider for proper diagnosis and personalized treatment is essential.
- The treatment approach should be tailored to the individual's specific needs, taking into account the presence of comorbid disorders or mental health conditions 5.
- Regular reassessment of medication and non-medication approaches is necessary to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.
The most recent study 1 provides an evidence-based approach to psychopharmacology for PTSD, supporting the use of prazosin for sleep impairments, including nightmares, and highlighting the importance of addressing underlying causes for long-term improvement.