Schoenfeld Frank B, Deviva Jason C, Manber Rachel
San Francisco Department of Veterans Affairs (VA) Medical Center, San Francisco, CA 94121, USA.
J Rehabil Res Dev. 2012;49(5):729-52. doi: 10.1682/jrrd.2011.09.0164.
Sleep disturbances are among the most commonly reported posttraumatic stress disorder (PTSD) symptoms. It is essential to conduct a careful assessment of the presenting sleep disturbance to select the optimal available treatment. Cognitive-behavioral therapies (CBTs) are at least as effective as pharmacologic treatment in the short-term and more enduring in their beneficial effects. Cognitive-behavioral treatment for insomnia and imagery rehearsal therapy have been developed to specifically treat insomnia and nightmares and offer promise for more effective relief of these very distressing symptoms. Pharmacotherapy continues to be an important treatment choice for PTSD sleep disturbances as an adjunct to CBT, when CBT is ineffective or not available, or when the patient declines CBT. Great need exists for more investigation into the effectiveness of specific pharmacologic agents for PTSD sleep disturbances and the dissemination of the findings to prescribers. The studies of prazosin and the findings of its effectiveness for PTSD sleep disturbance are examples of studies of pharmacologic agents needed in this area. Despite the progress made in developing more specific treatments for sleep disturbances in PTSD, insomnia and nightmares may not fully resolve.
睡眠障碍是创伤后应激障碍（PTSD）中最常被报告的症状之一。对出现的睡眠障碍进行仔细评估，以选择最佳可用治疗方法至关重要。认知行为疗法（CBT）在短期内至少与药物治疗一样有效，且其有益效果更持久。针对失眠的认知行为疗法和意象演练疗法已被开发出来，专门用于治疗失眠和噩梦，并有望更有效地缓解这些非常令人痛苦的症状。当CBT无效或无法获得，或患者拒绝接受CBT时，药物治疗作为CBT的辅助手段，仍然是PTSD睡眠障碍的重要治疗选择。非常需要对特定药物治疗PTSD睡眠障碍的有效性进行更多研究，并将研究结果传播给开处方的医生。哌唑嗪的研究及其对PTSD睡眠障碍有效性的研究结果就是该领域所需药物研究的例子。尽管在开发更具体的PTSD睡眠障碍治疗方法方面取得了进展，但失眠和噩梦可能无法完全消除。
