56-year-old patient with history of PTSD
A fifty-six-year-old male presents with history of post-traumatic stress disorder due to childhood physical abuse. He has trouble sleeping due to flashbacks, which he has had since his teenage years. He has tried therapy and EMDR, but continues to face insomnia. The patient reports falling asleep during the day, and having no trouble falling asleep at night. He reports that he struggles to stay asleep for more than forty-five minutes at one time. He does not note having any dreams. He denies any illicit drug, alcohol, or tobacco use. He lives by himself and is employed at a local marketing agency, where he manages technical infrastructure.
1. What treatment options would you offer this patient?
2. How would you recommend approaching testing this patient for any comorbidities?
An SSRI could be considered as well as Melatonin as his circadian sleep cycle is probably impaired.
Prazosin could be beneficial depending on response.
I would NOT prescribe hypnotics for sleep as short term indication and this seems to be more chronic from previous trauma.