Clinical relevance: Pimavanserin, an FDA-approved drug for Parkinson’s psychosis, could help veterans with PTSD-related insomnia find relief without the side effects of sleep aids.

Insomnia plagues 80 percent to 90 percent of veterans with PTSD. Many of them also suffer frequent nightmares. In a six-week pilot study, veterans taking pimavanserin reported improved sleep quality and fewer night disruptions. Participants expressed a strong desire to continue the medication, highlighting its potential as a safe, effective option for PTSD-related insomnia.

Insomnia is something of a quiet ghost haunting veterans wrestling with posttraumatic stress disorder (PTSD). The data reveals that upwards of 80 percent to 90 percent of PTSD patients report bouts of insomnia. And between 50 percent and 70 percent live with nightmares – averaging more than five a week.

All of that lost – and troubled – sleep takes a toll. These troubled patients wage a constant war against functional disabilities and a harder road to recovery.

A New Hope for PTSD Insomnia

Now it looks like there could be hope on the horizon. Research from late 2023 – published in The Journal of Clinical Psychology – suggests that pimavanserin, an FDA-approved drug typically prescribed to treat Parkinson’s disease psychosis, could help veterans with chronic insomnia. The results point to pimavanserin’s potential as an effective treatment for PTSD-related sleep issues.

Existing treatments often fall short for this prevalent – and persistent – problem. And worries about the potential for addiction and daytime drowsiness can severely limit one’s options.

Pimavanserin works as a selective 5-HT2A partial agonist and antagonist, triggering the brain’s serotonin receptors, which helps patients settle into deeper stages of sleep that PTSD so often interrupts. And unlike most sleep aids, it sidesteps the most common side effects, like daytime lethargy.

Methodology

The open-label pilot study, from the Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, observed half a dozen veterans with PTSD who reported notable improvements in sleep quality after taking the medication for six weeks.

The study recruited veterans (aged around 35 years) with moderate-to-severe chronic insomnia tied to their PTSD. The study participants submitted to home and clinical sleep assessments, – including polysomnography (PSG) and actigraphy – before and after the six-week trial.

Each participant took a fixed 34 mg dose at bedtime. While half of the group also lived with comorbid depressive disorders, the researchers evaluated each of them to track the treatment’s influence on both the insomnia and PTSD symptoms.

Promising Results

The research team noticed that most of the study participants experienced observable improvements in their ability to fall asleep. And all but one of the participants also reported fewer disruptions throughout the night. 

Additionally, participants showed improved sleep onset times, verified through actigraphy, and reported better sleep quality without problematic drowsiness throughout the day. Participants reported mild sleepiness after the initial dose as the only adverse effect. And researchers documented no serious side effects.

By the time the study concluded, every participant wanted to keep taking the meds. And a pair of them received special approval to remain on the medication after earlier failed attempts with other sleep aids.

Study lead Melissa B. Jones, MD, of Baylor College of Medicine commented that while these early findings were promising, further randomized controlled trials would be required to better assess pimavanserin’s effectiveness on a larger scale. She added that it owls help to investigate the mechanisms underlying its effects on sleep in PTSD patients.

Further Reading

Post-2020 Election Partisan Hostility Left Americans Traumatized

Prevalence, Correlates, and Burden of Subthreshold PTSD in US Veterans

Study Finds Brain Network That Could Protect Against PTSD