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Sarah, Psychologist
Category: Mental Health
Satisfied Customers: 143
Experience:  Chart'd Psych, 12 yrs exp. English prisons, Clinical Hypnotherapist, EMDR Therapist, BPS, HPC reg'd.
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My question involves sleep, PTSD, and medications. I am

Customer Question

My question involves sleep, PTSD, and medications.

I am recovering from long-term PTSD, and have long had sleep-maintenance insomnia (wake up at 3:00 am - 5:00 am, and have trouble falling back asleep). Many studies link sleep disturbances and PTSD.

Robert Stickgold, [EMDR: A Putative Neurobiological Mechanism of Action, Journal Of Clinical Psychology, Vol. 58(1), 61–75 (2002)] makes a strong case that REM sleep is necessary to recover from PTSD. At my last polysomnograph in 2007, my total REM sleep was one-third of normal duration.

I take a lot of medications, and wonder how my cocktail might be adjusted to improve both my sleep and my PTSD recovery.

QAM I take:
Prozac, 40mg, which I probably don't need any more
Exforge (amlodipine and valsartran) for BP

QHS I take:
nadolol 80mg, for migraine prophylaxis
Depakote ER 1500mg, for sleep-maintenance insomnia
clonidine 0.3mg, reasons lost in history
clonazepam 1.5mg, reasons lost in history

PART A: might you change anything above to enhance my sleep and recovery from PTSD? (and why?)

PART B: I read in detail that prazosin is often effective for sleep and other symptoms of PTSD. What might you think of replacing one or more of the above with prazosin? (and why?)


Submitted: 6 years ago.
Category: Mental Health
Expert:  Sarah replied 6 years ago.

Hi there Mark,


I have changed the format of your live chat to Q and A as you are offline right now. That means you can reply or accept when you are ready. I am not a doctor and I am afraid I cannot comment on your meds, but I cannot allow your question to pass me by without letting you know about EMDR therapy (Eye Movement Desensitisation and Reprocessing). It is the recommended therapy for PTSD by the National Institute of Clinical Excellence (NICE) here in England and it is used all over the world for traumas. I would like to explain about eye movements (REM) and how this works naturally and then how EMDR can be used to improve processing.


You are right when you say that REM sleep is part of the recovery - the theory is that the brain passes information from the left and right sides of the brain very quickly so that all parts of the memory are brought together (the emotional, the rational, the logical) etc. so that it can be processed away naturally during this stage of sleep. However, when we have experienced a trauma (read: highly emotional incident(s) that are beyond our natural expectation and our natural ability to deal with it/them) then the memory is held apart from the other memories in the brain (no physical evidence of this) and isn't processed away. If the brain tries to bring the memory into dreams, it often end up as a nightmare because the processing isn't successful.


OK, so the brain then needs help to process the memory (it may be one memory, it may be a succession of memories, then known as 'complex' trauma). EMDR is a therapy that simulates the eye movements (or is now often done with tapping as the bilateral stimulation appears to do the same) whilst the client is encouraged to think of the memory in a certain way, and then the processing can begin. There are no guarantees but it can often be very rapid, with surprising results. If you are dealing with a simple (single) memory, you may need just a few sessions, complex memories may require more sessions. Find out more details and local therapists at you may find that this relieves your migraines. If you can get a session booked with someone who treats migraines by Integrated EMDR then this could help too. The specialist is Steven V Marcus, from Kaiser Psychiatry Dept in Santa Clara, California. I do hope this is useful for you - I'm sorry I cannot comment on your drugs - you may find that after EMDR, you can cut some of them down or out, but obviously only with medical approval. My only health warning would be that EMDR could seriously change your life for the better! Best Wishes, Sarah

Sarah and other Mental Health Specialists are ready to help you
Customer: replied 6 years ago.
Thank you, Sarah. Yes, I know about EMDR, but unfortunately no EMDR practioner in town is covered by my insurance. I will pursue learning to do it by myself. I do have a therapist (and a masters degree in counseling psychology!).

I learned much from your complete description.

I have an appointment with a sleep neurologist to ask my question about medications. I don't intend prazosin to be a substitute for EMDR or therapy, but an adjunct.

I'm not sure how to use this website; I will leave you a tip, but I don't see where to specify the main payment.

Expert:  Sarah replied 6 years ago.

Hi Mark,


Glad it was useful for you - thanks for payment and bonus!


Have you heard of You can find therapists from England and Denmark online and carry out therapy over the phone, or more usefully perhaps by Skype. I'm not sure if there is anyone on there who has mastered the art of EMDR by Skype, but it might be worth looking into for you, there may be someone covered by your Insurance.


Alternatively, you could find a Thought Field Therapist, who can help you to tap away your belief structures, without the emotional experience of EMDR. I can certainly recommend Kevin Laye, who lives and works here in England, a good friend of Paul McKenna. He does much of his work on the telephone which might be useful for you. He claims to see most clients for only one session (amazingly!) and you can find out more about him at his website I attended some training with him last week and a friend of mine told Kevin during the tea break that I was in pain - he tapped me on my upper body for approximately 4 minutes and my knee quite literally snapped back into place, the bones in my spine straightened and the stiffness in my neck disappeared. I have been in the field of therapy and Psychology for a long time, but I can absolutely guarantee that he took my pain away as quick as it took me to sledge down the hill and walk back up again. (I knocked my knee out of place on a sledge before Christmas and had it x-rayed for fracture, it was so painful.) The theory is that the clinician multiplies the energy in the clients' body by tapping (if you speak to him over the phone he will guide you through where to tap on yourself) and the energy in the body then focuses on what it needs to do in order to rectify any problems, which is where my leg moved 'like magic' and 'by itself'. It challenged my beliefs about therapy if nothing else! If you choose to call him, I am happy for you to mention my name and I would LOVE to hear how you get on. (you could leave a short message with 'for Sarah' at the start and I will pick it up - I wouldn't expect a payment, but would much appreciate your effort). With very best wishes for your future, Sarah

Edited by Sarah on 1/19/2011 at 9:49 PM EST
Customer: replied 6 years ago.

Thanks for your comments, and I can sense your excitement from 6000 miles away. (I can also hear your accent.) I'm interested to know people in Europe do therapy by telephone. I don't think I'll need it, though, because I've discovered the root of my troubled emotions lays in attachment theory, not PTSD.

You said there's no physical evidence for trauma memories being in a different part of the brain. Yes, there is: SPECT imaging. Do a Google search on "PTSD 'brain imaging'" and you will be surprised.

Take care.

Expert:  Sarah replied 6 years ago.

Hi Mark,


Thanks very much for taking the time to tell me this. I will definitely be checking it out! This does make me very excited, the world is changing and I strongly believe that we don't need to suffer anymore in the way that we have done for a very long time, without many questions. Hope you liked my accent!! Take care, have a great day, Sarah

Customer: replied 6 years ago.
Yes, I like your excitement, your smile, AND your accent! If there weren't an ocean between us, I'd ask you out to lunch.
Expert:  Sarah replied 6 years ago.

That's sweet. Don't forget to call Kevin Laye if you would like to risk immediate relief - I did some more training with him last week - awesome! He charges a fair whack, but his results can really be amazing, even 6000 miles away. Enough of my waxing lyrical, wish you well, Sarah