- PTSD commonly causes sleep disturbances and is linked to sleep disorders like insomnia.
- Ramelteon is a non-controlled, non-narcotic sleep aid approved for treating sleep-onset insomnia.
- Recent research suggests that ramelteon may help to alleviate certain PTSD symptoms and related sleep problems.
- Experts recommend a comprehensive approach, including medication, psychotherapy, and lifestyle changes, to manage PTSD-related sleep problems.
Post traumatic stress disorder (PTSD) often takes a toll on sleep, causing disturbances like insomnia and nightmares. This can contribute to a vicious cycle of worsened sleep problems and PTSD symptoms. But PTSD sufferers may have new hope with ramelteon, a sleep aid that shows promise in easing PTSD-related sleep challenges.
What Is Ramelteon and How Does It Work?
Ramelteon is a non-controlled sleep aid designed to help you fall asleep. It was the first melatonin agonist approved by the Food and Drug Administration (FDA) to treat insomnia.
Melatonin agonists work by targeting the specific receptors responsible for regulating our sleep-wake cycles. They essentially mimic the action of the natural hormone melatonin to make you feel sleepier and help you to fall asleep.
Ramelteon is more than just a supplement, which is why it requires a prescription.
Ramelteon’s Efficacy in Treating PTSD-Related Sleep Disorders
Most people with PTSD suffer from sleep disturbances. PTSD symptoms like hyperarousal contribute to insomnia and nightmares. Researchers have recently started exploring the potential effectiveness of ramelteon in treating PTSD-related sleep disorders.
Ramelteon’s Efficacy in Treating PTSD Symptoms
Ramelteon is currently approved to treat insomnia in the general population, but it also shows promise in providing relief from certain PTSD symptoms. Several studies suggest that ramelteon can improve sleep, reduce hyperarousal, and alleviate anxiety. Most of these studies have been conducted in animals and not yet in humans, but the results are encouraging.
A noteworthy case report documented in the Journal of Psychiatry and Clinical Psychopharmacology delves into the use of ramelteon in treating insomnia with nightmares in a 32-year-old male patient diagnosed with PTSD. After starting ramelteon, the patient was able to reduce — and eventually stop — benzodiazepine for insomnia.
The findings suggest that ramelteon might offer a promising avenue for addressing sleep-related challenges in PTSD.
Intriguingly, a study in mice exhibiting behaviors akin to PTSD revealed that ramelteon improved all PTSD-like behaviors tested. Specifically, the mice showed a significant reduction in anxiety and hyperarousal.
This study underscores ramelteon’s potential as a therapeutic candidate for PTSD and sheds light on the intricate neural mechanisms involved in symptom relief.
Similar Studies in Humans
Ramelteon has been studied for its use in humans with other mental health conditions, such as anxiety and major depressive disorder. While these are separate conditions from PTSD, they commonly co-occur in people with PTSD, and many of the symptoms overlap.
In one study, adults with generalized anxiety disorder and trouble sleeping took ramelteon for 12 weeks. The results showed that taking ramelteon before bedtime helped reduce anxiety symptoms and improved how quickly people fell asleep and how long they slept.
Another study explored how taking ramelteon for eight weeks affected people who were already on antidepressant medication with both sleep-onset insomnia and major depressive disorder. The findings suggested that ramelteon improved sleep latency, total sleep time, and sleep quality, along with reducing depressive symptoms. Most people in the study reported feeling better.
While human clinical trials for ramelteon are needed to confirm its efficacy in treating PTSD, ongoing investigations explore its combination with other treatments. For example, trials combining ramelteon with prazosin, known for treating nightmares, and cognitive behavioral therapy (CBT) are underway. Positive outcomes could pave the way for ramelteon’s official approval by the FDA for PTSD treatment.
Potential Side Effects of Ramelteon
Ramelteon is generally well tolerated and considered safe for most people to use, as long as it’s taken as prescribed. However, like all prescription medications, it may cause side effects.
Common Side Effects
Most ramelteon side effects are mild and temporary. Regardless of the severity, you should always tell your doctor if you experience any side effects while taking ramelteon.
Common side effects for ramelteon include:
Severe Side Effects
Although uncommon, severe side effects such as hormonal imbalances and allergic reactions may occur. Tell your provider right away if you encounter significant side effects or observe troubling sleep behaviors while using ramelteon.
Some users of sleep medications, including ramelteon, report engaging in activities like sleepwalking, driving, or eating without full wakefulness. They often have no memory of these actions. This poses potential dangers to yourself and others and requires immediate medical attention.
Read our Ramelteon FAQ for answers to commonly asked questions about ramelteon.
Comparing Ramelteon with Other PTSD Treatments
Ramelteon isn’t the only pharmacotherapy option on the market that may help with PTSD-related sleep problems.
Other Pharmacotherapy Options for PTSD
Common pharmacotherapy options for treating sleep problems in individuals with PTSD include:
- Prazosin. Currently recommended as a first-line agent for PTSD-related insomnia, it effectively reduces nightmares and improves sleep quality. However, it has a sedating effect, so ramelteon may be a better choice for those who prefer a non-sedating medication.
- Selective serotonin reuptake inhibitors (SSRIs). Antidepressants like sertraline and paroxetine are often prescribed for PTSD, addressing mood-related symptoms and potentially improving sleep. But these drugs can have fairly serious side effects, which doesn’t make them the best choice for everyone.
- Trazodone. Trazodone is an antidepressant that’s not FDA-approved for insomnia, though it’s often used off-label for that purpose. Unlike ramelteon, trazodone is sedating.
- Benzodiazepines. Experts agree that people with PTSD should not take benzodiazepines, which are often prescribed for short-term treatment of sleep disorders. Benzodiazepines are known to cause cognitive side effects and come with a high risk for potential abuse. They’re sometimes prescribed for short-term use but should be used with caution.
Sleep aids in this class include:
- Temazepam (Restoril)
- Triazolam (Halcion)
- Estazolam (Prosom)
- Flurazepam (Dalmane)
Benefits of Non-Controlled Sleep Aids
When tackling sleep disturbances tied to PTSD, many patients prefer a non-controlled sleep aid. Benefits of non-controlled sleep aids like ramelteon include:
- Non-habit-forming. Ramelteon is not a controlled substance, assuring non-addictive use under a physician’s guidance.
- Safer for high-risk groups. Non-controlled sleep aids like ramelteon are generally considered safe for senior adults and those with respiratory conditions.
- Lower risk for alcohol interactions. While caution is urged, ramelteon exhibits milder interactions with alcohol than controlled or benzodiazepine sleep aids.
- No withdrawal symptoms. Ramelteon doesn’t induce withdrawal symptoms, even with prolonged use.
- Fewer drug interactions. Unlike ramelteon, controlled and benzodiazepine sleep aids tend to come with a higher risk of drug interactions.
Ramelteon and Sleep Hygiene for Sleep Disturbances Associated with PTSD
Ramelteon is most effective when it’s combined with good sleep hygiene. This is especially true for people living with PTSD.
You should sleep in a room that makes you feel safe, whatever that may mean for you. You can also practice good sleep hygiene by:
- Sticking to a regular bedtime
- Avoiding stressors before you wind down for the night
- Turning off bright lights and screens at least an hour before bed
- Limiting caffeine, especially in the evening
- Enjoying a relaxing bedtime routine, like a warm bath or meditation
- Sleeping in a cool, dark room
- Using a white noise machine or fan to block outside noise
Dosage and Administration of Ramelteon
To get the most out of ramelteon, you’ll need to take it exactly as prescribed by your provider. This means following any standard or specialized guidelines for dosage (how much and how often you take it) and administration (how you take it).
The standard dosage for ramelteon is eight milligrams per night. However, dosages vary based on individual needs and medical history. Always follow the dosage prescribed by your healthcare provider.
If you miss a dose, skip it. Don’t take the missed dose in the morning or double up at bedtime the next day.
Take ramelteon only under your healthcare provider’s supervision, even if you’ve used other sleep aids before.
Ramelteon is taken orally and providers typically recommend taking it with a full glass of water, 30 minutes before bedtime. You can take it with or without food, but you should avoid taking it after a high-fat meal.
Medication adherence is also important to get the most out of ramelteon. It can take time for ramelteon to work, so don’t get discouraged. Only stop taking it if instructed by your provider or if you notice concerning side effects.
Like many sleep aids, you shouldn’t take ramelteon if you don’t have at least seven hours for sleep before you need to be active again.
Safety and Precautions with Ramelteon Use
For those seeking safe and effective non-controlled sleep aid options, ramelteon may be the best prescription sleep medication. But don’t forget to carefully review potential drug interactions and to follow all patient safety precautions when taking ramelteon.
While ramelteon may have interactions with specific treatments, its overall safety profile surpasses most other sleep aids. Known drug interactions for ramelteon include:
- Fluvoxamine (used to treat obsessive-compulsive disorder)
- Rifampin (prescribed for tuberculosis and other bacterial infections)
- Ketoconazole and fluconazole (antifungal medications)
- Donepezil (used in dementia treatment)
- Doxepin (an antidepressant)
Patient Safety Precautions
There are a few safety precautions to consider when taking any sleep aid, including ramelteon. Precautions include:
- Avoiding alcohol. Mixing sleeping pills with alcohol is generally advised against. While ramelteon has fewer adverse interactions, it’s still recommended to avoid the combination due to potential additive effects.
- Checking for allergies. Inform your doctor or pharmacist about any allergies you have, as ramelteon may contain inactive ingredients that could trigger allergic reactions or other issues.
- Disclosing medical history. Discuss your medical history with your provider before starting ramelteon, especially if you have breathing problems or liver disease.
- Following provider instructions. Take ramelteon exactly as prescribed, preferably on an empty stomach to enhance absorption. Only use it when you have at least seven hours for uninterrupted sleep.
- Watching for dizziness or drowsiness. Be aware that ramelteon may cause dizziness or drowsiness. Take precautions, such as avoiding activities requiring alertness, until you understand how the medication affects you.
Read Ramelteon FAQ: Questions and Answers About Ramelteon (Rozerem) to learn more.
Personalized Approach in Prescribing Ramelteon for PTSD Patients
Health is deeply personal, which is why treatment plans should be individualized to the patient. This is especially true when managing a complex condition like PTSD. Always consult with your healthcare provider or pharmacist for personalized advice and detailed information based on your specific health concerns.
Addressing sleep challenges in PTSD requires personalized medicine as individuals may respond differently to treatments. Tailoring interventions ensures a more effective and targeted approach, promoting better sleep outcomes for those managing PTSD.
Medication is just one component of a comprehensive treatment plan for PTSD-related sleep problems. Psychotherapy and lifestyle adjustments also play crucial roles in managing sleep disturbances associated with PTSD. Work closely with your providers to find the most effective and personalized treatment approach for your condition and your lifestyle.
Pharmacist Role in Pharmacotherapy
Research shows that pharmacists and specialists, like sleep medicine specialists, play a critical role in the pharmacotherapy journey for PTSD-related sleep problems. Their expertise ensures precise medication management, personalized guidance, and ongoing support, enhancing the overall effectiveness of the treatment plan.
Ramelteon offers hope for those working to put PTSD-related sleep problems to bed. Studies suggest it improves sleep quality and may also help with symptoms like anxiety and hyperarousal. While additional research is needed to explore its full potential, ramelteon stands out among other sleep aids.
As a non-controlled and non-benzodiazepine sleep aid, ramelteon offers the benefits of being non-habit forming, safer for higher-risk groups, and having fewer side effects, like withdrawal symptoms. However, medication is just one important piece of a comprehensive treatment plan. You might benefit from combining medication with psychotherapy and lifestyle changes.
If you’re navigating PTSD-related sleep challenges, don’t hesitate to speak to a provider about your options. Remember, a tailored approach enhances the effectiveness of managing complex conditions like PTSD.
Better Sleep and Better Health with eDrugstore
We make it easier than ever to access safe and effective solutions for health problems like insomnia. At eDrugstore.com, we offer free consultations with a U.S.-licensed provider, who will write your prescription and deliver your medication right to your front door. Speak to a provider today about ramelteon and begin experiencing better sleep and overall well-being.
Shelby is a public health professional with research and field experience in sexual and reproductive health. She holds a Master of Public Health (MPH) and is a Certified Health Education Specialist (CHES).