Treating Hyper-Arousal Symptoms

can't sleep ptsd

Treating Hyper-Arousal Symptoms

February 28, 2015

Hyper-arousal symptoms are often the first sign of PTSD, and they’re directly linked to activation of the sympathetic nervous system. The most common symptom is a problem with sleep.

Hyper-arousal Symptoms:

  • Irritable or aggressive behavior
  • Self-destructive or reckless behavior
  • Hyper-vigilance
  • Exaggerated startle response
  • Problems in concentration
  • Sleep disturbance

Remember your high school Biology class? The sympathetic nervous system is the fight or flight part of our autonomic nervous system. It activates when you are faced with a potentially life-threatening situation.

The autonomic nervous system consists of 2 parts:

  1. The parasympathetic system is our body’s maintenance system. It lubricates our eyes, digests our food, releases sex hormones, helps us go to sleep, etc.
  2. The sympathetic system takes over during periods of extreme danger and stress, focusing all the body’s resources on immediate survival. To do this, it overrides the normal maintenance of our body.



  • It slows down or shuts off the parasympathetic nervous system
  • It activates the hypothalamus in the brain, which in turn activates the pituitary gland.
  • The pituitary gland triggers the adrenal gland to release adrenaline, noradrenalin, and glucocorticoids (stress chemicals), which:
  • Dilate the pupil,
  • Increase the flow of air into the lungs,
  • Accelerate the heart
  • Release glucose (fuel) from the liver.
  • Increase blood flow to the muscles and brain,
  • Increase strength and endurance,
  • Reduce inflammation,
  • Increase mental alertness,
  • Focus attention on the danger.

This is exactly what you want if you’re in a life-threatening situation. But prolonged exposure to those stress chemicals is harmful to your physical and your mental health.



Emotional Center of the Brain

  • The long green part is the hippocampus and is important in memory recall.
  • The round red part at its lower end is the amygdala, which promotes strong emotions like grief, terror, and rage.
  • The blue area is the hypothalamus, which controls the gray area below it, the pituitary gland, which then sends signals to the adrenal glands atop your kidneys.
  • The stress chemicals produced in your adrenal gland travel through the bloodstream and effect your whole body.
  • In your brain, stress chemicals inflame the amygdala (increasing the intensity of grief, terror, and rage).
  • Stress chemicals block the hippocampus from laying down and recalling memories.
  • If these chemicals continue for a prolonged time, the hippocampus may shrink and the amygdala will enlarge. (You can see these changes on an MRI brain scan.)
  • Parts of the cortex (the gray area on the outside that does most of your thinking) are also effected.
  • The VMPF (ventral medial prefrontal cortex), which controls emotions by calming the amygdala, becomes chemically unbalanced and dysfunctional.
  • Other areas in our cortex that help us speak and think coherently also can decrease in size.


Treating PTSD quickly can avoid these wounds because our brain is designed to handle short bursts of stress chemicals. Luckily our brain can make new cells, especially in the hippocampus, which repairs itself once stress chemicals subside. That means you can heal—although the longer PTSD goes untreated, the harder it can be to totally reverse.




We’ve seen that hyper-arousal is a physical problem, and we now have medications to help fix it. Below is a list of the medications used:

  • Alpha Blockers: 
    • Prazosin
    • Clonidine
  • Sedating Antidepressants: 
    • Trazodone,
    • Remeron,
    • Luvox,
  • Nonsedating Antidepressants:
    •  SSRIs: Lexapro, Paxil, Zoloft
    •  SNRIs: Cymbalta, Effexor, Pristiq
  • Antipsychotics:
    •  Old: Thorazine
    •  New: Seroquel
  • Anticonvulsants:
    • Gabapentin,

Alpha-blockers block receptors to adrenaline and noradrenalin, chemicals secreted by the adrenal gland. Developed to treat high blood pressure, researchers have found that two of the alpha-blockers, Prazosin and Clonidine, can sneak into the brain. Prazosin especially has been shown to work well to increase sleep, calm anxiety, and prevent nightmares in people suffering from PTSD.

The dose is variable, so you start low and increase the medication every night until it works. Both Prazosin and Clonidine have fairly short half-lives, so they won’t effect you the next day unless you take another dose. Common side effects that occur immediately are sleepiness and dizziness. Dizziness is less if you increase dose gradually. Drowsiness can help you sleep.

Other medications contain alpha-blockers, like Trazodone, Seroquel, and Thorazine. They not only help reduce arousal but can also work as antidepressants and antipsychotics. Unfortunately, they tend to have more side effects than prazosin.

Antidepressants repair chemistry in the VMPF (ventral medial prefrontal cortex), which helps to calm down the amygdala (the part of your brain involved in negative emotions). Activating your VMPF decreases your feelings of grief, terror, and rage. Paxil and Zoloft are FDA approved for PTSD, but the other SSRIs and SNRIs probably work just as well. It may take several trials to see which one works best for you.

Gabapentin is a seizure medication that works on GABA–the primary calming chemical in the brain. It helps with severe anxiety and isn’t addicting like the benzodiazepines (valium, xanax, klonopin) and alcohol can be.



The Stellate Ganglion is a collection of nerve cells located in your lower neck. Nerve blocks in this area have been used for years to treat chronic pain due to over-activity in the sympathetic nervous system.

For the last two years this technique has been tested on PTSD patients by Walter Reed Hospital, Bethesda and Balboa Naval Hospitals, Duke anesthesiology group, and Chicago Medical Innovations, among others. The doctor simply injects a local anesthetic into the Stellate Ganglion—sometimes with astonishing results.

A recent study at Balboa did not find a significant difference between real and sham injections, but a review of all the literature found that 70-75% of the participants had immediate improvement, even in older PTSD cases resistant to medications and exposure therapy. Further studies are in progress to determine which patients will respond.

This treatment is currently available through Chicago Medical Innovations, a not-for-profit organization started by Dr. Eugene Lipov to treat PTSD.



  • Service dogs—research is underway on this favorite therapy. Dogs and other animals have been shown to help calm down the sympathetic nervous system.
  • Mindfulness and meditation—these work if you are consistent in the practice. MRIs have shown positive changes in the brains of experienced meditators.
  • Time—some peoples’ hyper-arousal symptoms will improve over time, others just get worse. I’d suggest a consultation as soon as you see symptoms. Although watchful waiting may be appropriate, it’s good to have a knowledgeable outsider’s point of view.



If you’re having trouble with hyper-arousal symptoms, it’s important to discuss this with your doctor and find a treatment that helps calm you down, improves your sleep, and gives your brain a chance to heal.





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