Treatment for Hyperarousal Symptoms

can't sleep ptsd

Treatment for Hyperarousal Symptoms

October 26, 2014

Hyperarousal is often the first sign of PTSD, and it’s directly linked to activation of the sympathetic nervous system. The most common symptom is the inability to sleep.

Arousal Symptoms:

1) Irritable or aggressive behavior

2) Self-destructive or reckless behavior

3) Hyper-vigilance

4) Exaggerated startle response

5) Problems in concentration

6) Sleep disturbance

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

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.

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 our normal maintenance.


It prepares us to fight for our life or run away. More specifically, it slows down or shuts off the parasympathetic nervous system and activates the brain, which in turn triggers the release of adrenaline, noradrenalin, and glucocorticoids (stress chemicals). These dilate the pupil, increase the flow of air into the lungs, accelerate the heart, and release glucose (fuel) from the liver. They also increase blood flow to the muscles and brain, increase strength, increase endurance, reduce inflammation, increase mental alertness, and focus attention on the danger.

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


The colored areas in this brain highlight the parts involved in emotion. 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 emotions like sadness, fear, and anger. The blue area is the hypothalamus, which controls the gray area below it, the pituitary gland.

So when the sympathetic nervous system is activated, it alerts the hypothalamus, which alerts the pituitary gland, which tells the adrenal gland (atop your kidney) to make stress chemicals. Those chemicals travel through the bloodstream and affect your whole body. In your brain, they inflame the amygdala (increasing the intensity of sadness, fear, and anger) and block the hippocampus from laying down memory tracks.

If these chemicals continue for any length of time, the hippocampus shrinks and the amygdala enlarges. 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 affected, including the VMPF (ventral medial prefrontal cortex), which controls emotions by calming the amygdala. Other areas in our cortex that help us speak and think coherently also can decrease in size.


Treating PTSD quickly can avoid these wounds, since our brain is designed for short bursts from our sympathetic nervous system. Luckily our brain can make new cells, especially in the hippocampus, which can repair itself once the toxic chemicals subside. That means you can heal—although the longer hyperarousal goes untreated, the harder it will be to reverse.



Alpha-blockers: Prazosin and Clonidine

Sedating Antidepressants: Trazodone, Remeron, Luvox,

Nonsedating Antidepressants: SSRIs: Lexapro, Paxil, Zoloft.

SNRIs: Cymbalta, Effexor, Pristiq

Antipsychotics: Old: Thorazine, New: Seroquel, Risperdol

Anticonvulsants: Gabapentin, Tegretol, Trileptal, Ketamine, Depakote, Lamictal,

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. These medications work well to increase sleep and prevent nightmares in people suffering from PTSD.

The dose varies widely between people, 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. Side effects are less serious if you increase dose gradually. Sleepiness can be a blessing.

Other medications may contain alpha-blockers, like Trazodone, Seroquel, and low dose Remeron. These medications not only reduce arousal, but also work as antidepressants.

Antidepressants repair chemistry in the VMPF (ventral medial prefrontal cortex) so it can calm the amygdala again. That decreases feelings of sadness, fear, and rage. Paxil and Zoloft are FDA approved, but the other SSRIs and SNRIs work just as well.

Most of the antipsychotics, like Thorazine, contain an alpha-blocker, so they calm you down. But many of them have serious side effects, so I wouldn’t use them unless other drugs have failed. Seizure medicines can control rage outbursts, but they also have a lot of side effects.


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, Duke Anesthesiology, and a private group in Chicago. The doctors inject a local anesthetic into the Stellate Ganglion— with astonishing results.

A review of all the recent literature on Stellate Ganglion blocks reports that in PTSD cases resistant to medications and exposure therapy, 75% had immediate improvement with one shot. The improvement lasted from 3 months to a year or more and a second block brought increased relief. Side effects were minimal and PTSD symptoms were decreased by 30- 98%.

So far this technique is not FDA approved for use in PTSD patients, so insurance won’t cover it. The cost is $2000-$3000 a shot.


Since ancient times, men have sought ways to control their minds and bodies. The ancient Hindu art of meditation met this need. Yogis can lower their blood pressure and heart rate, both controlled by the autonomic nervous system, to almost hibernation levels. It takes a lot of time and practice to develop this technique, but if you want a non-medical approach, it still works.

Meditation may work because you successfully focus your total attention on a non-threatening idea. That may also explain the calming effect of animals. Many survivors find relief with their dogs, horses, and other animals. The non-threatening animal provides a sense of security that more challenging human friends can’t match. Service dog providers are available nationwide.

Other approaches that help you to let go of strong emotions will be covered in the  blog: Exposure Therapy for Flashbacks, etc. Check them out and see what works for you.


If you’re having trouble with hyperarousal symptoms, it’s VERY important to find an approach that helps you sleep, calms your emotions, and gives your brain a chance to heal. If you’ve tried all the medicines and flunked exposure therapy, look into getting a Stellate Ganglion block. If you want an alternative approach, learn meditation or bond with a non-threatening animal.


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