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Benefits of treating impaired sleep in OIF/OEF Veterans with TBI and PTSD

Benefits of treating impaired sleep in OIF/OEF Veterans with TBI and PTSD. Robert L. Ruff, MD, PhD Suzanne S. Ruff, PhD Cleveland Dept of Veterans Affairs Medical Center Cleveland OH 44106. Objectives. To consider how treatment can be adapted to the needs of the OIF/OEF veterans

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Benefits of treating impaired sleep in OIF/OEF Veterans with TBI and PTSD

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  1. Benefits of treating impaired sleep in OIF/OEF Veterans with TBI and PTSD Robert L. Ruff, MD, PhD Suzanne S. Ruff, PhD Cleveland Dept of Veterans Affairs Medical Center Cleveland OH 44106

  2. Objectives To consider how treatment can be adapted to the needs of the OIF/OEF veterans To consider treating sleep along with PTSD as initial step for veterans with mild TBI associated with exposure to explosions

  3. How do you deal with the complex of mTBI, PTSD and impaired sleep? • Have to develop a Rx strategy that vets will accept, that may improve their likelihood of responding to other Rx and that enables them to function in society. • We addressed impaired sleep first • Dr. Murray Raskind found Prazosin to be very effective in improving sleep of veterans with PTSD. Blocks nightmares without disrupting REM or the transition of REM to stage 3

  4. Prazosin/Sleep Hygiene Study • Study group – 74 OIF/OEF veterans who had neurocognitive deficits and headaches • All had baseline MOCA and Epworth Sleepiness Scale scores and headache intensity and frequency. • All were given sleep hygiene counseling and started on an upward taper of prazosin from 1mg qHS to 7 mg qHS • Assessments – baseline, 9 weeks later, 9 weeks + 6 months later

  5. Hypotheses 1) OIF/OEF veterans would tolerate prazosin with a low incidence of side effects 2) prazosin combined with sleep hygiene counseling would improve sleep among OIF/OEF veterans with mTBI 3) veterans who took prazosin and received sleep hygiene counseling would have less severe headache pain and fewer headaches.

  6. Prazosin/Sleep Hygiene Improved Performance

  7. Prazosin Compliance – 6 months • 64/74 (86%) taking prazosin • 26 of the veterans received additional medication for their headaches • 22 veterans - changes in the PTSD medication (dosing or drug)

  8. A baseline vs. 9 week - significant at the 0.05 level B baseline vs. 6 months - 0.05 level C 9 week vs. 6 months - 0.05 level

  9. Conclusions: Prazosin/Sleep Hygiene • Well tolerated • Reduced headache frequency and pain intensity and was associated with improved cognitive performance • Improving sleep may be able to break the triad of mTBI-PTSD-Pain (Kerns-P3) • Rod Vanderploeg – impaired sleep may be critical in prolonged post-mTBI symptoms

  10. Thank You Robert L. Ruff, MD, PhD Suzanne S. Ruff, PhD Cleveland Dept of Veterans Affairs Medical Center Cleveland OH 44106 robert.ruff1@va.gov suzanne.ruff2@va.gov 216-791-3800 ext 5230 (Robert) 4486 (Suzanne)

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