Ramelteon for Complex Insomnia in Veterans With PTSD

Inclusion Criteria: * Age ≥18 years and ≤70 years old * Diagnosis of PTSD as determined by the intake conducted through the PTSD Clinic or the Mental Health Clinic * Documented obstructive sleep apnea by polysomnography (AHI≥5 or more/hour) * CPAP non adherence defined as less than 70% of nights with \>4h CPAP use despite addressing modifiable barriers for CPAP adherence * Psychotherapeutic treatment stable for at least 4 weeks prior to randomization * Capable of giving informed consent Exclusion Criteria: * Medical: * Acute or unstable chronic medical illness * History of narcolepsy and/or cataplexy Use of any of these medications: Fluvoxamine, fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral); cimetidine (Tagamet); clarithromycin (Biaxin); fluoroquinolones including ciprofloxacin, levofloxacin (Levaquin), moxifloxacin (Avelox), norfloxacin (Noroxin), ofloxacin (Floxin), others; HIV protease inhibitors including indinavir (Crixivan), nelfinavir (Viracept), and ritonavir (Norvir, in Kaletra); nefazodone; rifampin * Treatment for seizure disorders * Pregnant or lactating * History of clinically significant hepatic impairment * History of hypersensitivity, intolerance, or contraindication to ramelteon * Unwilling to try or use CPAP Psychiatric/Behavioral: * Diagnosis of current schizophrenia or schizoaffective disorder * Diagnosis of a substance dependence/abuse disorder in the past year * Severe psychiatric instability or severe situational life crises, including evidence of being actively suicidal or homicidal, or any behavior which poses an immediate danger to patient or others * Diagnosis of bipolar disorder * Consumption of more than two alcoholic beverages per night * Receiving behavioral or pharmacological treatment for insomnia