A 38-year-old female combat medic presents with chronic hypervigilance, exaggerated startle response, difficulty concentrating, and persistent physiological arousal including elevated resting heart rate and diaphoresis. She reports these symptoms worsened after a second deployment and persist even in safe environments. The PMHNP initiates prazosin at bedtime for trauma-related nightmares and considers the neurobiological basis of her hyperarousal symptoms.