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Objective Posttraumatic stress disorder (PTSD) is a disorder with significant sleep morbidity and limited treatment options. Prazosin may constitute a novel management approach and has been tested recently in a number of trials. We conducted a meta-analysis to examine the effectiveness of prazosin for nightmares and other sleep disturbances in adults with PTSD. Method A systematic review of databases for randomized, double-blind, placebo-controlled trials of adults diagnosed with PTSD and reporting sleep disturbances that were treated with prazosin was conducted in January 2015. No limitations were placed on language or year of publication. Results Six randomized controlled trials of prazosin for sleep disturbances in patients with PTSD were included (sample n = 240). We found that prazosin was statistically significantly more effective than placebo in improving sleep quality [ g = 0.987, 95% confidence interval (CI): 0.324–1.651] and in reducing overall PTSD symptoms ( g = 0.699, 95% CI: 0.139–1.260) and sleep disturbances in particular ( g = 0.799, 95% CI: 0.391–1.234). Conclusions Prazosin showed medium-to-large and statistically significant effects on PTSD symptoms in general and sleep disturbances in particular. While promising, results should be interpreted with caution given the limited total number of participants and the limitations induced by the majority of participants being male and noncivilian. [ABSTRACT FROM AUTHOR]