• https://www.facebook.com/profile.php?id=100009856982302


An Interdisciplinary Journal on Sexual Health

Aktif Ziyaretçi1
Bugün Toplam18
Toplam Ziyaret582108
Web Site Map
Member's Pages


Sexsomnias & Parasomnias:
Sleep Related Sexual Seizures &Forensic Hints

Carlos Schenck

Abstract:  The first classification of sleep-related disorders and abnormal sexual behaviors and experiences was published in 2007. Parasomnias (abnormal sleep-related behaviors and experiences) and sleep-related epileptic seizures were the most frequent disorders, after Kleine-Levin syndrome (periodic hypersomnia with abnormal wakeful sexual behaviors). The first two conditions were named sexsomnia (sleepsex) and epileptic (ictal) sexsomnia, respectively. Sexsomnia usually emerges during confusional arousals (CAs) from delta non-REM sleep (N3 sleep), either associated or unassociated with obstructive sleep apnea (OSA). We now report an additional 22 cases of sexsomnia and 3 cases of ictal sexsomnia (temporal lobe epilepsy; bupropion-induced seizures) published from 2007-2015, based on a literature search in PubMed and Embase, and also separately for Turkish language publications. Eighteen of the 22 additional cases of sexsomnia had sufficient data provided to allow for comparative analysis. (The 4 other additional cases involved sexsomnia emerging with Parkinson's disease). The demographics of the second group of 18 sexsomnia cases were comparable to those of the first group of 31 cases (published in 2007), in regards to male gender predominance (67% vs. 81%); age at presentation (40 yrs vs. 32 yrs); age of onset (33 yrs vs. 26 yrs); and mean duration of sexsomnia in males (5.6 yrs vs. 8.3 yrs). The female groups were too small to compare. The distribution of sexual behaviors across the groups was generally comparable in regards to sexual vocalizations, masturbation, fondling, and intercourse/attempted intercourse. Amnesia for the sexsomnia by the affected person was 89% vs. 100%. Video-polysomnographic studies were conducted in nearly all patients in both groups, and provided important diagnostic findings in almost all patients. The mean number of parasomnias per patient was 1.8+1.4 vs. 2.2+1.0, respectively, with the range extending up to 5 parasomnias per patient. In both groups, a non-REM sleep parasomnia (disorder of arousal [DOA]) was the main cause of the sexsomnia (78% vs. 90%). There was a comparable percentage in each group having obstructive sleep apnea (OSA) as the presumed trigger for a DOA with sexsomnia (17% vs. 13%), and there was control of both sexsomnia and OSA with nasal CPAP in 100% (4/4) of treated cases. Overall treatment efficacy was 82% (n=18) in the 22 patients in the combined groups (n=53) for whom treatment was reported. Nine novel findings on sexsomnia were identified. An abstract on 41 consecutive cases of sexsomnia evaluated at a single sleep center in the U.K. was recently published, and the findings are highly congruent with the 53 cumulative cases in the world literature reported herein. Thus, there are now 94 total cases of sexsomnia reported in the world literature. The forensic implications of sexsomnia are discussed.


KEY WORDS:  sexsomnia, sleepsex, sexual behaviors of sleep, temporal lobe epilepsy, ictal orgasm, epileptic sexsomnia, polysomnography, non-REM sleep

SexuS Journal ● 2017 ● 2 (6): 257-288

American Academy of Sleep Medicine. International classification of sleep disorders, 2nd edition. Westchester, Illinois, 2005. American Academy of Sleep Medicine. International classification of sleep disorders, 3rd edition. Darien, Illinois, 2014.

Andersen ML, Poyares D, Alves RSC, Skomro R, Tufik. Sexsomnia: abnormal sexual behavior during sleep. Brain Res Reviews 2007; 56: 271-282.

Arino H, Iranzo A, Gaig C, Santamaria J. Sexsomnia: parasomnia associated with sexual behaviour during sleep. Neurologia 2014; 29 (3): 146-152.

Banerjee D. A case-based review of sleep-related criminal behaviours, treatment & outcomes. Sleep and Biological Rhythms 2014; 12: 7.

Bejot Y, Juenet N, Garrouty R, Maltaverne D, Nicolleau L, Giroud M, Didi-Roy R. Sexsomnia: an uncommon variety of parasomnia. Clin Neurol Neurosurg 2010; 112 (1): 72-75.

Bjorvatn B, Gronli J, Pallesen S. Prevalence of differentparasomnias in the general population. Sleep Medicine 2010; 11:1031-1034.

Chung SA, Yegneswaran B, Natarajan A, Trajanovic N, Shapiro CM. Frequency of sexomnia in sleep clinicpatients. Sleep 2010; 33: A226.

Cicolin A, Tribolo A, Giordano A, et al. Sexual behaviors during sleep associated with polysomnographically confirmed parasomnia overlap disorder. Sleep Med 2011;12: 523-528.

Coelho FMS, Moszczynski A, Narayansingh M, Parekh N, Pradella-Hallinan M. Sexual hypnagogic Hallucinations and narcolepsy with cataplexy: a case report. Sleep Science 2011;4(3): 110-112.

Cramer Bornemann MA. Sexsomnia: a medicolegal casebased approach in analyzing potential sleep-related abnormal sexual behaviors. In: Kothare SV, Ivanenko A, eds. Parasomnias. New York: Springer Science + Business Media 2013; pp. 431-461.

Cramer Bornemann MA, Mahowald MW, Schenck CH. Sexsomnia and sleep forensics: the interface between sleep-related abnormal sexual behaviors and the law. Sleep 2014; 37: A210.

Della Marca G, Dittoni S, Frusciante R, et al. Abnormal sexual behavior during sleep. J Sex Med 2009; 6 (12): 3490-3495.

Demir EY. Uykuda Orgazm Olan Postmenopozal Kadın Hasta. [Post-menopausal female patient with orgasm during sleep]. Düşünen Adam: The Journal of Psychiatry and Neurological Sciences 2014; 27 (3): 270–271. [Turkish]

Espa F, Dauvilliers Y, Ondze B, Billiard M, Besset A. Arousal reactions in sleepwalking and night terrors in adults: the role of respiratory events. Sleep 2002; 25: 32-36.

Fantini ML, Corona A, Clerici S, Ferini-Strambi L. Aggressive dream content without daytime aggressiveness in REM sleep behavior disorder. Neurology 2005;65(7):1010-1015.

Fernandez-Arcos A, Iranzo A, Serradell M, Gaig C, Santamaria J. The clinical phenotype of idiopathic REM sleep behavior disorder at presentation: a study in 203 consecutive patients. Sleep 2016 (in press).
Guilleminault C, Moscovitch A, Yuen K, Poyares D. Atypical sexual behavior during sleep. Psychosom Med 2002;64(2):328-336.

Ingravallo F, Poli F, Gilmore EV, Pizza F, Vignatelli L, Schenck CH, Plazzi G. Sleep related violence and sexual behavior in sleep: a systematic review of medical-legal case reports. J Clin Sleep Med 2014; 10: 927-935.

Iranzo A, Santamaría J. Severe obstructive sleepapnea/hypopnea mimicking REM sleep behaviordisorder. Sleep 2005;28(2):203-206.

Kennedy GA, Elzo F. Case studies of familial sexsomnia. Sleep and Biological Rhythms 2010; 8: A73-A74.

Kim SW, Schenck CH, Grant JE, Yoon G, Dosa P, Odlaug BL, Schreiber LRN, Hurwitz TD, Pfaus JG. The neurobiology of sexual desire. NeuroQuantology 2013; 2: 332-359.

Krol DG. Sexsomnia during treatment with a selective serotonin reuptake inhibitor. Tijdschr Psychiatr [J of Psychiatry] 2008; 50 (11): 735-739. [Dutch]

Mangan MA. A phenomenology of problematic sexual behavior occurring sleep. Arch Sex Behav 2004; 33: 287-293.

Mangan MA, Reips U-D. Sleep, sex, and the Web: surveying the difficult-to-reach clinical population suffering from sexsomnia. Behav Res Methods 2007; 39 (2): 233-236.

Morrison I; Rumbold JM; Riha RL. Medicolegal aspects of complex behaviours arising from the sleep period: a review and guide for the practising sleep physician. Sleep Medicine Reviews 2014; 18(3):249-260.

Muza RT, Lawrence M, Williams A. The reality of sexsomnia: characteristics and manifestations of sexsomnia. Sleep 2015; 38: A250.

Neto SMA, Pena-Pereira M, Sobreira ES, Chagas M, Fernandes RM, Eckeli AL, Tumas V. Sexsomnia in parkinson's disease patients. Sleep 2012; 35: A253-A254.

Organ A, Fedoroff JP. Sexsomnia: sleep sex research and its legal implications. Current Psychiatry Reports 2015; 17(5): 34. doi: 10.1007/s11920-015-0568-y.

Özcan H, Taşın C, Tandoğan M, ÖZakşit G. Uyku Esnasında Orgazm Olan İki Kadın. [Two women having orgasms during sleep]. Düşünen Adam Psikiyatri ve Nörolojik Bilimler Dergisi 2012; 25: 187–188. [Turkish]

Pelin Z, Yazla E. Abnormal sexual behavior during sleep in temporal lobe epilepsy: a case report. Balkan Med J 2012; 29: 211-213. Penas-Martinez ML, Guerrero-Peral AL, Toledano-Barrero AM, et al. Sexsomnia: descripcion de un nuevo caso. [Sexsomnia: description of a new case]. Revista de Neurologia 2008; 47 (6): 331-332. [Spanish]

Pressman MR. Hypersynchronous delta sleep EEG activity and sudden arousals from slow-wave sleep in adults without a history of parasomnias: clinical and Forensic implications. Sleep 2004;27(4):706-710.

Pressman MR. Disorders of arousal from sleep and violent behavior: the role of physical contact and proximity. Sleep 2007a; 30: 1039-1047. Pressman MR, Mahowald MW, Schenck CH, Bornemann MC. Alcohol-induced sleepwalking or confusional arousal as a defense to criminal behavior: a review of scientific evidence, methods and forensic considerations. J Sleep Res 2007b; 16(2):198-212.

Pressman MR, Mahowald MW, Schenck CH, Cramer Bornemann MA, Banerjee D, Buchanan P, Zadra A. Alcohol, sleepwalking and violence: lack of reliable scientific evidence. Brain 2013; 136(Pt 2):e229. doi: 10.1093/brain/aws248.

Pressman MR1, Grunstein RR, Mahowald MW, Schenck CH, Montplaisir JY, Bornemann MC, Zadra A, Buchanan PR. Alcohol and sleep review: flawed design, methods, and statistics cannot support conclusions. Alcohol Clin Exp Res 2015;39(5): 941-3.doi: 10.1111/acer.12712.