Sexsomina

Sexsomnia: A new parasomnia?
Shapiro, Colin M.. U Toronto, Trajanovic, Nikola N., Fedoroff, J. Paul.
The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie, Vol 48(5), Jun, 2003. pp. 311-317.
Abstract:
Describes a distinct parasomnia involving sexual behaviour, which the authors have named sexsomnia. Eleven patients (aged 16-43 yrs) with distinct behaviours of the sexual nature during sleep are described. The features in common with other nonrapid eye movement arousal parasomnias, such as sleepwalking are documented. Some patients had simply been referred to a tertiary sleep clinic for investigation of unrelated sleep problems. A small number had been involved in medicolegal issues. Sexsomnia has some distinct features that separate it from sleepwalking. The automatic arousal is more prominent, motor activities are relatively restricted and specific, and some form of dream mentation is often present. A significant number of patients with this unusual parasomnic behaviour were identified only after specific questions were asked, suggesting that the behaviour is more common than previously thought.

A phenomenology of problematic sexual behavior occurring in sleep.
Mangan, Michael A.
Archives of Sexual Behavior, Vol 33(3), Jun, 2004. pp. 287-293.
Abstract:
First-person reports of individuals’ experiences of problematic ‘sleep sex’ were collected in an Internet-based study. Qualitative analysis of 121 reports yielded 6 distinct themes: (1) fear and a lack of emotional intimacy; (2) guilt and confusion; (3) a sense of repulsion and feelings of sexual abandonment; (4) shame, disappointment, and frustration; (5) annoyance and suspicion; (6) embarrassment and a sense of ‘self-incrimination.’ Results suggest that sleep sex can elicit negative emotions and cognitions that may become a source of personal and relational distress. Clinician familiarity with problematic sleep sex may foster more effective communication with individuals presenting with such complaints.

Sleep, sex, and the Web: Surveying the difficult-to-reach clinical population suffering from sexsomnia.
Mangan, Michael A., Reips, Ulf-Dietrich.
Behavior Research Methods, Vol 39(2), May, 2007. pp. 233-236.
Abstract:
One major advantage of Web-based research lies in its ability to reach and study people who have rare conditions of interest. Another advantage is that, due to the anonymity of the survey situation, the Internet is particularly suited for surveys on sensitive topics. Sexsomnia is a newly identified medical condition whose sufferers engage in sexual behavior during their sleep. Problematic cases are highly distressing and have forensic implications. The consensus among opinion leaders in sleep medicine is that sexsomnia may be quite common but that it often goes unreported because of shame and embarrassment. Thus, little is known about this condition’s demographics and clinical features. This article reports findings from a sample analysis of 20 years of research on sexsomnia and discusses the results, strengths, and weaknesses of a recent Web-based survey conducted on the difficult-to-reach clinical population that suffers from sexsomnia.

Sleep and sex: What can go wrong? A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences.
Schenck, Carlos H., Arnulf, Isabelle, Mahowald, Mark W.
Sleep: Journal of Sleep and Sleep Disorders Research, Vol 30(6), Jun, 2007. pp. 683-702.
Abstract:
Study Objectives: To formulate the first classification of sleep related disorders and abnormal sexual behaviors and experiences. Design: A computerized literature search was conducted, and other sources, such as textbooks, were searched. Results: Many categories of sleep related disorders were represented in the classification: parasomnias (confusional arousals/sleepwalking, with or without obstructive sleep apnea; REM sleep behavior disorder); sleep related seizures; Kleine-Levin syndrome (KLS); severe chronic insomnia; restless legs syndrome; narcolepsy; sleep exacerbation of persistent sexual arousal syndrome; sleep related painful erections; sleep related dissociative disorders; nocturnal psychotic disorders; miscellaneous states. Kleine-Levin syndrome (78 cases) and parasomnias (31 cases) were most frequently reported. Parasomnias and sleep related seizures had overlapping and divergent clinical features. Thirty-one cases of parasomnias (25 males; mean age, 32 years) and 7 cases of sleep related seizures (4 males; mean age, 38 years) were identified. A full range of sleep related sexual behaviors with self and/or bed partners or others were reported, including masturbation, sexual vocalizations, fondling, sexual intercourse with climax, sexual assault/rape, ictal sexual hyperarousal, ictal orgasm, and ictal automatism. Adverse physical and/or psychosocial effects from the sleepsex were present in all parasomnia and sleep related seizure cases, but pleasurable effects were reported by 5 bed partners and by 3 patients with sleep related seizures. Forensic consequences were common, occurring in 35.5% (11/31) of parasomnia cases, with most (9/11) involving minors. All parasomnias cases reported amnesia for the sleepsex, in contrast to 28.6% (2/7) of sleep related seizure cases. Polysomnography (without penile tumescence monitoring), performed in 26 of 31 parasomnia cases, documented sexual moaning from slow wave sleep in 3 cases and sexual intercourse during stage 1 sleep/wakefulness in one case (with sex provoked by the bed partner). Confusional arousals (CAs) were diagnosed as the cause of ‘sleepsex’ (‘sexsomnia’) in 26 cases (with obstructive sleep apnea [OSA] comorbidity in 4 cases), and sleepwalking in 2 cases, totaling 90.3% (28/31) of cases being NREM sleep parasomnias. REM behavior disorder was the presumed cause in the other 3 cases. Bedtime clonazepam therapy was effective in 90% (9/10) of treated parasomnia cases; nasal continuous positive airway pressure therapy was effective in controlling comorbid OSA and CAs in both treated cases. All five treated patients with sleep related sexual seizures responded to anticonvulsant therapy. The hypersexuality in KLS, which was twice as common in males compared to females, had no reported effective therapy. Conclusions: A broad range of sleep related disorders associated with abnormal sexual behaviors and experiences exists, with major clinical and forensic consequences.

Sexsomnia: Abnormal sexual behavior during sleep.
Andersen, Monica L., Poyares, Dalva, Alves, Rosana S. C., Skomro, Robert. Tufik, Sergio.
Brain Research Reviews, Vol 56(2), Dec, 2007. pp. 271-282.
Abstract:
This review attempts to assemble the characteristics of a distinct variant of sleepwalking called sexsomnia/sleepsex from the seemingly scarce literature into a coherent theoretical framework. Common features of sexsomnia include sexual arousal with autonomic activation (e.g. nocturnal erection, vaginal lubrication, nocturnal emission, dream orgasms). Somnambulistic sexual behavior and its clinical implications, the role of precipitating factors, diagnostic, treatment, and medico-legal issues are also reviewed. The characteristics of several individuals described in literature including their family/personal history of parasomnia as well as the abnormal behaviors occurring during sleep are reported.

Sexual behaviour in sleep: An internet survey.
Trajanovic, Nikola N., Mangan, Michael. Shapiro, Colin M.
Social Psychiatry and Psychiatric Epidemiology, Vol 42(12), Dec, 2007. pp. 1024-1031.
Abstract:
The objective of the study was to provide further information related to newly described parasomnia variant, Sexual Behaviour in Sleep (SBS, sexsomnia). Previous studies dealt with selected population, typically middle-aged males, featuring extensive medico-legal exposure. At the same time, an anecdotal evidence suggested higher involvement of younger population, and skew towards balance between genders comparable to those seen in other non-Rapid Eye Movement (NREM) sleep parasomnias. The epidemiological information regarding this condition is still virtually non-existent. In order to sample this difficult-to-reach population, a 28-item Internet survey was posted on the sexsomniareference site and the link was also sent to prospective respondents (mostly registered visitors to this site). The respondents were able to complete the survey anonymously, which resulted in a need for the screening of bogus and duplicate results. At the end, a total of 219 validated responses were collected and analysed. The results showed greater representation of females (31% of the total number), and wider age distribution (mean age of 30.4 years). The respondents typically reported multiple sexsomnia episodes, in most cases precipitated by body contact, stress and fatigue. Relatively small number of respondents reported involvement of legal authorities (8.6% of males and 3% of females) and participation of minors in their sexsomnia (6% of the total sample). In spite of known limitations of such surveys, the study provided much needed insight into this complex nocturnal behaviour. It confirmed the anecdotal evidence about the gender and age distribution, and provided information on some key features, such as precipitating factors, type of behaviour, medication use, personal medical history and medico-legal aspects.

Abnormal sexual behavior during sleep.
Della Marca, Giacomo, Dittoni, Serena. Frusciante, Roberto. Colicchio, Salvatore. Losurdo, Anna. Testani, Elisa. Buccarella, Cristina. Modoni, Anna. Mazza, Salvatore. Mennuni, Gioacchino Francesco. Mariotti, Paolo. Vollono, Catello.
Journal of Sexual Medicine, Vol 6(12), Dec, 2009. pp. 3490-3495.
Abstract:
Introduction: Automatic, uncontrolled, and unaware sexual behaviors during sleep have occasionally been described. The clinical and polysomnographic features of nocturnal sexual behavior allow it to be considered a distinct parasomnia named ‘sexsomnia’. Recently, abnormal sexual behaviors during sleep have been evaluated in the forensic medical context because violent behaviors can be associated with this parasomnia. Aim: To describe the clinical and polysomnographic findings in three patients who referred to our sleep laboratory for sleep disorders and who reported episodes of sleep-related sexual activation. Main Outcome Measures: We analyzed video-polysomnographic recordings, sleep structure, sleep microstructure, and sleep-related respiratory events. Methods: The patients were three males aged 42, 32, and 46 years. All had unremarkable medical, neurological, and psychiatric histories. All underwent full-night polysomnography. Results: Each patient presented a distinct sleep disorder: one had severe obstructive sleep apnea syndrome (OSAS), one presented clinical and polysomnographic features of non-rapid eye movement (NREM) sleep parasomnia (somnambulism), and the third presented clinical and polysomnographic features of rapid eye movement behavior disorder. Conclusions: In our patients, the clinical and polysomnographic findings suggest that abnormal nocturnal sexual behavior can occur in association with distinct sleep disorders, characterized by different pathophysiologic mechanisms and distinctive treatments. Abnormal sexual behaviors during sleep should be investigated with polysomnography in order to define their pathophysiology and to establish appropriate treatments.

Relationship satisfaction, sexual satisfaction, and sexual problems in sexsomnia.
Klein, Liesa A.. Houlihan, Daniel.
International Journal of Sexual Health, Vol 22(2), Apr, 2010. pp. 84-90.
Abstract:
Relationship and sexual satisfaction, sexual functioning, and sexual desire were examined in an Internet sample of 32 individuals reporting engagement of sexual behavior during sleep (i.e., sexsomnia). Individuals with sexsomnia reported lower levels of sexual satisfaction, lower levels of relationship satisfaction, and similar levels of sexual desire compared with controls. More frequent incidence of sexsomnia resulted in lower sexual satisfaction; however, frequency was not found to impact relationship satisfaction or level of sexual desire. Individuals with sexsomnia reported high instances of sexual problems with 81% reporting at least one problem.

Spectrum of rapid eye movement sleep behavior disorder (overlap between rapid eye movement sleep behavior disorder and other parasomnias).
Schenck, Carlos H.. Howell, Michael J.
Sleep and Biological Rhythms, Vol 11(Suppl 1), Jun, 2013. pp. 27-34.
Abstract:
Parasomnia Overlap Disorder (POD) was described and named in 1997 with a series of 33 cases of rapid eye movement (REM) sleep behavior disorder (RBD) combined with a disorder of arousal from non-rapid eye movement (NREM) sleep (sleepwalking, sleep terrors) that emerged idiopathically or symptomatically with neurological and other disorders. POD is a subtype of RBD in the International Classification of Sleep Disorders Diagnostic and Coding Manual, second edition (ICSD-2). An updated classification of POD also includes subclinical RBD-NREM parasomnia, RBD-sleep-related eating disorder, RBD-sexsomnia, RBD-rhythmic movement disorder, and status dissociatus (SD), which is another subtype of RBD in the ICSD-2. Similar to POD, a core feature of SD is sleep motor-behavioral dyscontrol, with release of dream-related behaviors suggestive of RBD, but with nearly continuous ambiguous polygraphic sleep precluding the identification of NREM/REM sleep states. SD exemplifies extreme state dissociation. SD is always a symptomatic disorder, and is causally associated with a broad range of neurologic disorders, often with thalamic, limbic, striatal, and pontine involvement. The parasomnia behaviors associated with POD and SD—typical RBD behaviors—can often be controlled with bedtime clonazepam therapy, including the abnormal dreaming.

A scale for assessing the severity of arousal disorders.
Arnulf, Isabelle. Zhang, Bin. Uguccioni, Flamand, Mathilde. de Fontréaux, Alix Noël. Leu-Semenescu, Smaranda. Brion, Agnès.
Sleep: Journal of Sleep and Sleep Disorders Research, Vol 37(1), Jan 1, 2014. pp. 127-136.
Abstract:
Background: Arousal disorders may have serious health consequences. Objective: To develop a scale assessing the severity of arousal disorders (Paris Arousal Disorders Severity Scale, PADSS). Setting: University hospital. Design: Controlled study. Participants: Consecutive patients (older than 15 y), with sleepwalking (SW) and/or sleep terrors (ST), subjects with previous SW/ST, normal controls and patients with rapid eye movement sleep behavior disorder. Intervention: The self-rated scale listed 17 parasomniac behaviors (PADSS-A), assessed their frequency from never to twice or more per night (PADSS-B) and evaluated the consequences (PADSS-C: disturbed sleep, injuries, fatigue, and psychological consequences). The clinimetric properties and face validity of the scale were tested. Results: Half of the 73 patients with SW/ST (more men than women) had injured themselves or others, whereas 15% had concomitant sexsomniaand 23% had amnestic eating behaviors. The total PADSS score (range: 0-50) was 19.4 ± 6.3 (range: 8-36) in this group, 11.7 ± 5.9 in 26 subjects with previous SW/ST, 8.8 ± 3.2 in 26 patients with RBD, and 2.0 ± 3.5 in 53 normal controls (P < 0.05). The PADSS demonstrated high sensitivity (83.6%), specificity (87.8%), internal consistency, and test-retest reliability (0.79). The best cutoff for the total score was at 13/14. Exploratory factor analysis revealed two components: wandering and violence/handling. The complexity of behaviors emerging from N3 sleep (scored on videopolysomnography) positively correlated with scores for the PADSS-total, PADSS-A, PADSS-C, and the ‘violence/handling’ factor. Conclusion: This scale had reasonable psychometric properties and could be used for screening and stratifying patients and for evaluating the effects of treatments.

Medicolegal aspects of complex behaviours arising from the sleep period: A review and guide for the practising sleep physician.
Morrison, Ian. Rumbold, John M. Riha, Renata L.
Sleep Medicine Reviews, Vol 18(3), Jun, 2014. pp. 249-260.
Abstract:
[Correction Notice: An Erratum for this article was reported in Vol 18(6) of Sleep Medicine Reviews (see record 2014-54105-011). In the original article, the authors regret that there is an error on page 256. The corrections are present in the erratum.] This review is aimed at summarizing the current state of knowledge regarding parasomnias, which have been implicated in medicolegal cases as well as providing guidance to those working within common-law jurisdictions regarding the technical aspects of the law. Sleepwalking and sexsomnia as a defence are being raised more frequently in criminal cases and there has been public debate on their validity. Unfortunately, expert evidence on forensic sleep disorders continues to be heavily opinion-based with the potential for miscarriages of justice seen in recent highly publicized cases. There is an apparent inertia in research into violent sleep disorders. We review the current state of forensic sleep science in the United Kingdom (UK) and abroad and discuss the need to formulate guidelines based on available evidence. We also highlight the pressing necessity for more research in this area as well as the need to reform the law, which is the subject of a recent Criminal Law Commission report in the United Kingdom. In time, this will facilitate the efficient, proportionate, and just disposal of violence arising from sleep, thus benefitting both society and the individual sufferer.