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Andersen ML, Schenck CH, Tufik S. Understanding Sexual Parasomnias: A Review of the Current Literature on Their Nature, Diagnosis, Impacts, and Management. Sleep Med Clin 2024; 19:21-41. [PMID: 38368067 DOI: 10.1016/j.jsmc.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Sexual behavior during sleep, known as sexual parasomnias, has captured the interest of researchers and clinicians. These parasomnias involve various sexual activities that occur unconsciously during sleep. Although relatively rare, they can profoundly affect well-being and relationships and can carry legal consequences. Understanding their nature, prevalence, and causes is crucial for advancing knowledge in this field. This article revisits the topic of sexsomnia, presenting new data and discussing cases published from 2007 to 2023. By analyzing these cases, we aim to enhance recognition, diagnosis, and management of sexsomnia, reducing stigma and providing better support for affected individuals.
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Affiliation(s)
- Monica Levy Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Sleep Institute, São Paulo, Brazil.
| | - Carlos H Schenck
- Department of Psychiatry, Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center and University of Minnesota Medical School, R7701 Park Avenue, Minneapolis, MN 55415, USA
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Sleep Institute, São Paulo, Brazil
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Mainieri G, Loddo G, Provini F, Nobili L, Manconi M, Castelnovo A. Diagnosis and Management of NREM Sleep Parasomnias in Children and Adults. Diagnostics (Basel) 2023; 13:diagnostics13071261. [PMID: 37046480 PMCID: PMC10093221 DOI: 10.3390/diagnostics13071261] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Non-rapid eye movement (NREM) sleep parasomnias are recurrent abnormal behaviors emerging as incomplete arousals out of NREM sleep. Mounting evidence on NREM sleep parasomnias calls for an update of clinical and therapeutical strategies. In the current review, we summarize the state of the art and provide the necessary background to stimulate a critical revision of diagnostic criteria of disorders of arousal (DoA), the most common NREM sleep parasomnia. In particular, we highlight the poor sensitivity of the diagnostic items related to amnesia and absence of conscious experiences during DoA episodes, encourage the role of video-polysomnography and home-video recordings in the diagnostic and treatment work-up, and suggest three levels of diagnostic certainty based on clinical and objective findings. Furthermore, we highlight current gaps of knowledge that prevent the definition of standard guidelines and future research avenues.
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Fernandez JD, Soca R. Sexsomnia in Active Duty Military: A Series of Four Cases. Mil Med 2023; 188:e436-e439. [PMID: 33822139 DOI: 10.1093/milmed/usab126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/26/2021] [Accepted: 03/23/2021] [Indexed: 01/11/2023] Open
Abstract
Sexsomnia is a type of non-rapid eye movement (NREM) parasomnia in which sexual behaviors arise during sleep; these behaviors are varied and can include masturbation, orgasms with or without self-stimulation, sexual vocalizations and talking, and sexual fondling and/or intercourse with the bed partner. The military creates a challenging environment, with sleep deprivation, shift work, and increased psychosocial stress that may predispose service members to an increased risk for all NREM parasomnias, including sexsomnia. Given that sexsomnia is sometimes invoked in sexual assault military lawsuits, it may behoove the military community to understand how this condition usually manifests so that its medicolegal implications can be addressed more clearly. Here, we present the largest case series of sexsomnia to date in active duty military service members, which adds to the limited literature on such cases in the military and to the broader but still growing literature on this rare disorder. We compare and contrast these cases with the available literature to highlight their similarities and differences in addition to commenting on the relevance of these cases in forensic investigations. As none of these cases were involved in legal issues, they could provide useful information about this rare condition in individuals who are less likely to be affected by the biases that are inherent to litigation.
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Affiliation(s)
- Juan D Fernandez
- Department of Adult Neurology, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD 20889, USA
| | - Rodolfo Soca
- Sleep Disorders Center, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD 20889, USA.,Department of Medicine, Uniformed Services University, Bethesda, MD 20889, USA
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Kim DS, Foster BE, Scott JA, Rizzo MM, Collen JF, Soca R. A rare presentation of sexsomnia in a military service member. J Clin Sleep Med 2021; 17:107-109. [PMID: 32959776 DOI: 10.5664/jcsm.8832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
NONE Sexsomnias are unconscious sexual behaviors during sleep (parasomnias) that are garnering more attention as they become increasingly evident in forensic cases. Presentations of sexsomnia in active duty service members are seldom described, and often evaluation is clouded by intoxication with substances such as alcohol, sleep deprivation, untreated sleep disturbances, or criminal behavior masquerading as a medical disorder. We present a case of a 40-year-old male soldier evaluated in our sleep clinic for multiple episodes of sleep masturbation occurring over a period of 2 years. The patient was concerned about his suitability for deployment to a combat zone and participation in field training exercises (both require sleeping in groups in an open environment). Video polysomnography confirmed moderate obstructive sleep apnea, and the patient showed improvement with continuous positive airway pressure therapy. The authors also discuss the relevance of this case compared with previously reported sexsomnia cases and expand on parasomnia topics that are more common in military populations.
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Affiliation(s)
- David S Kim
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Brian E Foster
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Internal Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jasmine A Scott
- F. Edward Herbert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Meagan M Rizzo
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Internal Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jacob F Collen
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Internal Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Rodolfo Soca
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Internal Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Schenck CH. RBD, sexsomnia, sleepwalking, and sleep paralysis comorbidities: relevance to pulmonary, dental, and behavioral sleep medicine. Sleep Sci 2021; 14:87-91. [PMID: 34381571 PMCID: PMC8340893 DOI: 10.5935/1984-0063.20210018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Carlos H. Schenck
- Minnesota Regional Sleep Disorders Center, Departments of Psychiatry,
Hennepin County Medical Center and University of Minnesota Medical School,
Minneapolis, USA
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Cramer Bornemann MA, Schenck CH, Mahowald MW. A Review of Sleep-Related Violence. Chest 2019; 155:1059-1066. [DOI: 10.1016/j.chest.2018.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 10/19/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022] Open
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Martynowicz H, Smardz J, Wieczorek T, Mazur G, Poreba R, Skomro R, Zietek M, Wojakowska A, Michalek M, Wieckiewicz M. The Co-Occurrence of Sexsomnia, Sleep Bruxism and Other Sleep Disorders. J Clin Med 2018; 7:jcm7090233. [PMID: 30142877 PMCID: PMC6162860 DOI: 10.3390/jcm7090233] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/19/2018] [Accepted: 08/19/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Sleep sex also known as sexsomnia or somnambulistic sexual behavior is proposed to be classified as NREM (non-rapid eye movement) parasomnia (as a clinical subtype of disorders of arousal from NREM sleep—primarily confusional arousals or less commonly sleepwalking), but it has also been described in relation to REM (rapid eye movement) parasomnias. Methods: The authors searched the PubMed database to identify relevant publications and present the co-occurrence of sexsomnia and other sleep disorders as a non-systematic review with case series. Results: In the available literature the comorbidity of sexsomnia and other sleep disorders were reported mainly in case reports and less in case series. Sexsomnia was reported both with one and with multiple sleep-related disorders, with NREM parasomnias and obstructive sleep apnea (OSA) being the most commonly reported. Furthermore, the authors enrich the article with new findings concerning two novel cases of sleep bruxism triggering recurrent sexsomnia episodes. Conclusions: Sexsomnia has still not been reported in the literature as often as other parasomnias. The coexistence of sexsomnia and other sleep-related disorders should be more thoroughly examined. This could help both in sexsomnia as well as other sleep-related disorders management.
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Affiliation(s)
- Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, 50-367 Wroclaw, Poland.
| | - Joanna Smardz
- Department of Experimental Dentistry, Wroclaw Medical University, 50-367 Wroclaw, Poland.
| | - Tomasz Wieczorek
- Department and Clinic of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland.
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, 50-367 Wroclaw, Poland.
| | - Rafal Poreba
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, 50-367 Wroclaw, Poland.
| | - Robert Skomro
- Division of Respiratory Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada.
| | - Marek Zietek
- Department of Periodontology, Wroclaw Medical University, 50-367 Wroclaw, Poland.
| | - Anna Wojakowska
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, 50-367 Wroclaw, Poland.
| | - Monika Michalek
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, 50-367 Wroclaw, Poland.
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 50-367 Wroclaw, Poland.
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