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Sexsomnia
Pronunciation	/sɛkˈsɒmni.ə/
Specialty	Psychiatry, sleep medicine
Complications	Allegations of sexual assault; rape
Causes	stress, sleep deprivation, pre-existing parasomnia conditions, consumptions of alcohol or drugs
Diagnostic method	Based on symptoms, clinical studies
Treatment	medications, anticonvulsant therapy, CPAP

Sexsomnia, also known as sleep sex, is a distinct form of parasomnia, or an abnormal activity that occurs while an individual is asleep. Sexsomnia is characterized by an individual engaging in sexual acts while in non rapid eye movement (NREM) sleep. Sexual behaviors that result from sexsomnia are not to be mistaken with normal nocturnal sexual behaviors, which do not occur during NREM sleep. Sexual behaviors that are viewed as normal during sleep and are accompanied by extensive research and documentation include nocturnal emissions, nocturnal erections, and sleep orgasms.

Sexsomnia can present in an individual with other pre-existing sleep-related disorders.

While parasomnia disorders like somnabulism (sleep walking), sleep talking, and night terrors are widely researched and discussed, lack of research and hesitance associated with the discussion of the disorder arises from its sexually aggressive nature. Although they may appear to be fully awake, individuals who suffer from sexsomnia often have no recollection of the sexual behaviors they exhibit while asleep.

In some cases, a medical diagnosis of sexsomnia has been used as a criminal defense in court for alleged sexual assault and rape cases.

Classification

Anatomy of the human brain.

DSM-5 Criteria

Under DSM-5 criteria, there are 11 diagnostic groups that comprise sleep-wake disorders. These include, Insomnia disorder, Hypersomnolence disorder, Narcolepsy, Obstructive sleep apnea hypopnea, Central sleep apnea, Sleep-related hypoventilation, Circadian rhythm sleep-wake disorders, Non–rapid eye movement (NREM) sleep arousal disorders, Nightmare disorder, Rapid eye movement (REM) sleep behavior disorder, Restless legs syndrome, and substance-medication-induced sleep disorder. Sexsomnia is classified under NREM arousal parasomnia.

NREM arousal parasomnia

Parasomnia disorders are classified into the following categories:

• arousal disorders
• sleep-wake transition disorders
• parasomnias associated with REM sleep

Symptoms

Symptoms

Symptoms of sexsomnia include, but are not limited to:

• masturbation
• fondling
• intercourse with climax
• sexual assault or rape

Reports of masturbation during sleep was first reported as a clinical disorder in 1986. The case involved a 34 year old male who was reported to masturbate each night until climax, even after reporting to have had sexual intercourse with his wife each night before falling asleep. Through the use of video-polysomnography (vPSG), a documented case of sexsomnia was able to provide further information into the nature of this unusual form of parasomnia.

A confusing characteristic for those witnessing an individual in an episode of sexsomnia is the appearance of their eyes being open. Though the eyes are described as being "vacant" and "glassy", they give the appearance of the individual being awake and conscious, although the individual is completely unconscious and unaware of their actions.

Causes

Symptoms of sexsomnia can be caused by or be associated with:

• stress factors
• sleep deprivation
• Consumption of alcohol or other drugs
• Pre-existing parasomnia behaviors

Sleep deprivation is known to have negative effects on the brain and behavior. Extended periods of sleep deprivation often results in the malfunctioning of neurons, directly effecting an individual's behavior. While muscles are able to regenerate even in the absence of sleep, neurons are incapable of this ability. Specific stages of sleep are responsible for the regeneration of neurons while others are responsible for the generation of new synaptic connections, the formation of new memories, etc.

Zolpidem, widely known the sedative Ambien, is used as common treatment for insomnia and has been seen to result in sexsomnia as an adverse effect.

Sexsomnia can also be triggered by physical contact initiated by a partner, or an individual sharing the same bed.

Risk factors

Sexsomnia affects individuals of all age groups and backgrounds but present as an increased risk for individuals who possess the following:

• coexisting sleep disorders
• sleep disruption secondary to obstructive sleep apnea
• sleep related epilepsy
• certain medications

Behaviors of pelvic thrusting, sexual arousal, and orgasms are often attributed to sleep related epilepsy disorder. In some cases, physical contact with a partner in bed acted as a trigger to initiate sexsomia behaviors.

Medications, such as the commonly prescribed treatment for insomnia, Ambien, have been shown to induce symptoms commonly associated with sexsomnia.

Like sleep-related eating disorders, sexsomnia presents more commonly in adults than children. However, these individuals usually have a history of parasomnias that began during childhood.

Effects

It is possible for an individual who suffers from sexsomnia to experience a variety of negative emotions due to the nature of their disorder. The following are commonly seen secondary effects of sexsomnia:

• Anger
• Confusion
• Denial
• Frustration
• Guilt
• Repulsion
• Shame

The effects of sexsomnia also extend to those in relationship with the sufferer. Whether the significant other is directly involved, in the case of sexual intercourse, or a bystander, in the case of masturbation behavior, they are often the first to recognize the abnormal behavior. These abnormal sexual behaviors may be unwanted by the partner, which could lead to the incident being defined as sexual assault.

Mechanism

NREM Sleep

Non Rapid Eye Movement sleep, or NREM, consists of three stages. Stage 1 is described as "drowsy sleep" or "somnolence" and is characterized by breathing rates becoming increasingly more consistent, the beginning of a decrease in muscle activity, and a decrease in heart rate.The typical duration of Stage 1 is around 10 minutes and accounts for approximately 5% of an individual's total sleep. Stage 2 is characterized by further decline in muscle activity accompanied by a fading sense of consciousness of surroundings. Brain waves during Stage 2 are seen in the theta range. Stage 2 accounts for approximately 45-50% of an individual's total sleep. Stage 3 is the final stage of NREM sleep and the most common for parasomnias to occur. Also known as slow wave sleep (SWS), Stage 3 is characterized by brain temperature, respiratory rate, heart rate, and blood pressure being measured at their lowest. Representing approximately 15-20% of an individual's total sleep, brain waves during this stage are seen in the delta range. When an individual awakes during this stage, they are likely to exhibit grogginess and require up to thirty minutes to regain normal function and consciousness.

Diagnosis

Though there it is not possible for a definitive diagnosis of sexsomnia, a series of factors are considered to determine the presence of the condition. Clinical tests may also be utilized for further study.

Determining Factors

Though there it is not possible for a definitive diagnosis of sexsomnia, a series of factors are considered to determine the presence of the condition. Factors include but are not limited to:

• a family history of somnabulism, or sleepwalking
• prior episodes of somnabulism
• disorientation when awoken
• observed confusional or autonomic behavior
• amnesia of episode
• trigger factors the individual posses
• lack of regard to conceal episode and
• the nature of event compared to the individual's baseline character

Clinical Tests

Electroencephalography

Electroencephalograms, or EEG, are tests used to depict electrical activity and waves produced by the brain. This test has the ability to detect abnormalities that are associated with disorders that affect brain activity. Episodes of sexsomnia occur most commonly during slow-wave-sleep, or SWS. During this stage of sleep, brain waves tend to slow down and become larger. Through the use of electroencephalography, health professionals are able to determine if the sexual behaviors are occurring non-REM sleep or if the individual is fully conscious.

Polysomnography

Polysomnography is a study conducted while the individual being observed is asleep. A polysomnograph (PSG) is a recording of an individual's body functions as they sleep. Complete sleep studies are most commonly facilitated at a designated sleep center. Specialized electrodes and monitors are connected to the individual and remain in place throughout study. Video cameras can be used in certain cases to record physical behaviors occurring while the individual is asleep. Typically the unwanted sexual behaviors do not present on film, therefore the majority of information is taken from a sleep study.

The image above depicts an individual undergoing a sleep study.

Body functions measured by a PSG include:

• inspiratory and expiratory air flow
• oxygen saturation in blood
• respiratory effort
• respiratory rate
• eye movements
• brain waves
• electrical activity in muscles
• position of body

Polysomongraphy is also used to aid in the diagnosis of other sleep disorders such as obstructive sleep apnea (OSA), narcolepsy, and restless leg syndrome (RLS). Normal test results show little to no episodes of sleep apnea and normal electrical activity in the individual's brain and muscles during sleep.

Prevention

Since there is not an FDA-approved medication on the market specifically designed for the treatment of sexsomnia, health professionals attempt to treat the disorder through a variety of approaches. Among the first line of prevention for sexsomnia involves creating and maintaining a safe environment for all who are affected as a result of the disorder. Precautionary measures include, but are not limited to, the individual in question sleeping in a separate bedroom and the installation of locks and alarms on doors.

Treatment

Pictured above is an individual wearing a CPAP device.

Treatment for sexsomnia involves one or more of the following:

• prescription medications
• CPAP
• lifestyle changes

Medications

Clonazepam, commonly referred to as Klonopin, has been prescribed as treatment for sexsomnia. This medication is classified as a benzodiazepine and works by acting on the GABA-A receptors present in the central nervous system (CNS). Benzodiazepines open the chloride channels to allow chloride to enter the neuron. The most common use of this medication is for the treatment of anxiety, seizures, panic disorders, and sleep disorders. Anticonvulsant therapy is used to treat sexual behaviors that result secondary to sleep related epilepsy.

CPAP

Continuous positive airway pressure is commonly used as treatment for sleep apnea. In cases where the individual suffered from both sleep apnea and sexual behaviors consistent with sexsomnia, the implementation of a continuous positive airway pressure resulted in a complete discontinuation of unwanted behaviors.

Lifestyle Changes

Positive lifestyle changes are encouraged for individuals suffering with sexsomnia. Reducing stress and anxiety triggers may reduce the likelihood of an exacerbation of the disorder. The use of open discussion and understanding between couples decrease the negative emotional feelings and stress felt and generates a support system.

Research

Research findings for sexsomnia first appeared in 1996 publication by Colin Shapiro and Nik Trajanovic of the University of Toronto. In the most recent study of sexsomnia, 832 individuals were surveyed at a sleep disorder center. Among these individuals, 8% reported sexual behaviors consistent with sexsomnia, with men reporting three times more frequently than women.

Researchers of sexsomnia speculate underrepresentation and lack of reporting due to the shame felt by those who suffer from this disorder. Considering 4% of the population of the world suffers from sleep walking, it is possible a larger percentage of the population is also experiencing these behaviors.

Society and Culture

Sexsomnia has begun to gain attention through its exposure on television, news platforms, and social media outlets.

Media Exposure

Articles regarding sexsomnia continue to circulate on Glamour.com, the Huffington Post, and Refinery 29 among many others. Increased exposure has resulted in a conversation between those who have the disorder and those directly affected. Sexsomnia has also been featured in popular television series including House, MD, Law and Order: Special Victims Unit, and Desperate Housewives.

Legal Cases

Sex Offender Controversies

The number of sex offenders claiming sexsomnia as the cause of their offenses is rapidly growing. The Australasian Sleep Association has urged qualified physicians to contribute in expert testimony in such cases to ensure the individual's claims are valid and not just an attempt to be released of sexual offense charges.

Smith v. State

Smith v. State of Georgia officially established a separate affirmative defense for the unconscious. According to the defense, "A person who commits an act during unconsciousness or sleep has not committed a voluntary act and is not criminally responsible for the act." In order for the incident to be recognized by the State of Georgia, the accused must have voluntarily committed the act and exhibited intent to carry out the act.

Swedish Man Acquitted of Rape with Sexsomnia Defense

Mikael Halvarsson was acquitted of rape in Sweden due to the sexsomnia defense. Charges were brought against Halvarsson after reports of sexual assault were filed by his girlfriend at the time. Upon investigation, Halvarsson was found still asleep in the alleged victim's bed when police arrived. During the appeal, a previous girlfriend of Halvarsson testified of similar behavior she had observed in the past, as well as his mother reporting unusual sleep behaviors beginning at a young age.

See Also

• Automatism
• Nocturnal emission
• Somnabulism
• Somniloquy
• Parasomnia
• Sleep Medicine

References

Category:Psychiatric diagnosis Category:Sleep disorders Category:Sleeplessness and sleep deprivation