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 sleep-sex, 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.