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MDLinxPeople with This Rare Condition Have Sex While They’re Asleep

Understanding Sexsomnia: Etiology, Diagnosis, and Management Strategies for a Rare Sleep Disorder with Significant Psychosocial and Medicolegal Implications

Sexsomnia, a rare sleep disorder involving sexual behaviors during sleep, poses unique diagnostic and management challenges for clinicians. It is classified under non–rapid eye movement (NREM) parasomnias and can result in serious psychosocial and legal consequences. Current management approaches emphasize behavioral and psychological treatments, as formal practice guidelines are lacking.

Key Points:

  • Definition and Classification:
    • Sexsomnia is a rare sleep disorder characterized by sexual activities during sleep, classified under NREM parasomnias, which include sleepwalking and sleep terrors.
    • Episodes can also occur during REM sleep, complicating the classification.
  • Prevalence and Onset:
    • The estimated lifetime prevalence of sexsomnia is 7.1%, similar to sleepwalking.
    • Unlike sleepwalking, which typically begins in childhood, sexsomnia usually manifests in adulthood.
  • Clinical Manifestations:
    • Common behaviors include sexual intercourse or attempts, masturbation (predominantly in women), pelvic thrusting, sexual vocalizations, and groping bed partners.
    • Reports of aggression, violence, and spontaneous sleep orgasms are also documented.
    • Patients often experience excessive daytime sleepiness, pain, and a diminished quality of life.
  • Diagnostic Approaches:
    • Diagnosis involves a comprehensive physical and psychiatric evaluation, patient and bed partner interviews, and dream report analysis.
    • Video-polysomnography can aid in diagnosing unusual cases, identifying triggers, and differentiating parasomnias from epilepsy.
    • EEG and functional brain imaging reveal wake-like activation in motor and limbic regions with increased sleep intensity in the frontoparietal network during episodes.
  • Treatment Strategies:
    • No formal practice guidelines exist for sexsomnia treatment.
    • Nonpharmacological strategies are generally preferred, including cognitive behavioral therapy, sleep hygiene, scheduled awakenings, and hypnosis.
    • Pharmacological treatments are used off-label and can have side effects; medications like zolpidem should be discontinued due to their potential to trigger NREM parasomnias.
    • Management of comorbid sleep disorders, such as insomnia, is crucial.

“Certain medications can instigate NREM parasomnias, such as zolpidem, and therefore patients should be advised to discontinue their use. Patients should also seek treatment for comorbid sleep disorders, such as insomnia.”

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