1 Second, there is an expanding set of sleep disorders and other nocturnal disorders known to be associated with abnormal sexual behaviors, or the misperception of sexual behaviors. First, there is growing awareness that abnormal sexual behaviors can emerge during sleep, described as “sleepsex,” “atypical sexual behavior during sleep” and “sexsomnia.” 2– 4 The ICSD-2 recognized this phenomenon as a parasomnia classified as a variant of confusional arousals (and sleepwalking). We now present such a classification for several reasons. THE RECENTLY REVISED INTERNATIONAL CLASSIFICATION OF SLEEP DISORDERS-2 ND EDITION ( ICSD-2) CONTAINS A SUBSTANTIALLY UPDATED SECTION ON THE parasomnias, which encompass sleep related behaviors, emotions, perceptions, dreaming, and autonomic nervous system events during entry into sleep, within sleep, or during arousals from sleep.” 1 Instinctual behaviors are often released inappropriately, as seen with sleepwalking (locomotion), REM sleep behavior disorder (aggression), sleep related eating disorder (feeding), and confusional arousals (sexual behaviors).Ī classification of sleep related disorders associated with abnormal sexual behaviors and experiences, to our knowledge, has not been published. The hypersexuality in KLS, which was twice as common in males compared to females, had no reported effective therapy. All five treated patients with sleep related sexual seizures responded to anticonvulsant therapy. 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. REM behavior disorder was the presumed cause in the other 3 cases. Confusional arousals (CAs) were diagnosed as the cause of “sleepsex” (“sexsomnia”) in 26 cases (with obstructive sleep apnea comorbidity in 4 cases), and sleepwalking in 2 cases, totaling 90.3% (28/31) of cases being NREM sleep parasomnias. 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). All parasomnias cases reported amnesia for the sleepsex, in contrast to 28.6% (2/7) of sleep related seizure cases. Forensic consequences were common, occurring in 35.5% (11/31) of parasomnia cases, with most (9/11) involving minors. 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. 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. 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. ![]() Parasomnias and sleep related seizures had overlapping and divergent clinical features. Kleine-Levin syndrome (78 cases) and parasomnias (31 cases) were most frequently reported. 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.
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