Sexsomnia: A Specialized Non-REM Parasomnia?

OBJECTIVE: To describe patients with sexsomnia and to contrast their clinical and sleep measures with those of healthy controls and sleepwalkers.

METHODS: Subjects referred for sexsomnia and for sleepwalking/night terror were interviewed, completed the Paris Arousal Disorder Severity Scale (PADSS) and were monitored one to two nights with video-polysomnography.

RESULTS: Seventeen patients (70.6% male, aged 17 to 76 years) had sexsomnia, with amnestic fondling of the bed partner (n=11), complete sexual intercourse (n=8), masturbation (n=8) and spontaneous orgasm (n=1). The sexual behaviors were more direct during sleep than during wakefulness (n=12), leading to 6 sexual assaults, including intra-conjugal rape (n=3), assault of a family member (n=2), rape of a friend (n=1) and forensic consequences (n=2). In 47% of sexsomnia patients, there was a history or current occurrences of sleepwalking/night terrors. Patients with sexsomnia had more N3 awakenings than healthy matched controls and the same amount as regular sleepwalkers. Half of them presented evidence of cortico-cortical dissociation, including concomitant slow (mostly frontal) and rapid (mostly temporal and occipital) EEG rhythms, with concomitant N3 penile erection in one case. Of 89 sleepwalkers, 10% had previous episodes of amnestic sexual behaviors, with a higher PADSS-A score and a trend of a higher total PADSS score than the 80 sleepwalkers without sexsomnia.

CONCLUSION: In this single-center series, we confirmed the male predominance of sexsomnias and its potential for severe clinical and forensic consequences. The results suggest a continuum of regular sleepwalking, sleepwalking with occasional sexsomnia and quasi-exclusive sexsomnia.