Update on Sexsomnia, Sleep Related Sexual Seizures, and Forensic Implications

Abstract

The first classification of sleep-related disorders and abnormal sexual behaviors and experiences was published in 2007. Parasomnias (abnormal sleep-related behaviors and experiences) and sleep-related epileptic seizures were the most frequently reported disorders, apart from Kleine-Levin syndrome (periodic hypersomnia with abnormal wakeful sexual behaviors). The first set of conditions were named sexsomnia (sleepsex) and epileptic (ictal) sexsomnia, respectively. Sexsomnia usually emerges during confusional arousals (CAs) from delta non-REM sleep (N3 sleep), either associated or unassociated with obstructive sleep apnea (OSA). We now report an additional 16 cases of sexsomnia and 2 cases of ictal sexsomnia (temporal lobe epilepsy; bupropion-induced seizures) published from 2007-2014, based on a literature search in PubMed and Embase. The demographics of the second group of 16 sexsomnia cases were similar to those of the first group of 31 cases, in regards to male gender predominance (75% vs. 81%); age at presentation (39 yrs vs. 32 yrs); age of onset (33 yrs vs. 26 yrs); and duration of sexsomnia in males (5.6 yrs vs. 8.3 yrs). The female groups were too small to compare. The distribution of sexual behaviors across the groups was generally comparable in regards to sexual vocalizations, masturbation, fondling, and intercourse/attempted intercourse. Amnesia for the sexsomnia by the affected person was 100% in both groups. Video-polysomnographic studies were conducted in nearly all patients in both groups, and provided important diagnostic findings in almost all patients. The mean number of parasomnias per patient was 1.9+1.4 vs. 2.2+1.0, respectively, with the range extending up to 5 parasomnias per patient. In both groups, a non-REM sleep parasomnia (disorder of arousal [DOA]) was the main cause of the sexsomnia (75% vs. 90%), including a comparable percentage in each group having obstructive sleep apnea (OSA) as the presumed trigger for a DOA with sexsomnia (18.7% vs. 12.9%), which was strongly supported by the control of both sexsomnia and OSA with therapy of OSA with nasal CPAP in 100% (4/4) of treated cases. Overall treatment efficacy was very high in the combined groups (82% [18/22]). Eight novel findings on sexsomnia and ictal sexsomnia were identified. The forensic implications of sexsomnia are discussed.