Wide range of sleep-related disorders associated with abnormal sexual behaviors, experiences

A paper published in the June 1st issue of the journal SLEEP is the first literature review and formal classification of a wide range of documented sleep-related disorders associated with abnormal sexual behaviors and experiences.

These abnormal sexual behaviors, which emerge during sleep, are referred to as "sleepsex" or "sexsomnia".

"It seems that more and more reports are surfacing of abnormal sexual behaviors emerging during sleep," said Carlos H. Schenck, MD, a senior staff psychiatrist at the Minnesota Regional Sleep Disorders Center in Minneapolis and the lead author of the review. "While people may think this type of behavior is humorous, in reality it can be disturbing, annoying, embarrassing and a potentially serious problem for some individuals and couples. Despite their awareness of the condition, many sufferers often delay seeking help, either because they don't know that it's a medical disorder or for fear that others will instead judge it as willful behavior. This paper highlights the expanding set of sleep disorders and other nocturnal disorders known to be associated with abnormal sexual behaviors and experiences, or the misperception of sexual events. The legal consequences are also described and discussed."

Prior to the writing and publication of the review, Dr. Schenck and his colleagues conducted computerized literature searches of peer-reviewed journal articles and looked through textbooks and other sources for information on sexual activity during sleep or sexual behaviors associated with sleep disorders.

The following is a listing of sleep-related disorders and abnormal sexual behaviors and experiences that Dr. Schenck and his colleagues developed from their searches:

I. Parsomnias with abnormal sleep-related sexual behaviors (sexual vocalizations, masturbation, fondling another person, sexual intercourse with or without orgasm, aggressive sexual behaviors)

A. Confusional arousals, or CAs (with or without obstructive sleep apnea, or OSA)

B. Sleepwalking

C. REM sleep behavior disorder

II. Sleep-related sexual seizures (sexual vocalizations, libidinal hyperarousal, genital arousal, ictal orgasm, sexual automatisms, aggressive sexual behaviors)

III. Sleep disorders with abnormal sexual behaviors during wakefulness and wake-sleep transitions

A. Kleine-Levin syndrome (KLS), a rare sleep disorder characterized by recurrent and unusually long episodes of hypersomnia.

1. Broad range of hypersexual and deviant sexual arousal and behaviors

B. Severe chronic insomnia

1. Increased libido, genital arousal, compulsive sexual behaviors

C. Restless legs syndrome

1. Masturbation, rhythmic pelvic/coital-like movements

IV. Special Clinical Considerations

A. Narcolepsy

1. Compelling sexual hypnagogic/hypnopompic hallucinations and REM- onset dream attacks, cataplectic orgasm

B. Sleep exacerbation of persistent sexual arousal syndrome

1. Genital-sensory sexual arousal without increased libidinal arousal; sexual behaviors

C. Sleep-related painful erections and increased sexual activity

1. Increased sexual behaviors ? masturbation and intercourse

D. Sleep-related dissociative disorders

1. Pelvic movements and other sexualized behaviors, attempted reenactments of past sexual/physical abuse scenarios

E. Nocturnal psychotic disorders

1. Sexual delusions/hallucinations after awakenings

F. Miscellaneous sleep and sex associations

1. Masturbation, sexual intercourse, sexual hypnagogic/hypnopompic hallucinations with sleep paralysis

Those who think they might have a sleep disorder, with or without a related sexual disorder, are urged to discuss their problem with their primary care physician, who will issue a referral to a sleep specialist.

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