Skip to main content

Abnormal Sexual Behavior During Sleep: Sexsomnia and More

Sleep and Vigilance volume 3, pages 81–89 (2019)Cite this article

Abstract

Background

The purpose of the paper was to describe cases of abnormal sexual behavior during sleep in Saudi Arabian patients and classify them under the pertinent subtype.

Methods

Patients diagnosed with abnormal sexual behavior during sleep received a clinical interview and underwent video-polysomnography recordings at the University Sleep Disorders Center, King Saud University Medical City, Riyadh.

Results

Three men and one woman between 27 and 46 years of age reported abnormal sexual behaviors during sleep, with duration of symptoms ranging from 4 months to 3 years. Episodes consisted of masturbation without seeking the participation of a sleeping partner (case no. 1), attempts at sexual intercourse with inappropriate and uncharacteristic vocalizations and behaviors (cases no. 2 and 3), and rapid eye movement (REM) behavior disorder (RBD) presenting with abnormal sexual behavior (case no. 4). The frequency of the episodes ranged from 1–3 per week to 2–3 per night. Cases 1, 2, and 3 were amnestic of these events and expressed surprise to their partners’ account of their behavior. However, case no. 4 had a full recall of the event.

Conclusions

Sexsomnia (a non-REM parasomnia) is characterized by abnormal sexual behavior during sleep ranging from masturbation to inappropriate attempts at achieving sexual intercourse followed by total amnesia of the event. Nevertheless, REM behavioral disorder can, at times, present as abnormal sexual behavior during sleep, like sexual dream enactments, which may mimic sexsomnia. Therefore, the condition warrants diagnostic consideration as abnormal sleep-related sexual behavior.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Shapiro CM, Trajanovic NN, Fedoroff JP. Sexsomnia—a new parasomnia? Canadian journal of psychiatry Revue canadienne de psychiatrie. 2003;48(5):311–7. https://doi.org/10.1177/070674370304800506.

    Article  PubMed  Google Scholar 

  2. Schenck CH. Update on sexsomnia, sleep related sexual seizures, and forensic implications. NeuroQuantology. 2015;13(4):518–41. https://doi.org/10.14704/nq.2015.13.4.873.

    Article  Google Scholar 

  3. American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Darien: American Academy of Sleep Medicine; 2014.

    Google Scholar 

  4. Pandi-Perumal SR, BaHammam AS, Shapiro CM. Parasomnias. In: Stolerman I, Price LH, editors. Encyclopedia of psychopharmacology. 2nd ed. Berlin: Springer; 2015. p. 1210.

    Google Scholar 

  5. Avidan AY, Kaplish N. The parasomnias: epidemiology, clinical features, and diagnostic approach. Clin Chest Med. 2010;31(2):353–70. https://doi.org/10.1016/j.ccm.2010.02.015.

    Article  PubMed  Google Scholar 

  6. Almeneessier AS, BaHammam AS. A snoring man with an abnormal sexual behavior. J Nat Sci Med. 2018;1(2):85–8.

    Google Scholar 

  7. Rouzi AA, Sahly N, Sawan D, Kafy S, Alzaban F. The prevalence of sexual dysfunction in the female health care providers in Jeddah, Saudi Arabia. Sci Rep. 2015;5:7905. https://doi.org/10.1038/srep07905.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Al-Zahrani A. Women’s sexual health care in Saudi Arabia: a focused ethnoaphic study. Sheffield: University of Sheffield; 2011.

    Google Scholar 

  9. Mohebbi A, Holoyda BJ, Newman WJ. Sexsomnia as a defense in repeated sex crimes. J Am Acad Psychiatry Law. 2018;46(1):78–85.

    PubMed  Google Scholar 

  10. Dubessy AL, Leu-Semenescu S, Attali V, Maranci JB, Arnulf I. Sexsomnia: a specialized non-REM parasomnia? Sleep. 2017;40(2):zsw043. https://doi.org/10.1093/sleep/zsw043.

    Article  Google Scholar 

  11. Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL, et al. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, Version 2.1. Darien: American Academy of Sleep Medicine; 2014. http://www.aasmnet.org. Accessed 15 Nov 2018.

  12. Andersen ML, Poyares D, Alves RS, Skomro R, Tufik S. Sexsomnia: abnormal sexual behavior during sleep. Brain Res Rev. 2007;56(2):271–82. https://doi.org/10.1016/j.brainresrev.2007.06.005.

    Article  PubMed  Google Scholar 

  13. Wong K. Masturbation during sleep—a somnambulistic variant. Singap Med J. 1986;27(6):542–3.

    CAS  Google Scholar 

  14. Muza R, Lawrence M, Drakatos P. The reality of sexsomnia. Curr Opin Pulm Med. 2016;22(6):576–82. https://doi.org/10.1097/MCP.0000000000000321.

    Article  PubMed  Google Scholar 

  15. Buchanan A. Sleepwalking and indecent exposure. Med Sci Law. 1991;31(1):38–40. https://doi.org/10.1177/002580249103100107.

    Article  CAS  PubMed  Google Scholar 

  16. Guilleminault C, Moscovitch A, Yuen K, Poyares D. Atypical sexual behavior during sleep. Psychosom Med. 2002;64(2):328–36.

    Article  PubMed  Google Scholar 

  17. Fenwick P. Sleep and sexual offending. Med Sci Law. 1996;36(2):122–34. https://doi.org/10.1177/002580249603600207.

    Article  CAS  PubMed  Google Scholar 

  18. Arnulf I, Zhang B, Uguccioni G, Flamand M, Noel de Fontreaux A, Leu-Semenescu S, et al. A scale for assessing the severity of arousal disorders. Sleep. 2014;37(1):127–36. https://doi.org/10.5665/sleep.3322.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Chung SA, Yegneswaran B, Natarajan A, Trajanovic N, Shapiro CM. Frequency of sexsomnia in sleep clinic patients. Sleep. 2010;33:A226.

    Google Scholar 

  20. Bjorvatn B, Gronli J, Pallesen S. Prevalence of different parasomnias in the general population. Sleep Med. 2010;11(10):1031–4. https://doi.org/10.1016/j.sleep.2010.07.011.

    Article  PubMed  Google Scholar 

  21. Alkaabi S, Meyerovich MD, Yakubov B, Shapiro CM. Triggers of parasomnias—what sleep experts think? Disord Psychiatr Neurol J. 2018;1(1):1–8.

    Google Scholar 

  22. Schenck CH, Arnulf I, Mahowald MW. Sleep and sex: what can go wrong? A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences. Sleep. 2007;30(6):683–702.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Klein LA, Houlihan D. Relationship satisfaction, sexual satisfaction, and sexual problems in sexsomnia. Int J Sex Health. 2010;22(2):84–90. https://doi.org/10.1080/19317610903510489.

    Article  Google Scholar 

  24. Soca R, Keenan JC, Schenck CH. Parasomnia overlap disorder with sexual behaviors during sleep in a patient with obstructive sleep apnea. J Clin Sleep Med. 2016;12(8):1189–91. https://doi.org/10.5664/jcsm.6066.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Della Marca G, Dittoni S, Frusciante R, Colicchio S, Losurdo A, Testani E, et al. Abnormal sexual behavior during sleep. J Sex Med. 2009;6(12):3490–5. https://doi.org/10.1111/j.1743-6109.2009.01371.x.

    Article  PubMed  Google Scholar 

  26. Oudiette D, De Cock VC, Lavault S, Leu S, Vidailhet M, Arnulf I. Nonviolent elaborate behaviors may also occur in REM sleep behavior disorder. Neurology. 2009;72(6):551–7. https://doi.org/10.1212/01.wnl.0000341936.78678.3a.

    Article  CAS  PubMed  Google Scholar 

  27. Postuma RB, Montplaisir JY, Pelletier A, Dauvilliers Y, Oertel W, Iranzo A, et al. Environmental risk factors for REM sleep behavior disorder: a multicenter case-control study. Neurology. 2012;79(5):428–34. https://doi.org/10.1212/WNL.0b013e31825dd383.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Postuma RB, Montplaisir JY. Antidepressants and REM behavior disorder. Sleep. 2014;37(8):1395. https://doi.org/10.5665/sleep.3940.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Aurora RN, Zak RS, Maganti RK, Auerbach SH, Casey KR, Chowdhuri S, et al. Best practice guide for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med. 2010;6(1):85–95.

    PubMed  PubMed Central  Google Scholar 

  30. Boeve BF. Idiopathic REM sleep behaviour disorder in the development of Parkinson’s disease. Lancet Neurol. 2013;12(5):469–82. https://doi.org/10.1016/S1474-4422(13)70054-1.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Mysliwiec V, Brock MS, Creamer JL, O’Reilly BM, Germain A, Roth BJ. Trauma associated sleep disorder: a parasomnia induced by trauma. Sleep Med Rev. 2018;37:94–104. https://doi.org/10.1016/j.smrv.2017.01.004.

    Article  PubMed  Google Scholar 

  32. Khawaja IS, Hurwitz TD, Schenck CH. Sleep-related abnormal sexual behaviors (sexsomnia) successfully treated with a mandibular advancement device: a case report. J Clin Sleep Med. 2017;13(4):627–8. https://doi.org/10.5664/jcsm.6560.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bejot Y, Juenet N, Garrouty R, Maltaverne D, Nicolleau L, Giroud M, et al. Sexsomnia: an uncommon variety of parasomnia. Clin Neurol Neurosurg. 2010;112(1):72–5. https://doi.org/10.1016/j.clineuro.2009.08.026.

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by the Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia (MED511-02-08). The study sponsors played no role in the study design, the collection, analysis or interpretation of data, writing the manuscript, or the decision to submit the manuscript.

Author information

Authors and Affiliations

  1. Department of Medicine, College of Medicine, The University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia

    AbdulRouf Pirzada, Aljohara S. Almeneessier & Ahmed S. BaHammam

  2. Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Aljohara S. Almeneessier

Authors
  1. AbdulRouf Pirzada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aljohara S. Almeneessier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmed S. BaHammam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aljohara S. Almeneessier.

Ethics declarations

Conflict of interest

The authors have conflict of interest to declare.

Research involving human participants and/or animals

The study was approved by the Institutional Review Board, King Saud University and informed consent was obtained from the participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Pirzada, A., Almeneessier, A.S. & BaHammam, A.S. Abnormal Sexual Behavior During Sleep: Sexsomnia and More. Sleep Vigilance 3, 81–89 (2019). https://doi.org/10.1007/s41782-019-00057-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41782-019-00057-5

Keywords

  • Parasomnia
  • Obstructive sleep apnea
  • REM sleep behavior disorder
  • NREM sleep
  • Sex