Sexsomnia: A Case Series Looking At A Rare Parasomnia

Abstract Introduction Sexsomnia is a male predominant, rare subset of NREM parasomnia involving sleep-related sexual activity. Symptoms can range from individual sexual acts, such as masturbation, to acts involving bed partners, often without recollection. Sexsomnia results in profound personal, social, and legal ramifications. Though typically treated with benzodiazepines, here we present three patients that were managed nontraditionally. Report of case(s) Case 1 A 34-year-old man with a history of optimized obstructive sleep apnea (OSA), alcohol abuse, and bipolar disorder reported eight-years of parasomnia characterized by fondling, sexual intercourse, and aggressive sexual acts, despite treatment with benzodiazepines. His fiancé noted that his advances when sleeping were atypical for their normal intimate interactions. He was observed to have frequent arousals from N3 sleep during PSG. The patient denied current substance use, but did report bilateral foot discomfort leading to sleep disturbance. His ferritin was 38 ng/mL, and he was started on oral iron and vitamin C. Case 2 A 41-year-old woman with a history of anxiety, psoriatic arthritis, insomnia and childhood somnambulism presented with parasomnia ranging from fondling to sexual intercourse. Her husband noted that during the episodes, her mannerisms and speech pattern were vastly different from normal. She endorsed difficulty initiating sleep, with a sleep latency of one hour and frequent arousals despite using trazodone nightly. She consumed two to five glasses of whiskey in the evenings several nights a week. Parasomnia events were more prevalent on nights that she partook in alcohol and improved with alcohol cessation. Case 3 A 44-year-old man with a history of optimized mild OSA presented with parasomnias characterized by somnambulism with goal-directed behavior and sexual activity, with a family history of violent parasomnias. Given the atypical nature of his events, he was referred to the epilepsy monitoring unit, which was ultimately nondiagnostic. Benzodiazepine therapy was ineffective. He chose to defer further medical management, leading the patient to pursue cognitive behavioral therapy, with moderate benefit. He reports infrequent parasomnias off medications. Conclusion Sexsomnia remains a rare, and likely under reported phenomenon. In each of the highlighted cases, the patients responded to treatment without the use of standard benzodiazepine therapy. Support (if any):