CHICAGO -- Sexsomnia -- engaging in sexual activity while asleep -- is something physicians may want to consider as a diagnosis in some patients, , said here Saturday at the annual meeting of the .
The disorder can take different forms, "as mild as [patients] rubbing their buttocks or genitals to self-gratification" and even intercourse, Moore, a fourth-year psychiatry resident at Western Michigan University, in Kalamazoo, told ľֱ in a phone interview.
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Although sexsomnia appears for the first time as a diagnosis in DSM-5, it has previously been discussed in medical literature, Moore noted in his poster presentation at the meeting, in Chicago. discussed nine criminal cases in which sexsomnia was used as a defense; the verdict favored the defendant in seven of those cases, he noted.
Engaging in sex while asleep is an occasional side effect of some insomnia drugs such as zolpidem (Ambien), but Moore was referring to cases with other causes.
Moore presented a case study of a patient with sexsomnia. The patient, a 44-year-old male, presented for treatment for presumed restless legs syndrome, which was made worse with medication. He was not obese and did not have a history of sleep apnea; overall, he had a "pretty normal body habitus," Moore said.
Clinicians noted that the patient was "very active in his sleep, and at times he has inadvertently hit his spouse and grabbed her without realizing it," Moore noted. "Sleep-related sexual behavior also was reported, including spanking, and this behavior was noted to occur more frequently in relation to increased daytime stressors."
A workup by a neurologist included interviewing both the patient and his wife, as well as keeping a sleep diary. The interview revealed that sexual behavior during sleep, including intercourse, had been happening over the last 20 years. "The spouse indicated that she did not believe he was awake or orientated during these events, and that they sometimes included aggressive behavior, such as pinching," Moore noted in the poster.
The sexsomnia was "definitely distressing to the relationship," Moore said in the phone interview. "At times his partner wasn't sure what to make of it: 'Is this person asleep or are they not asleep?' He didn't seem to be himself or be aware, though at times he looked awake."
In addition, polysomnography resulted in "several episodes during non-REM sleep that were consistent with confusional arousals, including at least one episode of the patient rubbing his buttocks," the poster noted. There was no indication of sleep-disordered breathing or abnormal limb movement, however.
One other finding of interest -- something Moore said he hadn't seen in the scientific literature on the subject -- was that "this gentleman had a very early sexual history, and was looking at sexualized material at a young age -- 9-to-10 years old -- on a pretty frequent basis. I have never been able to identify that in any other cases ... [but] clinically I do have my suspicions."
The patient was treated with clonazepam (Klonopin), a benzodiazepine, started by another physician, "and that has been helpful to him," Moore said.
Sexsomnia is a diagnosis that a primary care physician could definitely make, he said. "I don't think anybody has to have a psychiatry skill to at least ask about it and flush it out. Given the fact that that it's popped up in the literature over the years with limited cases, I suspect it's highly under-reported. I think the fact that it's in the DSM now offers legitimacy."
Primary Source
American Academy of Psychiatry and the Law
Source Reference: Moore B "Sexsomnia: Case presentation on a New DSM-5 diagnosis" AAPL 2014.