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Atypical Sexual Behavior During Sleep

From the Sleep Disorders Center, Stanford University, Stanford, CA.

Address reprint requests to: Christian Guilleminault, MD, Stanford Sleep Disorders Center, 401 Quarry Road, Suite 3301, Stanford, CA 94305. Email: cguil@ leland.stanford.edu

OBJECTIVE: This article reports a case series of atypical sexual behavior during sleep, which is often harmful to patients or bed partners.

METHODS: Eleven subjects underwent clinical evaluation of complaints of sleep-related atypical sexual behavior. Complaints included violent masturbation, sexual assaults, and continuous (and loud) sexual vocalizations during sleep. One case was a medical-legal case. Sleep logs, clinical evaluations, sleep questionnaires, structured psychiatric interviews, polysomnography, actigraphy, home electroencephalographic monitoring during sleep, and clinical electroencephalographic monitoring while awake and asleep were used to determine clinical diagnoses.

RESULTS: Atypical sexual behaviors during sleep were associated with feelings of guilt, shame, and depression. Because of these feelings, patients and bed partners often tolerated the abnormal behavior for long periods of time without seeking medical attention. The following pathologic sleep disorders were demonstrated on polysomnography: partial complex seizures, sleep-disordered breathing, stage 3 to 4 non–rapid eye movement (REM) sleep parasomnias, and REM sleep behavior disorder. These findings were concurrent with morning amnesia.

CONCLUSIONS: The atypical behaviors were related to different syndromes despite the similarity of complaints from bed partners. In most cases the disturbing and often harmful symptoms were controlled when counseling was instituted and sleep disorders were treated. In some cases treatment of seizures or psychiatric disorders was also needed. Clonazepam with simultaneous psychotherapy was the most common successful treatment combination. The addition of antidepressant or antiepileptic medications was required in specific cases.

Key Words: sexual behavior during sleep, • violence, • non–rapid eye movement sleep parasomnia, • rapid eye movement behavior disorders, • seizure disorder, • sleep-disordered breathing.

Abbreviations: ECG = electrocardiogram;; EEG = electroencephalogram;; EMG = electromyogram;; EOG = electrooculogram;; NREM = non–rapid eye movement (sleep);; PLM = periodic limb movement;; PSG = polysomnography;; REM = rapid eye movement (sleep);; SWS = slow-wave sleep.

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