Vol.:(0123456789) 1 3 Sleep and Vigilance https://doi.org/10.1007/s41782-019-00057-5 ORIGINAL ARTICLE Abnormal Sexual Behavior During Sleep: Sexsomnia and More AbdulRouf Pirzada 1  · Aljohara S. Almeneessier 1,2  · Ahmed S. BaHammam 1 Received: 4 December 2018 / Revised: 2 February 2019 / Accepted: 5 March 2019 © Springer Nature Singapore Pte Ltd. 2019 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 participa- tion 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. Keywords Parasomnia · Obstructive sleep apnea · REM sleep behavior disorder · NREM sleep · Sex 1 Introduction Nocturnal behaviors have a complex nature and present as difcult diagnostic challenges in sleep medicine. A precise and accurate diagnosis of these sleep-related events gen- erally relies on the correct distinction between nocturnal seizures, disorders of arousal from non-rapid eye move- ment (NREM) sleep, and rapid eye movement (REM) sleep behavioral disorder (RBD), although other parasomnias and sleep-related movement disorders may warrant consideration [1, 2]. Abnormal nocturnal/sleep behaviors can vary from potentially harmless to extremely violent, and from subtle to extremely dramatic. The abnormal behavior that occurs during sleep is a type of parasomnia. Parasomnias (“para” means next to, and “somnus” means sleep) comprise a group of the most challenging, fascinating, and unusual behavioral disorders that occur during sleep, which are characterized by sleep- related acute, abnormal behavioral or physiological events. The International Classifcation of Sleep Disorders, Third Edition (ICSD‐3) defnes parasomnias as undesirable physi- cal events or experiences that occur during entry into sleep, within sleep, or during arousal from sleep [3]. Human physi- ological consciousness states consist of waking conscious- ness, NREM sleep, and REM sleep; thus, parasomnias may occur during NREM, REM, or during transitions to and from sleep [3]. It is thought that parasomnias are associated with central nervous system activation, increases in skeletal * Aljohara S. Almeneessier aljoharas@yahoo.com Ahmed S. BaHammam ashammam2@gmail.com; ashammam@ksu.edu.sa 1 Department of Medicine, College of Medicine, The University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia 2 Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia