DOI: 10.14704/nq.2015.13.4.873

Update on Sexsomnia, Sleep Related Sexual Seizures, and Forensic Implications

Carlos H. Schenck


The first classification of sleep-related disorders and abnormal sexual behaviors and experiences was published in 2007. Parasomnias (abnormal sleep-related behaviors and experiences) and sleep-related epileptic seizures were the most frequently reported disorders, apart from Kleine-Levin syndrome (periodic hypersomnia with abnormal wakeful sexual behaviors). The first set of conditions were named sexsomnia (sleepsex) and epileptic (ictal) sexsomnia, respectively. Sexsomnia usually emerges during confusional arousals (CAs) from delta non-REM sleep (N3 sleep), either associated or unassociated with obstructive sleep apnea (OSA). We now report an additional 16 cases of sexsomnia and 2 cases of ictal sexsomnia (temporal lobe epilepsy; bupropion-induced seizures) published from 2007-2014, based on a literature search in PubMed and Embase. The demographics of the second group of 16 sexsomnia cases were similar to those of the first group of 31 cases, in regards to male gender predominance (75% vs. 81%); age at presentation (39 yrs vs. 32 yrs); age of onset (33 yrs vs. 26 yrs); and duration of sexsomnia in males (5.6 yrs vs. 8.3 yrs). The female groups were too small to compare. The distribution of sexual behaviors across the groups was generally comparable in regards to sexual vocalizations, masturbation, fondling, and intercourse/attempted intercourse. Amnesia for the sexsomnia by the affected person was 100% in both groups. Video-polysomnographic studies were conducted in nearly all patients in both groups, and provided important diagnostic findings in almost all patients. The mean number of parasomnias per patient was 1.9+1.4 vs. 2.2+1.0, respectively, with the range extending up to 5 parasomnias per patient. In both groups, a non-REM sleep parasomnia (disorder of arousal [DOA]) was the main cause of the sexsomnia (75% vs. 90%), including a comparable percentage in each group having obstructive sleep apnea (OSA) as the presumed trigger for a DOA with sexsomnia (18.7% vs. 12.9%), which was strongly supported by the control of both sexsomnia and OSA with therapy of OSA with nasal CPAP in 100% (4/4) of treated cases. Overall treatment efficacy was very high in the combined groups (82% [18/22]). Eight novel findings on sexsomnia and ictal sexsomnia were identified. The forensic implications of sexsomnia are discussed.


sexsomnia; sleepsex; sexual behaviors of sleep; temporal lobe epilepsy; ictal orgasm; epileptic sexsomnia; polysomnography; non-REM sleep parasomnia; confusional arousals; obstructive sleep apnea; REM sleep behavior disorder; clonazepam; SSRI; bupropion;

Full Text:

Full Text PDF


American Academy of Sleep Medicine. International classification of sleep disorders, 3rd edition. Westchester, Illinois, 2014.

Andersen ML, Poyares D, Alves RSC, Skomro R, Tufik. Sexsomnia: abnormal sexual behavior during sleep. BrainRes Reviews 2007; 56: 271-282.

Arino H, Iranzo A, Gaig C, Santamaria J. Sexsomnia: parasomnia associated with sexual behaviour during sleep. Neurologia 2014; 29 (3): 146-152.

Banerjee D. A case-based review of sleep-related criminal behaviours, treatment & outcomes. Sleep and Biological Rhythms 2014; 12: 7.

Bejot Y, Juenet N, Garrouty R, Maltaverne D, Nicolleau L, Giroud M, Didi-Roy R. Sexsomnia: an uncommon variety of parasomnia. Clin Neurol Neurosurg 2010; 112 (1): 72-5.

Bjorvatn B, Gronli J, Pallesen S. Prevalence of different parasomnias in the general population.

Sleep Medicine 2010; 11:1031-1034.

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

Cicolin A, Tribolo A, Giordano A, et al. Sexual behaviors during sleep associated with polysomnographically confirmed parasomnia overlap disorder. Sleep Med 2011;12: 523-528.

Coelho FMS, Moszczynski A, Narayansingh M, Parekh N, Pradella-Hallinan M. Sexual hypnagogic hallucinations and narcolepsy with cataplexy: a case report. Sleep Science 2011;4(3): 110-112.

Cramer Bornemann MA. Sexsomnia: a medicolegal case-based approach in analyzing potential sleep-related abnormal sexual behaviors. In: Kothare SV, Ivanenko A, eds. Parasomnias. New York: Springer Science + Business Media 2013; pp. 431-461.

Cramer Bornemann MA, Mahowald MW, Schenck CH. Sexsomnia and sleep forensics: the interface between sleep-related abnormal sexual behaviors and the law. Sleep 2014; 37: A210.

Della Marca G, Dittoni S, Frusciante R, et al. Abnormal sexual behavior during sleep. J Sex Med 2009; 6 (12): 3490-5.

Espa F, Dauvilliers Y, Ondze B, Billiard M, Besset A. Arousal reactions in sleepwalking and night terrors in adults: the role of respiratory events. Sleep 2002; 25: 32-36.

Fantini ML, Corona A, Clerici S, Ferini-Strambi L. Aggressive dream content without daytime aggressiveness in REM sleep behavior disorder. Neurology 2005;65(7):1010-5.

Ingravallo F, Poli F, Gilmore EV, Pizza F, Vignatelli L, Schenck CH, Plazzi G. Sleep related violence and sexual behavior in sleep: a systematic review of medical-legal case reports. J Clin Sleep Med 2014; 10: 927-935.

Iranzo A, Santamaría J. Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder. Sleep 2005;28(2):203-6.

Kennedy GA, Elzo F. Case studies of familial sexsomnia. Sleep and Biological Rhythms 2010; 8: A73-A74.

Kim SW, Schenck CH, Grant JE, Yoon G, Dosa P, Odlaug BL, Schreiber LRN, Hurwitz TD, Pfaus JG. The neurobiology of sexual desire. NeuroQuantology 2013; 2: 332-359.

Krol DG. Sexsomnia during treatment with a selective serotonin reuptake inhibitor. Tijdschr Psychiatr [J of Psychiatry] 2008; 50 (11): 735-739. [Dutch].

Mangan MA. A phenomenology of problematic sexual behavior occurring sleep. Arch Sex Behav 2004; 33: 287-293.

Mangan MA, Reips U-D. Sleep, sex, and the Web: surveying the difficult-to-reach clinical population suffering from sexsomnia. Behav Res Methods 2007; 39 (2): 233-236.

Morrison I; Rumbold JM; Riha RL. Medicolegal aspects of complex behaviours arising from the sleep period: a review and guide for the practising sleep physician. Sleep Medicine Reviews 2014; 18(3):249-60.

Muza RT, Lawrence M, Williams A. The reality of sexsomnia: characteristics and manifestations of sexsomnia. Sleep 2015; 38: A250.

Neto SMA, Pena-Pereira M, Sobreira ES, Chagas M, Fernandes RM, Eckeli AL, Tumas V. Sexsomnia in parkinson's disease patients. Sleep 2012; 35: A253-A254.

Organ A, Fedoroff JP. Sexsomnia: Sleep Sex Research and Its Legal Implications. Current Psychiatry Reports 2015; 17: 34.

Pelin Z, Yazla E. Abnormal sexual behavior during sleep in temporal lobe epilepsy: a case report. Balkan Med J 2012; 29: 211-213.

Penas-Martinez ML, Guerrero-Peral AL, Toledano-Barrero AM, et al. Sexsomnia: descripcion de un nuevo caso. [Sexsomnia: description of a new case]. Revista de Neurologia 2008; 47 (6): 331-332. [Spanish].

Pressman MR. Hypersynchronous delta sleep EEG activity and sudden arousals from slow-wave sleep in adults without a history of parasomnias: clinical and forensic implications. Sleep 2004;27(4):706-10.

Pressman MR. Disorders of arousal from sleep and violent behavior: the role of physical contact and proximity. Sleep 2007a; 30: 1039-1047.

Pressman MR, Mahowald MW, Schenck CH, Bornemann MC. Alcohol-induced sleepwalking or confusional arousal as a defense to criminal behavior: a review of scientific evidence, methods and forensic considerations. J Sleep Res. 2007b;16(2):198-212.

Pressman MR, Mahowald MW, Schenck CH, Cramer Bornemann MA, Banerjee D, Buchanan P, Zadra A. Alcohol, sleepwalking and violence: lack of reliable scientific evidence. Brain. 2013; 136(Pt 2):e229. doi: 10.1093/brain/aws248.

Pressman MR1, Grunstein RR, Mahowald MW, Schenck CH, Montplaisir JY, Bornemann MC, Zadra A, Buchanan PR. Alcohol and sleep review: flawed design, methods, and statistics cannot support conclusions. Alcohol Clin Exp Res 2015;39(5):941-3.doi: 10.1111/acer.12712.

Sarisoy G, Özdin S. Seksomnia: Bir Gözden Geçirme (Sexsomnia: A Review). J of Mood Disorders 2014; 4 (2): 80-87.

Schenck CH, Milner DM, Hurwitz TD, Bundlie SR, Mahowald MW. A polysomnographic and clinical report on sleep-related injury in 100 adult patients. American J Psychiatry 1989a; 146: 1166-1173.

Schenck CH, Milner DM, Hurwitz TD, Bundlie SR, Mahowald MW. Dissociative disorders presenting as somnambulism: polysomnographic, video and clinical documentation (8 cases). Dissociation 1989; 2: 194-204.

Schenck CH, Hurwitz TD, O'Connor KA, Mahowald MW. Additional categories of sleep-related eating disorders and the current status of treatment. Sleep 1993; 16: 457-466.

Schenck CH, Boyd JL, Mahowald MW. A parasomnia overlap disorder involving sleepwalking, sleep terrors, and REM sleep behavior disorder in 33 polysomnographically confirmed cases. Sleep 1997;20:972-981.

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: 683-702.

Schenck CH, Mahowald MW. Parasomnias associated with sleep-disordered breathing and its therapy, including sexsomnia as a recently recognized parasomnia. Somnology 2008; 12: 38-49.

Şengül MCB, Hanci E. Uyku sırasında orgazm: Bupropiona bağlı bir nöbet olgusu. (Orgasm during sleep: bupropione induced seizure). Pam Med J 2014; 7(2):155-157.

Sixel-Döring F, Trautmann E, Mollenhauer B, Trenkwalder C. Associated factors for REM sleep behavior disorder in Parkinson disease. Neurology 2011;77(11):1048-54.

Trajanovic NN, Mangan M, Shapiro CM. Sexual behaviour in sleep: an internet survey. Soc Psychiatry Psychiatr Epidemiol 2007; 42: 1024-1031.

Supporting Agencies

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

| NeuroScience + QuantumPhysics> NeuroQuantology :: Copyright 2001-2019