Sexsomnia: Clinical Analysis of an Underdiagnosed Parasomnia
Sexsomnia: Clinical Analysis of an Underdiagnosed Parasomnia
Recent cases from England and Canada are examples of a growing number of acquittals resulting from a sexsomnia defense. Those who argue against this stance claim that people who know they are at risk for performing sexual acts during sleep should take steps to prevent this disorder from causing harm to others. Proponents of the parasomnia defense state that behaviors can go unnoticed until the inciting event and because people with parasomnias have no conscious awareness of their actions, they cannot be held legally responsible.
As with other parasomnias that have the potential for violence or significant social consequences, behavioral and environmental modifications are the mainstay of treatment. Healthy sleep hygiene, a regimented sleep-wake cycle that promotes adequate sleep, avoidance of alcohol or antagonistic medications, and treatment of disorders that fragment sleep will all minimize the likelihood of a sexsomnia event.
Medication may be required in refractory cases. Although sexsomnia has not been rigorously and independently studied, it presumably can be treated in a similar manner to other NREM parasomnias. Benzodiazepine medications, such as clonazepam, are effective treatments for RBD and NREM parasomnias. Melatonin and various other medications have been studied, but little high-quality data support use of these agents.
In summary, sexsomnia is an important and often underrecognized parasomnia that can result in substantial social and legal problems. Clinicians should reflexively ask about sexual behavior during sleep if any other type of parasomnia is suspected. Interviewing bed partners is also advised. It is critical to formulate a treatment plan that centers on behavioral and environmental modification to avoid potential triggers.
Legal Implications
Recent cases from England and Canada are examples of a growing number of acquittals resulting from a sexsomnia defense. Those who argue against this stance claim that people who know they are at risk for performing sexual acts during sleep should take steps to prevent this disorder from causing harm to others. Proponents of the parasomnia defense state that behaviors can go unnoticed until the inciting event and because people with parasomnias have no conscious awareness of their actions, they cannot be held legally responsible.
Treatment and Conclusion
As with other parasomnias that have the potential for violence or significant social consequences, behavioral and environmental modifications are the mainstay of treatment. Healthy sleep hygiene, a regimented sleep-wake cycle that promotes adequate sleep, avoidance of alcohol or antagonistic medications, and treatment of disorders that fragment sleep will all minimize the likelihood of a sexsomnia event.
Medication may be required in refractory cases. Although sexsomnia has not been rigorously and independently studied, it presumably can be treated in a similar manner to other NREM parasomnias. Benzodiazepine medications, such as clonazepam, are effective treatments for RBD and NREM parasomnias. Melatonin and various other medications have been studied, but little high-quality data support use of these agents.
In summary, sexsomnia is an important and often underrecognized parasomnia that can result in substantial social and legal problems. Clinicians should reflexively ask about sexual behavior during sleep if any other type of parasomnia is suspected. Interviewing bed partners is also advised. It is critical to formulate a treatment plan that centers on behavioral and environmental modification to avoid potential triggers.