Parasomnias and sleep-related movement disorders (SRMD) are major causes of sleep disorders and may be drug induced. The objective of this study was to conduct a systematic review of the literature to examine the association between drug use and the occurrence of parasomnias and SRMD. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for reporting systematic reviews, we searched PubMed databases between January 2020 and June 2023. The searches retrieved 937 records, of which 174 publications were selected for full-text screening and 73 drugs were identified. The most common drug-induced parasomnias were nightmares and rapid eye movement (REM) sleep behaviour disorders and sleepwalking. In terms of drug-induced SRMD, restless legs syndrome, periodic limb movement disorders (PLMD), and sleep-related bruxism were most frequent. Medications that inhibit noradrenergic, serotonergic, or orexin transmission could induce REM sleep (e.g., nightmares). Regarding sleepwalking, dysregulation of serotoninergic neurone activity is implicated. Antipsychotics are mentioned, as well as medications involved in the gamma-aminobutyric acid (GABA) pathway. A mechanism of desensitisation-autoregulation of GABA receptors on serotoninergic neurones is a hypothesis. SRMD and PLMD could involve medications disrupting the dopamine pathway (e.g., antipsychotics or opioids). Opioids would act on mu receptors and increase dopamine release. The role of adenosine and iron is also hypothesised. Regarding bruxism, the hypotheses raised involve dysregulation of mesocortical pathway or a downregulation of nigrostriatal pathway, related to medications involving dopamine or serotonin. Parasomnias are rarely identified in drug product labels, likely due to the recent classification of their diagnoses. An analysis of pharmacovigilance data could be valuable to supplement existing literature data.

Objective: The objective of this study was to address the relationships between demographics and sexsomnia episodes, and sexual health issues in affected individuals. This study is the first sexsomnia survey conducted in Turkey. Sexsomnia comprises involuntary, unconscious sexual behavior during sleep, observed by a bed partner. Method:To reach people with and without sexsomnia, an online survey method was used. Among 274 participants, 42 of them reported having sexsomnia. Results: Women who do not have sexsomnia have more sexual problems than women who have sexsomnia episodes. The sexsomnia experiences of men and women also differed. Additionally, there were gender differences with difficulties caused by the sexsomnia. Conclusions: There is a need for further studies on sexsomnia that address socio-cultural, gender, and biological factors (including sleep disorders).

We describe a 42-year-old married woman diagnosed with sexsomnia as a NREM parasomnia, who sought medical assistance motivated by relationship problems with her husband after two sexsomnia episodes. This is the second case of sexsomnia reported in Brazil, but the first case with comprehensive follow-up. The patient was clinically evaluated, no psychiatric history was found, and she denied using pharmaceutical or recreational drugs. A video-polysomnography documented nine episodes of short- lasting abrupt awakening from N2 and N3, indicating a non-REM parasomnia, some with masturbation characteristics. The findings of this case, including unusual features, are considered in regard to the range of adverse psychosocial consequences of sexsomnia in these patients and the need for specialized interventions that can be provided by sleep specialists. We discuss the misinformation and delay of proper diagnosis and treatment that occurs with sexsomnia and emphasize the importance of understanding the broad set of problems and consequences related to sexsomnia, including physical, psychological, marital/relationship and at times legal aspects that affect the lives of sexsomniac patients and their bed partners.

Sleep sex may be a defense for alleged sexual assault. The International Classification of Sleep Disorders (ICSD3) states: \"Disorders of arousal should not be diagnosed in the presence of alcohol intoxication… The former [alcohol blackouts] are exponentially more prevalent.\" A panel member of ICSD3, quoting ICSD3 asserts: \"alcohol intoxication should rule out a sleep-walking defense\". This implies extremely strong support for a prosecution hypothesis (Hp ) over a defense hypothesis (Hd ). I use Bayesian methodology to evaluate the evidential probity of alcohol intoxication. The likelihood ratio, LR, measures the amplification of prior odds of guilt, LR = Posterior odds of guilt after considering alcohol intoxication /Prior odds of guilt before considering alcohol intoxication . By Bayes\' theorem, LR = p ( alcohol intoxication, given H p ) / p ( alcohol intoxication, given H d ) . I use data from cross-sectional studies of sexual assault and prevalence of alcohol use, in college students, with data from longitudinal studies, and data from the epidemiology of parasomnias to evaluate LR (alcohol). LR ~1.5 or 5, depending whether alcohol does, or does not, increase the risk of parasomnias. The proposition of extremely strong support for Hp implies a LR ~1,000,000, so the proposition in ICSD3 is not supported by formal analysis. The statistical reasoning in ICSD3 is unclear. There appears to be inversion of the Bayesian conditional (confusing intoxication given assault, and assault given intoxication) and failure to evaluate alcohol intoxication in Hd . Similar statistical errors in R. v Sally Clark are discussed. The American Academy of Sleep Medicine should review the statistical methodology in ICSD3.

Sexsomnia has been reported and is well described in 115 prior cases in the literature. There have been associations with other sleep disorders serving as triggers for confusional arousals, thereby worsening sexsomnia episodes. We present a case of an adolescent boy with a history of resected and treated pineoblastoma who later developed sexsomnia marked by multiple episodes of masturbatory events per night. He had additional suspicions of obstructive sleep apnea. Polysomnography confirmed severe obstructive sleep apnea and captured multiple episodes of sexsomnia from both REM and NREM sleep. The patient also had daytime symptoms of severe anxiety and hypersomnia that required pharmacological intervention, cognitive behavioral techniques, and hypnosis. The patient showed improvement with hypnosis along with a multimodal approach to the treatment of sexsomnia.

BACKGROUND: Sleep sex also known as sexsomnia or somnambulistic sexual behavior is proposed to be classified as NREM (non-rapid eye movement) parasomnia (as a clinical subtype of disorders of arousal from NREM sleep-primarily confusional arousals or less commonly sleepwalking), but it has also been described in relation to REM (rapid eye movement) parasomnias.
METHODS: The authors searched the PubMed database to identify relevant publications and present the co-occurrence of sexsomnia and other sleep disorders as a non-systematic review with case series.
RESULTS: In the available literature the comorbidity of sexsomnia and other sleep disorders were reported mainly in case reports and less in case series. Sexsomnia was reported both with one and with multiple sleep-related disorders, with NREM parasomnias and obstructive sleep apnea (OSA) being the most commonly reported. Furthermore, the authors enrich the article with new findings concerning two novel cases of sleep bruxism triggering recurrent sexsomnia episodes.
CONCLUSIONS: Sexsomnia has still not been reported in the literature as often as other parasomnias. The coexistence of sexsomnia and other sleep-related disorders should be more thoroughly examined. This could help both in sexsomnia as well as other sleep-related disorders management.

We report a case of problematic spontaneous orgasms during sleep in a 57-year-old woman who also complained of hypnic jerks and symptoms of exploding head syndrome. To our knowledge, this is the first case report in the English language literature of problematic spontaneous orgasms during sleep. She had a complex medical and psychiatric history, and was taking oxycontin, venlafaxine, amitriptyline, and lurasidone. Prolonged video electroencephalogram monitoring did not record any ictal or interictal electroencephalogram discharges, and nocturnal video polysomnography monitoring did not record any behavioral or orgasmic event. Periodic limb movement index was zero events/h. Severe central sleep apnea was detected with apnea-hypopnea index = 130 events/h, but she could not tolerate positive airway pressure titration. Sleep architecture was disturbed, with 96.4% of sleep spent in stage N2 sleep. Bedtime clonazepam therapy (1.5 mg) was effective in suppressing the sleep-related orgasms and hypnic jerks.