Sexsomnia in Active Duty Military: A Series of Four Cases.

Sexsomnia is a type of non-rapid eye movement (NREM) parasomnia in which sexual behaviors arise during sleep; these behaviors are varied and can include masturbation, orgasms with or without self-stimulation, sexual vocalizations and talking, and sexual fondling and/or intercourse with the bed partner. The military creates a challenging environment, with sleep deprivation, shift work, and increased psychosocial stress that may predispose service members to an increased risk for all NREM parasomnias, including sexsomnia. Given that sexsomnia is sometimes invoked in sexual assault military lawsuits, it may behoove the military community to understand how this condition usually manifests so that its medicolegal implications can be addressed more clearly. Here, we present the largest case series of sexsomnia to date in active duty military service members, which adds to the limited literature on such cases in the military and to the broader but still growing literature on this rare disorder. We compare and contrast these cases with the available literature to highlight their similarities and differences in addition to commenting on the relevance of these cases in forensic investigations. As none of these cases were involved in legal issues, they could provide useful information about this rare condition in individuals who are less likely to be affected by the biases that are inherent to litigation.

We live and die by the sun: motor vehicle fatalities and circadian timing in the USA 2001 to 2018.

BACKGROUND: Motor vehicle accidents continue to be one of the leading causes of morbidity and mortality across the world. The distribution of accidents during the 24-h period exhibits a known pattern which includes three well-defined peaks during day, with circadian factors exerting significant influence. Time zones standardize time for large geographic areas and create misalignment between the natural position of the sun, or "solar" time, and the time imposed by the time zone, or "social" time. The light/dark cycle that is created by the sun is the main zeitgeber of the circadian system and it is unknown if this affects the pattern of accidents that is observed in different areas of a given time zone (Easter portion vs Western portion). METHODS: We analyzed public data from the Fatality Analysis Reporting System from 2001 to 2018 to compare the pattern of accidents from Eastern portions of the time zone to those from the Western portions. RESULTS: The accident curves on both sides of the time zones were shifted, or out of phase, showing a shift of approximately 45 min between accident patterns. CONCLUSION: This shift in patterns suggests that solar time, rather than clock time, is the most important factor in the pattern of accidents.

A rare presentation of sexsomnia in a military service member.

NONE: Sexsomnias are unconscious sexual behaviors during sleep (parasomnias) that are garnering more attention as they become increasingly evident in forensic cases. Presentations of sexsomnia in active duty service members are seldom described, and often evaluation is clouded by intoxication with substances such as alcohol, sleep deprivation, untreated sleep disturbances, or criminal behavior masquerading as a medical disorder. We present a case of a 40-year-old male soldier evaluated in our sleep clinic for multiple episodes of sleep masturbation occurring over a period of 2 years. The patient was concerned about his suitability for deployment to a combat zone and participation in field training exercises (both require sleeping in groups in an open environment). Video polysomnography confirmed moderate obstructive sleep apnea, and the patient showed improvement with continuous positive airway pressure therapy. The authors also discuss the relevance of this case compared with previously reported sexsomnia cases and expand on parasomnia topics that are more common in military populations.

Thermo-parasomnia. Prediction of a possible sleep disorder or entity.

Parasomnias are a group of sleep disorders that are characterized by the presence of undesirable behavioral, experiential, or autonomic nervous system events during sleep initiation, within sleep, or during arousals from any stage of non-rapid eye movement (NREM) or rapid eye movement (REM) sleep. During wakefulness and NREM sleep, the hypothalamus plays a central role in thermoregulation. REM sleep has a very distinct thermoregulatory response that is characterized by an inhibition of hypothalamic control over body temperature, with resulting poikilothermia. The role of the thermoregulatory features of REM sleep is currently unknown. Drawing conclusions from other parasomnias one can assume that a disorder could exist in which the thermoregulatory features of REM sleep are impaired. The existence of this condition may have eluded current research because most of the research on thermoregulation has been completed using animal models or healthy volunteers. If this disorder were to exist, it could be associated with metabolic disorders, or with neurodegenerative conditions, and perhaps it could be an early biomarker for alpha-synucleinopathies in idiopathic REM sleep behavior disorder. New and evolving wearable technologies offer the promise of facilitating the monitoring of core body temperature and the testing of this hypothesized thermoregulatory autonomic disorder and its clinical correlates.

Parasomnia Overlap Disorder with Sexual Behaviors during Sleep in a Patient with Obstructive Sleep Apnea.

ABSTRACT: Sleep-related abnormal sexual behaviors (sexsomnia) are classified as a subtype of NREM sleep parasomnias. Sexsomnia has been reported as part of parasomnia overlap disorder (POD) in two other patients. We present the case of a 42-year-old male patient with video-polysomnography (vPSG) documented POD. The patient had sleepwalking, sleep-related eating, confusional arousals, sexsomnia, sleeptalking, and REM sleep behavior disorder (RBD). Confusional arousals and RBD were documented during the vPSG. This case had the added complexity of obstructive sleep apnea (OSA) playing a role in sleepwalking and sleep related eating, with good response to nasal continuous positive airway pressure (nCPAP). The sexsomnia did not respond to nCPAP but responded substantially to bedtime clonazepam therapy.

Sexsomnia and REM- predominant obstructive sleep apnea effectively treated with a mandibular advancement device.

Parasomnias with sexual behavior or sexsomnias are considered a subtype of NREM parasomnias. Obstructive sleep apnea/hypopnea (OSAH) has been described as a known triggering factor for parasomnias including sexsomnia. Nasal continuous positive airway pressure (nCPAP) has been the standard of treatment for OSAH but mandibular advancement devices (MAD) are becoming an important treatment alternative. We present the case of a patient with mild OSAH and sexsomnia who had resolution of both conditions with a MAD. This patient had the added uniqueness of having REM-predominant OSAH.

The Prevalence and Characteristics of REM Sleep without Atonia (RSWA) in Patients Taking Antidepressants.

STUDY OBJECTIVES: The association of REM sleep without atonia (RSWA) as well as REM sleep behavior disorder (RBD) with the intake of selective serotonin reuptake inhibitors (SSRI) and selective norepinephrine reuptake inhibitors (SNRI) is well established. Our study objective was to determine the prevalence of RSWA and RBD among a group of sleep center patients taking SSRI and SNRI. METHODS: A retrospective chart review was done at our tertiary sleep center, and 10,746 consecutive records from October 1, 2007, through October 31, 2013, were searched for SSRI and SNRI names using the Sleep Cataloguer Software. RESULTS: The search resulted in 1,444 records, which were then reviewed for keywords of RSWA and RBD. The AASM scoring criteria were used to determine RSWA. Reports of 41 patients with known narcolepsy or α-synucleinopathies were excluded. The remaining records were mined for age, sex, presence of obstructive sleep apnea (OSA), type of antidepressant (SSRI or SNRI), and diagnosis for which antidepressant was prescribed. We used logistic regression analysis to adjust for age, OSA, and sex. Of the 1,444 participants on antidepressants, 176 (12.2%) had RSWA (all confirmed by the investigators) compared to 226 of the entire sleep lab population of 10,746 (2.1%), risk ratio (95% CI) 9.978 (8.149, 12.22). Seven of the 176 patients on antidepressants had RBD (0.48%) compared to 108 of 10,746 (1%), p = 0.005. CONCLUSIONS: SSRI and SNRI are associated with a higher prevalence of RSWA but not of RBD. This is independent of medication type.