Секссомния: Сексуальное поведение во сне и его диагностика.

Sexsomnia, also known as sleep sex, is a distinct form of parasomnia, or an abnormal activity that occurs while an individual is asleep. Sexsomnia is characterized by an individual engaging in sexual acts while in non rapid eye movement (NREM) sleep. Sexual behaviors that result from sexsomnia are not to be mistaken with normal nocturnal sexual behaviors, which do not occur during NREM sleep. Sexual behaviors that are viewed as normal during sleep and are accompanied by extensive research and documentation include nocturnal emissions, nocturnal erections, and sleep orgasms. Sexsomnia can present in an individual with other pre existing sleep related disorders. Sexsomnia is most often diagnosed in males beginning in adolescence. Although they may appear to be fully awake, individuals who have sexsomnia often have no recollection of the sexual behaviors they exhibit while asleep. As a result, the individual that they share the bed with notices and reports the sexual behavior.

Non rapid eye movement sleep, or NREM, consists of three stages. Stage 1 is described as "drowsy sleep" or "somnolence" and is characterized by breathing rates becoming increasingly more consistent, the beginning of a decrease in muscle activity, and a decrease in heart rate. The typical duration of Stage 1 is around 10 minutes and accounts for approximately 5% of an individual's total sleep. Stage 2 is characterized by a further decline in muscle activity accompanied by a fading sense of consciousness of surroundings. Brain waves during Stage 2 are seen in the theta range. Stage 2 accounts for approximately 45 50% of an individual's total sleep. Stage 3 is the final stage of NREM sleep and the most common for parasomnias to occur. Also known as slow wave sleep (SWS), Stage 3 is characterized by brain temperature, respiratory rate, heart rate, and blood pressure being measured at their lowest. Representing approximately 15 20% of an individual's total sleep, brain waves during this stage are seen in the delta range. When an individual awakes during this stage, they are likely to exhibit grogginess and require up to thirty minutes to regain normal function and consciousness.

Though it is not possible for a definitive diagnosis of sexsomnia, a series of factors are considered to determine the presence of the condition. Clinical tests may also be utilized for further study.

Electroencephalograms, or EEG, are tests used to depict electrical activity and waves produced by the brain. This test has the ability to detect abnormalities that are associated with disorders that affect brain activity. Episodes of sexsomnia occur most commonly during slow wave sleep, or SWS. During this stage of sleep, brain waves tend to slow down and become larger. Through the use of electroencephalography, health professionals are able to determine if the sexual behaviors are occurring during non REM sleep or if the individual is fully conscious.

Polysomnography is a study conducted while the individual being observed is asleep. A polysomnograph (PSG) is a recording of an individual's body functions as they sleep. Specialized electrodes and monitors are connected to the individual and remain in place throughout study. Video cameras can be used to record physical behaviors that occur while the subject is asleep. Typically, the unwanted sexual behaviors do not present on film and the majority of information is taken from a sleep study. A PSG cannot determine a diagnosis every time it is performed, but can assist in determining what diagnoses should be considered or excluded. While PSG is a useful diagnostic tool, it cannot replace forensic examination. A PSG study may identify sexsomnia, but cannot determine whether it was responsible for an individual's actions or present during the time of an alleged crime. Likewise, the study may not identify sexsomnia, but that does not mean that the patient has never experienced it, so it is essential to collect information from as many sources as possible. This could include interviews with friends, family, and significant others, as well as medical records concerning the individual's sleep previous patterns. Polysomnography is also used in the diagnosis of other sleep disorders such as obstructive sleep apnea, narcolepsy, and restless leg syndrome.

Since there is not an FDA approved medication on the market specifically designed for the treatment of sexsomnia, health professionals attempt to treat the disorder through a variety of approaches. Among the first line of prevention for sexsomnia involves creating and maintaining a safe environment for all who are affected as a result of the disorder. Precautionary measures include, but are not limited to, the individual in question sleeping in a separate bedroom and the installation of locks and alarms on doors.

Clonazepam has been prescribed as treatment for sexsomnia. This medication is classified as a benzodiazepine and works by acting on the GABA A receptors present in the central nervous system (CNS). Benzodiazepines open the chloride channels to allow chloride to enter the neuron. The most common use of this medication is for the treatment of anxiety, seizures, panic disorders, and sleep disorders. Anticonvulsant therapy is used to treat sexual behaviors that result secondary to sleep related epilepsy.

Continuous positive airway pressure is commonly used as a treatment for sleep apnea. In cases where the individual has both sleep apnea, and sexual behaviors consistent with sexsomnia, the implementation of a continuous positive airway pressure resulted in complete discontinuation of unwanted behaviors.

Positive lifestyle changes are encouraged for individuals with sexsomnia. Reducing stress and anxiety triggers may reduce the likelihood of an exacerbation of the disorder. The use of open discussion and understanding between couples decrease the negative emotional feelings and stress felt and generates a support system.

Articles regarding sexsomnia continue to circulate on Glamour. com, the Huffington Post, and Refinery29 among many others. Increased exposure has resulted in a conversation between those who have the disorder and those directly affected. Sexsomnia has also been featured in popular television series including House, MD, Law and Order: Special Victims Unit, and Desperate Housewives.

The number of alleged sex offenders claiming sexsomnia as the cause of their offenses is rapidly growing. The Australasian Sleep Association has urged qualified physicians to contribute in expert testimony in such cases to ensure the individual's claims are valid and not just an attempt to be released of sexual offense charges.

Smith v. State of Georgia officially established a separate affirmative defense for the unconscious. According to the defense, "A person who commits an act during unconsciousness or sleep has not committed a voluntary act and is not criminally responsible for the act." In order for the assault to be considered a crime by the State of Georgia, the accused must have voluntarily committed the act and exhibited intent to carry out the act.

In 2022, a case came to light in England, where an allegation of rape in 2017 was dropped in 2020 by the Crown Prosecution Service (CPS) due to expert opinion that the woman involved had sexsomnia, and so the male defendant may have believed that she was consenting, and was thus formally acquitted. The woman involved later appealed the decision. A chief crown prosecutor separate from the department that made the decision to close the case reviewed the evidence of the case again: he concluded that the case should have gone to court; that the expert opinions on sexsomnia should have been challenged in court; and that the decision to close the case was a mistake. The reviewing chief prosecutor apologised unreservedly to the woman when concluding the review. Despite the review, the case could not be reopened because the case had been formally closed and the defendant declared not guilty.