Sexsomnia and obstructive sleep apnea

This chapter discusses the case of a 32-year-old married man presented with a chief complaint of fondling his wife during sleep. He was an alert, healthy-looking, white male in no distress. The oropharynx was clear, without redundant tissue, and he had a normal neck circumference. A psychiatric interview was unremarkable, apart from some dysphoria over the long-standing, involuntary sleep-sex with his wife. The PSG study documented clinically significant obstructive sleep apnea (OSA), but no other sleep disorder or abnormal polysomnography (PSG) finding. A diagnosis was made of OSA with confusional arousals and sexsomnia, together with sleep-talking. According to the man's history, the sexsomnia began in close association with the onset of snoring, and both progressed in tandem over time. Sexsomnia may be triggered by OSA through confusional arousals with abnormal sexual behaviors during sleep. Nasal continuous positive airway pressure (CPAP) therapy controls both OSA and the associated sexsomnia.