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Sexomnia in a health professional and its Implications to clinical practice
Non-REM sleep parasomnias are a heterogeneous group of sleep disorders that occur in any age group. Pathophysiology is related to changes in sleep state stability, dissociation and expression of subcortical areas, without conscious cortical control, and genetic predisposition. Sexomnia is a variant of sleepwalking characterized by sexual behavior during sleep. Its occurrence in inappropriate environments can lead to embarrassing situations, as well as legal problems.
To describe a clinical case of sexomnia
We here describe a medical doctor, 26 years old, who came to our sleep outpatient clinic complaining of sleepwalking since her childhood. Family members describe episodes of getting up from bed, walking around the house and opening doors. Episodes were more frequent until 18 years of age. About a year ago, after she started a medical residency, she reported sexual activity with her husband during sleep, less than once a month, between 1:00 and 2:00 am (she sleeps around 10:00 pm). She kisses, caresses him and practices oral sex and penile penetration. She then wakes up confused and does not remember anything about what have happened. She has positive familiar history for somnambulism. Her concern is about happening these episodes of sexsomnia during night shifts of medical residency colleagues. She sleeps 7 hours per night in the week and 10 hours in the weekends. She also has excessive daytime sleepiness (Epworth Scale 10). She does not have obstructive apnea of sleep or restless leg syndrome. Her physical exam has no abnormalities. We recommended sleep hygiene, environmental protection. We also prescribed melatonin during night shifts.
This case exemplifies the social repercussion of this parasomnia, which although rare, impairs the quality of life of the referred patient. It is worth mentioning the family and previous pathological history of the patient with reported sleepwalking episodes. It is also necessary to report as a possible fragmenting factor sleep deprivation due to the beginning of medical residency. Although pharmacological treatment is performed in situations with frequent episodes, it may be initiated in situations involving risk to the patient. However, the possible side effects of clonazepam, such as amnesia, awakening difficulties and cognitive impairment make it impossible to use in the workplace.
Sexomnia; Parasomnia; Sleepwalking
Relato de Caso
Patrícia Gomes Damasceno, Rafael César dos Anjos de Paula, Mayara Gonçalves de Castro, Pedro Braga-Neto, Manoel Alves Sobreira-Neto