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International Journal of Sexual Health logoLink to International Journal of Sexual Health
. 2025 Oct 1;37(4):711–721. doi: 10.1080/19317611.2025.2547309

Sleep-Related Eating Disorder and Sexsomnia; Two Rare Parasomnias? A Mini-Review with Illustrative Case-Reports

Gábor Barcs a, József Janszky b, Mengesha Srahbzu c, Réka Horváth b, Vivian Miranda Correa c, Anna Szűcs c,✉
PMCID: PMC12867415  PMID: 41641063

Abstract

Objectives

Sleep-related eating disorder and sexsomnia are non-rapid eye movement (NREM) parasomnias, characterized by reward-seeking behaviors during NREM sleep. These conditions are likely underpinned by specific patterns of sleep-wake dissociation and appear to be more common than expected, leading to significant health risks, psychological distress and even forensic consequences.

Methods

We briefly review recent literature on sleep-related eating disorder and sexsomnia, and present three cases of each; for illustrating their clinical features and complexity.

Results

Genetic predisposition may set the stage for sleep-related eating disorder and sexsomnia; stress, alcohol-use and sleep-disruption promoting the episodes. While sharing the common pathophysiology of sleep-wake dissociation, the dissociation-patterns underlying sleep-related eating disorder, sexsomnia, and other NREM parasomnias might be different. One of our cases (sex without consent of the partner) points to the potential forensic consequence of sexsomnia; and two cases highlight the side-effect of Quetiapine and Zolpidem (alike several additional psychoactive drugs) provoking sleep-related eating-episodes. Rarely, these drug-related side-effects may have unexpected therapeutic benefits.

Conclusion

Sleep-related eating disorder and sexsomnia are under-recognized NREM parasomnias. Sexsomnia often leads to legal consequences with hard questions of responsibility; given its challenging multidisciplinary aspects. Regular sleep-schedule and other lifestyle-improvements help managing these conditions treated by Melatonin, certain antidepressants and, sedatives. Understanding their mechanism may provide meaningful data on reward-seeking during sleep.

Keywords: Sexsomnia, Sleep-related eating disorder, NREM parasomnia, Quetiapine, Zolpidem

Introduction

NREM parasomnias also termed disorders of arousal result from an unstable dissociated state between partial arousal/wakefulness and non-rapid eye movement (NREM) sleep (Sateia, 2014; Irfan et al., 2021; Idir et al., 2022; Parrino et al., 2022; Mainieri et al., 2023). Circumstances and conditions thatcause cortical arousals and deepen sleep thus promoting sleep inertia, promote episodes of NREM parasomnias by impairing normal arousal-mechanisms (Irfan et al., 2021). Sleepwalking, sleep terror, confusional arousal, sleep-related eating disorder (SRED) and sexsomnia (a sleep disorder in that people are engaged in sexual behaviors while they are asleep; sometimes also referred to as sleep-sex) are the known subtypes (Sateia, 2014; Ma, 2022). The prevalence of disorders of arousal declines with age; it is 14-30% in childhood, 2-4% in adulthood and < 1% in the elderly; starting then or continuing from childhood (Hrozanova et al., 2019).

The most prevalent type is sleepwalking, constituting about 80% of NREM parasomnias (Correa et al., 2024). It may associate to manipulations and activities that include eating, drinking or various sexual activities (Ma, 2022; Dubessy et al., 2017); the latter activities are respectively termed SRED (Vasiliu, 2024) and sexsomnia (Sateia, 2014; Irfan et al., 2021; Idir et al., 2022; Shapiro et al., 2003; Schenck et al., 2007; Cankardas & Schenck, 2021; Andersen et al., 2024). SRED and sexsomnia are rare in childhood; this is one of the reasons why the question is justified: do NREM parasomnias of childhood and adulthood represent two ends of one spectrum or two distinct entities? (Walsh et al., 2022).

SRED and sexsomnia are poorly understood and surrounded by skepticism and doubts; but clinical and polysomnographic studies have evidenced their existence as activities performed in sleep (Cankardas & Schenck, 2021; Walsh et al., 2022). The prevailing view is that NREM parasomnias are unconscious automatisms without recall; however. a recent review found that 50-60% of NREM parasomnia-events are followed by patchy memories; at least immediately after the episodes (Castelnovo et al., 2024).

SRED has not been involved in the group of eating-disorders (Vasiliu, 2023); while 15% of people experiencing them have SRED as well, and it may result in frustrating weight-gain and (Winkelman et al., 1999). In SRED, injuries and poisoning may happen due to preparing food in half-sleeping states and consuming inedible or poisonous substances. Based on a recent Hungarian representative survey, it may affect 0.1% of the population (Correa et al., 2024); as frequently as anorexia nervosa (Van Eeden et al., 2021). A Norwegian cross-sectional population-survey puts the prevalence of SRED even higher, at 2.2% (Bjorvatn et al., 2010). In sleep-clinic populations and other non-representative surveys its prevalence reaches 2-5% (Vasiliu, 2023; Winkelman et al., 1999; Bjorvatn et al., 2010; Hanif et al., 2024; Matsui et al., 2020).

There are scarce data on the prevalence of sexsomnia either (Schenck et al., 2007; Cankardas & Schenck, 2021; Mangan & Reips, 2007; Holoyda et al., 2021), but its high frequency in sleep-clinic populations (Dubessy et al., 2017; Schenck et al., 2007; Cankardas & Schenck, 2021; Andersen et al., 2024) as well as in the few reported internet-surveys (Mangan & Reips, 2007), suggest the existence of many undetected cases. In sexsomnia, amnesia to the sleep-events is deemed more consistent than in other NREM parasomnias; affecting 96% of individuals (Holoyda et al., 2021).

Sexomnia often involving a sexual offense toward bedpartners, have posed forensic issues in a high proportion (25%!) of cases (Dubessy et al., 2017; Holoyda et al., 2021; Pressman, 2023). The typical setting is sexual behavior of males toward adult or minor females (Schenck et al., 2007; Holoyda et al., 2021; Trajanovic et al., 2007; Schenck, 2015). It may be the cause of gynecologic disease of bedpartners (Ebeling et al., 2024), affect sexual health, lead to psychologic adverse effects and disrupt partnerships or marital links (Dubessy et al., 2017). The management of sexsomnia includes lifestyle corrections for having regular and sufficient sleep; avoiding alcohol and recreational drugs. Its pharmacotherapy of dubious efficacy includes clonazepam, melatonin and antidepressants (Mainieri et al., 2023).

Sexsomnia has been used as a legal defence in cases of nocturnal sexual crimes, and due to its increasing recognition, it might arise in court more often in the future. While it is now recognized by both the ICSD-3 (1) and DSM-5 (Ma, 2022), the variability of related sex-behaviors (including masturbation, spontaneous orgasms and sexual vocalizations, oral and anal sex, fondling another person, attempted and completed sexual intercourse) and the possibility of malingering in medico-legal situations may hamper forensic evaluation. The studies of Mohebbi et al. (Mohebbi et al., 2018) and Holoyda et al. (Holoyda et al., 2021) have impressively discussed the legal assessment of sexsomnia-cases highlighting the challenges of objective evaluation regarding diagnosis, malingering and legal responsibility. Based on the suggestion of Ingravallo et al. (Ingravallo et al., 2014) the following data are considered essential in both making the diagnosis and in medico-legal evaluation:

  • Family history for sleep disorders;

  • The history of the defendant’s motor behaviors during sleep with collateral information from witnesses;

  • Data on age at onset, timing, duration and frequency of sleep-events;

  • The degree of amnesia;

  • Sleep/wake habits, drug-, caffeine and alcohol use;

  • Circumstantial factors;

  • Physical, neurologic and psychiatric evaluations;

  • Psychosexual assessment for detecting potential paraphilia;

  • Video-polysomnography for identifying or ruling out other sleep disorders associated with unusual motor behaviors such as dissociative states or epileptic seizures (however, the usefulness of polysomnography is contradictory in legal assessment, because either the occurrence or lack of a sexsomnia-episode during the polysomnography-night does not clarify the episode in question); and

  • Assessing potential malingering by forensic psychiatric evaluation.

Our mini-review and illustrative case-report study was conducted to summarize the clinical features, diagnostic considerations, and management strategies for sleep-related eating disorder (SRED) and sexsomnia, two rare forms of non-rapid eye movement (NREM) parasomnias. Our case reports were included for providing real-world insights into these conditions’ complexity, clinical presentations and diagnostic challenges. We aimed to call attention to these sleep-related conditions, for the benefit of patients and promoting future research.

Methods and Material

Three cases of sexsomnia and three of SRED are presented. We have seen and treated them in the Sleep-clinic of the Institute of Behavioral Science, Semmelweis University and in the Neurology Outpatient Clinic of Ferencváros, in Budapest. Clinical observations, patient interviews and medical records were collected with informed consent from the individuals involved. The diagnosis was made on the basis of clinical history; witness accounts and polysomnography in some of the cases. Cases 1 and 2 have been presented in MVC’s Ph.D. thesis.

Inclusion criteria for case reports

  • Patients with a confirmed diagnosis of either SRED or sexsomnia based on clinical history and, when available, polysomnographic findings.

  • Cases that highlight unique aspects of symptomatology, triggers, or treatment responses.

Ethical consideration

This study adhered to ethical guidelines for case report publication, ensuring confidentiality and de-identification of patient data. The Scientific and Ethical Committee of Semmelweis University has approved these reports (SE RKEB number: 3/2025).

Sexsomnia

Case-1

A 52-year-old married woman working as a hospital nurse had no parasomnia as a child or in her family. She had high blood pressure and reported not using alcohol or recreational drugs. Her neurology status was normal. She worked alternating day/night shifts resulting in irregular sleep.

Her symptoms had evolved in the last 2 years. She experienced sleepwalking in association with sexual activity two-to-three times/week, about one hour after sleep-onset.

In the episodes, she masturbated, screamed and slapped, fought, and scolded her husband and sometimes even her teenage son; using obscene words. It was difficult to wake her up, and she did not remember the episodes. The morning after, she felt exhausted and, depressed. She was worried of the deterioration of her marriage for calling her previous partner’s name in the episodes (as claimed by her husband), and felt guilty and humiliated especially for molesting his son. Still, she refused to have a polysomnography sleep-study, possibly due to the fear of having her awkward symptoms witnessed in the sleep-lab. Her EEG after sleep-deprivation was normal. The MRI brain-scan revealed small vascular lesions consistent with vascular encephalopathy (Fazekas grade-3). For finance-related issues, she also refused to reschedule her working pattern. Clonazepam 1 mg before bedtime proved useless during the 2 month’s follow-up period, and we lost her from follow-up.

Case-2

This 28-year-old metalworker reported sleep-related sexual activities; leading to a legal case of sexual offense toward his partner; “raping” her in sleep. He worked 12-hour day-shifts, drank alcohol regularly, and smoked. His medical history was unremarkable with normal sexual life in waking; he was on no medication; slept well and woke up rested most of the time. His neurology status was normal. His father had sleepwalking and he had sleepwalked as a teenager; his sexsomnia-episodes have evolved for the last 4-5 years, 2-8 times a year.

He had full amnesia to the episodes. Based on his girlfriend’s report, he left the bed, got dressed and turned on the light in the episodes; masturbation and full sex (without the consent of his girlfriend), followed. His facial expression was different from usual. Typically, this happened when he was tired and went to bed late. On several occasions, two-to-three hours after falling asleep, he sexually assaulted his girlfriend without being aware or remembering it after. His video-polysomnography revealed a fragmented sleep with frequent awakenings from N3 sleep; no sexual activity was captured. His MRI brain-scan was normal. For treatment, he decreased alcohol, tried to keep a regular sleep-wake pattern and have sufficient sleep; and started Melatonin 2 mg before bedtime. Because another episode occurred while taking this dose, we increased it to 6 mg. No more episodes happened during the 23-month follow-up time.

Case-3

A 33-year-old engineer was seen in the sleep-clinic for his frequent sexual activities in the first half of the night; occurring frequently in the last two years. It was mostly masturbation observed by his changing partners; sometimes full sex, apparently not disapproved by any of them. He did not remember these activities. He consumed alcohol regularly but not excessively. His physical status was normal; he was cooperative and intelligent. He was told by parents to have had sleep-walked and sleep-talked as a child; this had faded away by age 7-8. He considered his episodes as proofs of masculinity, however, he linked them to work-stress. Melatonin 2 mg taken one hour before bedtime, has made the episodes less frequent.

Sleep-related eating disorder

Case-4

A 54-year-old administrator living on her own, had no parasomnia in her history. She had high blood pressure, consumed alcohol irregularly, and smoked 15-20 cigarettes/day. She had been medically incapacitated for mood disorders. She presented in the Sleep Clinic for eating in the first third of her night-sleep; consuming sweets and anything at hand including cleaning-substances and cigarette stubs without recall; three-four times/week for the last few years. During this time, she had gained significant weight reaching a BMI of 33; thankfully; no poisoning occurred.

Her physical status was normal apart from the overweight. Her regular medication included Amlodipine, Bisoprolol, Atorvastatin, Paracetamol (for low back pain) and, Clonazepam. The MRI brain scan was unremarkable. Whole-night polysomnography revealed a fragmented sleep (several short awakenings and frequent microarousals from N3 sleep). A short eating-episode was captured: she sat up and slowly consumed the small piece of pastry on her bed-side table while her eyes remained closed, she mumbled in an apparent sleeping state, then she lay back to her bed. The EEG - disturbed by movement-artefacts - revealed delta waves suggestive of N3 sleep. Her apnea/hypopnea index was 4/hour during the polysomnography night. Escitalopram 15 mg in the morning and 4 mg Melatonin before bed-time have not helped.

Case-5

A 73-year-old woman, a retired accountant presented with headache in the outpatient neurology clinic. She had mild Parkinsonian signs and the MRI brain-scan revealed vascular encephalopathy. There was no parasomnia in her or in her family’s history. She had high blood pressure and, type-2 diabetes, both treated, and had been under mental health-care for years for anxiety and paranoid delusions.

Two months before the visit in the neurology clinic, Quetiapine 200 mg had been started. While discussing her headache and related symptoms, she adventitiously reported recently consuming ‘forbidden’ foods (cakes, confectionary, sweets etc.) during sleep; this had scared and embarrassed her a great deal. We supposed that her apparent SRED was a side-effect of Quetiapine, therefore, her antipsychotic treatment was swapped to Olanzapine 10 mg in the evening. At the next visit in six weeks’ time she reported that her sleep-eating had ceased.

Case-6

A 66-year-old businessman was diagnosed with Erdheim-Chester disease (a non-Langerhans histiocytosis); based on clinical signs and immune-histochemical evidence of a BRAF mutation from a specimen of kidney-biopsy; taken from a ‘hairy kidney’. He was treated with Vemurafenib (Kulkarni et al., 2024). At a certain stage, he had become unable to eat due to bilateral facial muscle-dystonia interfering with mouth-closure and grinding; resulting in significant weight-loss. His eating was not helped by muscle relaxants, benzodiazepines and Trihexyphenydil. Since he could not sleep in this period, Zolpidem 10 mg before bedtime was started. From that point, while struggling/unable to eat during the day, his wife noticed his sleepwalking each night; and in those states, he consumed whatever food he found while apparently remaining asleep. He had no memory of these episodes. Zolpidem was clearly beneficial, therefore he increased its dose to 20 and 30 mg and even tried it in the daytime (then not helping his facial dystonia), for enhancing this effect. Unfortunately, due to multi-organ damage, he passed away at age 69.

Results and discussion

We call attention to the neglected NREM parasomnias sexsomnia and SRED (Bjorvatn et al., 2010). In them, a release of “hedonistic” - reward-seeking - behaviors during sleep can be noted (opposite emotions occur in the fearful arousals of sleep terrors (Halász et al., 2024)). While hedonistic behaviors seem to be activated by sleep, interestingly, they can be promoted by sleep-deprivation (Liu et al., 2016; Guo et al., 2023) as well. The activating effect of sleep accords with the observation that certain sleep-promoting drugs especially the sleeping pill Zolpidem and the dual orexin-receptor antagonist Suvorexant may provoke SRED. (Note that Suvorexant may promote SRED also by its metabolic effect and anti-orexin influence on feeding behavior and reward-seeking both during NREM sleep and waking (Merino et al., 2022; Han et al., 2020; Mohammadkhani et al., 2024; Jamesa et al., 2021)).

About 40-50% of NREM parasomnia cases have a family background. A NREM parasomnia-case in family, increases the individual’s odds to develop it by seven times (Correa et al., 2024; Battiato et al., 2025; Pressman, 2007; Hublin et al., 2001); however, this genetic determination seems stronger in children than in adult cases (Mainieri et al., 2023). An underlying genetic mutation was identified but in one big family, where an autosomal dominant inheritance with reduced penetrance could be shown (Licis et al., 2011). In most adult cases other factors such as medications, alcohol, stress, childhood trauma, sleep disruption and unknown causes constitute the background. In accordance with this, out of our six adult NREM parasomnia cases, just two with sexomnia have carried a family predisposition, and in them, regular alcohol use may have contributed. Alcohol may exert a chronic sleep-modifying effect, even during periods of abstinence; often compounded by lifestyle issues (Battiato et al., 2025; Pressman, 2007; Hublin et al., 2001Colrain et al., 2014; Inkelis et al., 2020; Sharma et al., 2022). Although both the ICSD-3 and the DSM-5 have eliminated alcohol-intoxication as a trigger for NREM parasomnia-episodes (Sateia, 2014; Ma, 2022; Pressman, 2023), the long-lasting sleep-harm caused by alcohol should not be overlooked.

The interplay between sleep-promoting and wake-promoting forces may facilitate sleep-wake dissociation (a part of the brain remaining in sleep while another part is partially or fully awake); probably underlying NREM parasomnia episodes (Parrino et al., 2022; Halász et al., 2022; Halász & Szűcs, 2020). It is likely, that different variants of NREM parasomnias, may be underlain by diverse dissociation-patterns of the brain. Understanding the reasons and mechanisms of those dissociation patterns needs further research.

An ingenious study regarding the mechanism of parasomnias has been recently advanced by Avidan et al. (Avidan et al., 2025), who observed the shift of hand-dominance during masturbatory episodes of seven sexsomnia patients. They interpreted this finding as one supporting the notion of Tassinari et al. (Tassinari et al., 2009) on the role of the so called central pattern generators – neural networks regulating automatic rhythmic movements including walking, eating or sex. Those central pattern generators would be released from cortical inhibition by sleep, producing then automatic parasomnia-behaviors e.g. sexsomnia; or by ictal epileptic activity of the cortex, producing hypermotor seizures. The lack of cortical involvement in the regulation of those movements would explain the amnesia to parasomnia-episodes.

Our late-onset female sexsomnia Case-1 is somewhat unusual. This woman had her first symptoms over age 50 years with no family or personal history of NREM parasomnia; unlike most sexsomnia-cases in the literature; young adult males with a history or a family-predisposition for sleepwalking (Trajanovic et al., 2007; Drakatos et al., 2019; Cankardas & Schenck, 2021). Sexsomnia in females (Brás et al., 2023) and NREM parasomnias starting over age fifty (Loddo et al., 2022) have been reported in the literature, but to our knowledge, no late-onset female sexsomnia has been documented.

This atypical presentation with the reported difficulty of waking her up from the episodes, have made us raise the possibility of epileptic seizures with ictal sex-manifestations (Rémillard et al., 1983; Janszky et al., 2004) or episodes of sleep-related dissociative states (Lopez et al., 2022; Schenck, 2024); both conditions typically affecting women.

She had an EEG after sleep deprivation not supporting, but no fully excluding epilepsy. She declined further investigation such as giving collateral information from husband, a video-polysomnography or a 24-hour EEG that could clarify her condition.

Sleep-related epilepsies, especially sleep-related hypermotor epilepsy (SHE) is a challenging but significant differential-diagnostic condition of NREM parasomnias. SHE and NREM parasomnias may overlap in clinical symptoms, in sleep-distribution; and show even genetic links (Mutti et al., 2020; Halász et al., 2012). The objective tool of differentiation would be sleep EEG-polysomnography; the presence or lack of epileptic signs supporting or standing against the diagnosis of epilepsy respectively. However, in many SHE cases, there are no epileptic signs on the scalp-EEG, therefore, other discriminatory features - gained from home-video records and historic data- are needed. Several (up to 30-40) short (<1 minute), abrupt onset episodes/night, jerking, convulsing, vocalizing wordlessly support epilepsy, while rare/very episodes (maximum 1-2/night) with often coherent or semi-coherent activities and speech during a few minutes-lasting episodes may support a NREM parasomnia (Montini et al., 2021).

Sleep-related dissociative states occurring in awake persons during their sleeping period close to bedtime, make another challenging issue to diagnose. In these cases, wakefulness during, before and after the nocturnal episodes shown by video-polysomnography; the long (> 1 hour) duration of the episodes, self-inflicted injuries (83.3%), and the presence of daytime dissociative symptoms (72.7%), may give a clue (Loddo et al., 2020).

The potential marital consequences and feelings of shame associated with sexsomnia (Toscanini et al., 2021), require a thoughtful psychological approach. The irregular sleep-wake pattern and vascular encephalopathy observed in our Case-1 may have contributed to her episodes by disrupting sleep and reducing her ability to cope.

In Case-2, a young man with a personal and family history of NREM parasomnias experienced an extension of his early sleepwalking into episodes of sexsomnia, possibly linked to alcohol use and insufficient sleep. His polysomnography revealed fragmented sleep alike in other NREM parasomnia cases; sleep fragmentation with frequent arousals from N2 and N3 sleep considered a sensitive biomarker of NREM parasomnias (Rossi et al., 2023). A life-style change and the use of melatonin appeared to help during the nearly two-year follow-up period. Unfortunately, we could not get information on the outcome of his legal case.

Also in Case-3, childhood sleepwalking preceded sexsomnia of a young man; stress and alcohol might have primed his events. In his case, a positive subjective feeling of masculinity with an improvement of sexual life could be raised in relation to sexsomnia; alike in other reported cases in the literature (Cankardas & Schenck, 2021).

In summary, the interplay between genetic predisposition, shift work, lifestyle issues, alcohol, stress and organic brain-lesions could create a complex set for individuals for developing sexsomnia. The combination of historic (family or childhood) sleepwalking with sexsomnia in adulthood (Cases 2 and 3), highlights the spectral nature and overlap of NREM parasomnias (Soca et al., 2016).

In Case-4, night-eating syndrome (eating in the awake state at night (Dubessy et al., 2017; Matsui et al., 2020) could be suspected based on the patient’s patchy memories of consuming food at night; however, the (although fragmentary) slow waves suggesting N3 sleep seen on polysomnography-EEG while she had been eating, confirmed the diagnosis of SRED. Her obesity and high blood pressure have raised the possibility of a concomitant sleep apnea syndrome, however, this was not supported by polysomnography. Unfortunately, different pharmacotherapies, counseling and trials of cognitive behavior therapies remained practically useless during the one-year follow-up period.

In Cases 5 and 6, SRED seemed to be associated with certain drugs. In Case 5, the symptoms had begun with the initiation of Quetiapine and ceased when it was discontinued; supporting a causal relationship. In Case 6, the complex and, in this instance, favorable combination of Zolpidem’s side-effects could be considered. Since there are more than 500 cases in the literature now reporting on drug-related sleepwalking and SRED apparently caused by Quetiapine and Zolpidem (e.g. Vasiliu, 2024; Merino et al., 2022), it seems justified to suppose that his sleepwalking and SRED that he had not experienced before starting this drug, were induced by Zolpidem. Given the anti-dystonic property of Zolpidem also known to the literature (Miyazaki et al., 2012; Horisawa et al., 2024), one may presume the combination of these side-effects in our patient; however, interestingly, helping his facial dystonia during sleep only.

It is crucial for clinicians to identify and recognize the effects of various medications in provoking sleepwalking and SRED (Vasiliu, 2024; Merino et al., 2022; Morgenthaler & Silber, 2002; Nzwalo et al., 2013). In addition to Quetiapine and Zolpidem - the latter also linked to incidents of sleep-driving in a series of eight patients (Poceta, 2011), SRED has been associated with other Z-drugs, Sodium Oxybate, Risperidone, several psychostimulants, and selective serotonin-norepinephrine reuptake inhibitor antidepressants (Vasiliu, 2024; Merino et al., 2022; Morgenthaler et al., 2004). A recent study found that Zolpidem suppressed norepinephrine oscillations and glymphatic flow, possibly related to its specific sleep-modifying effects (Hauglund et al., 2025).

Among the potential mechanisms of action of both quetiapine and zolpidem is a common transient antagonism of brain dopamine cells along with dose-related increases in dopamine release in both prefrontal cortex and limbic regions like the nucleus accumbens. Quetiapine acts as a transient antagonist of D2 receptors (Horacek et al., 2006) which, if acting on dopamine auto-receptors, can increase dopamine release in different regions of the brain. Similarly, stimulating GABA transmission, Zolpidem can inhibit dopamine cell bodies directly, or disinhibit them by GABA A receptor actions on GABA neurons themselves (Scatton et al., 1986). As dopamine is important for the transition between sleep stages, and particularly the transition from NREM into REM (Dzirasa et al., 2006), an increase in dopamine release in the nucleus accumbens could suppress REM sleep and cataplexy, upsetting the balance between muscle atonia at REM and dream states. Quetiapine also acts as a 5-HT1A auto-receptor agonist (which can suppress serotonin release) and as a 5-HT2A antagonist (Anderson & Vande Griend, 2014). 5-HT1A receptor activation in the frontal cortex is likely important for top-down inhibition of sexual arousal and desire (Pfaus, 2009), and flibanserin, a drug with similar antagonistic actions on serotonin to quetiapine is currently used to treat sexual desire disorders (Lee et al., 2022). Thus, both zolpidem and quetiapine could facilitate sexomnia or SRED as a side-effect of its mixed facilitation of dopamine and suppression of serotonin in susceptible individuals.

SRED and sexsomnia represent a crossroad for neurology, psychiatry, nutrition-science and sexology. In these conditions, the roles of sleep regulation, the patterns of sleep-dissociation and reward-seeking need to be studied together with psychosexual, psychiatric and metabolic functioning (Mutti et al., 2023; Agrawal et al., 2024; Martins-de-Passos et al., 2024) for helping patients and evaluating the challenging aspects of consciousness determining legal responsibility. Future research based on functional neuroimaging should investigate the neural basis, especially the likely diverse sleep-wake dissociation-patterns underlying these conditions. Longitudinal clinical studies could further explore the issues of awareness, consciousness and memory, related to the episodes. These questions closely link to sleep-physiology especially to sleep’s double-faced character (during sleep, the apparently unconscious individual keeps a flexible partial power of discrimination) (Halász et al., 2014). Understanding these aspects would contribute to both diagnosis and legal evaluation.

This paper aims to raise awareness about these intriguing and often dangerous parasomnias that require proper recognition and treatment.

Acknowledgement

The authors are grateful for the reviewers’ selfless help importantly augmenting the paper’s value.

During the preparation of this work the author(s) used ChatGPT in order to improve readability and clarity of the text. After using this tool, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.

Funding Statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Disclosure statement

No potential conflict of interest was reported by the author(s).

References

  1. Agrawal, P., Singh, S. M., Able, C., Kohn, T. P., & Herati, A. S. (2024). Sleep disorders are associated with testosterone deficiency and erectile dysfunction—a US claims database analysis. International Journal of Impotence Research, 36(1), 78–82. 10.1038/s41443-022-00649-2 [DOI] [PubMed] [Google Scholar]
  2. Andersen, M. L., Schenck, C. H., & Tufik, S. (2024). Understanding Sexual Parasomnias: A Review of the Current Literature on Their Nature, Diagnosis, Impacts, and Management. Sleep Medicine Clinics, 19(1), 21–41. 10.1016/j.jsmc.2023.10.002 [DOI] [PubMed] [Google Scholar]
  3. Anderson, S. L., & Vande Griend, J. P. (2014). Quetiapine for insomnia: A review of the literature. American Journal of Health-System Pharmacy: AJHP: Official Journal of the American Society of Health-System Pharmacists, 71(5), 394–402. 1 10.2146/ajhp130221 [DOI] [PubMed] [Google Scholar]
  4. Avidan, A. Y., Hasan, R., Badami, V., & Schenck, C. H. (2025). Hand dominance shift during sleep in sexsomnia: A clue to pathophysiology? Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine, 21(5), 937–941. 10.5664/jcsm.11554 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Battiato, A., Dodet, P., Chaumereuil, C., Maranci, J.-B., Leu-Semenescu, S., Gales, A.-Z., Groffen, A. J., & Arnulf, I. (2025). Familial and sporadic non-rapid eye movement parasomnia in adults: Clinical and sleep differences. Sleep, zsaf103. 10.1093/sleep/zsaf103 [DOI] [PubMed] [Google Scholar]
  6. Bjorvatn, B., Grønli, J., & Pallesen, S. (2010). Prevalence of different parasomnias in the general population. Sleep Medicine, 11(10), 1031–1034. 10.1016/j.sleep.2010.07.011 [DOI] [PubMed] [Google Scholar]
  7. Brás, J., Schenck, C. H., Andrade, R., Costa, A. P., Teixeira, C., & Meira E Cruz, M. (2023). A challenging case of sexsomnia in an adolescent female presenting with depressive-like symptoms. Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine, 19(10), 1845–1847. 10.5664/jcsm.10714 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cankardas, S., & Schenck, C. H. (2021). Sexual behaviors and sexual health of sexsomnia individuals aged 18–58. International Journal of Sexual Health: Official Journal of the World Association for Sexual Health, 33(1), 29–39. 10.1080/19317611.2020.1850597 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Castelnovo, A., Siclari, F., Spaggiari, S., Borth, D., Manconi, M., Arnulf, I., et al. (2024). Conscious experiences during non-rapid eye movement sleep parasomnias. Neuroscience & Biobehavioral, 67, 105919. 10.1016/j.neubiorev.2024.105919 [DOI] [PubMed] [Google Scholar]
  10. Colrain, I. M., Nicholas, C. L., & Baker, F. C. (2014). Alcohol and the sleeping brain. Handbook of Clinical Neurology, 125, 415–431. 10.1016/B978-0-444-62619-6.00024-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Correa, V. M., Biresaw, M. S., Vitrai, J., & Szűcs, A. (2024). NREM parasomnia-related behaviors and adverse childhood experiences. Sleep Medicine, 121, 365–369. 10.1016/j.sleep.2024.07.027 [DOI] [PubMed] [Google Scholar]
  12. Drakatos, P., Marples, L., Muza, R., Higgins, S., Nesbitt, A., Dongol, E. M., Macavei, R., Gnoni, V., Perez Carbonell, L., Duncan, I., Birdseye, A., Dastagir, S., Rosenzweig, I., O’Regan, D., Williams, A. J., Leschziner, G. D., & Kent, B. D. (2019). Video polysomnographic findings in non-rapid eye movement parasomnia. Journal of Sleep Research, 28(2), e12772. 10.1111/jsr.12772 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Dubessy, A.-L., Leu-Semenescu, S., Attali, V., Maranci, J.-B., & Arnulf, I. (2017). Sexsomnia: A specialized non-REM parasomnia? Sleep, 40(2). 10.1093/sleep/zsw043 [DOI] [PubMed] [Google Scholar]
  14. Dzirasa, K., Ribeiro, S., Costa, R., Santos, L. M., Lin, S.-C., Grosmark, A., Sotnikova, T. D., Gainetdinov, R. R., Caron, M. G., & Nicolelis, M. A. L. (2006). Dopaminergic control of sleep-wake states. The Journal of Neuroscience: The Official Journal of the Society for Neuroscience, 26(41), 10577–10589. 10.1523/JNEUROSCI.1767-06.2006 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Ebeling, M., Shufflebarger, E. F., & Pacheco, Z. (2024). Vaginitis in the Context of an Uncommon Parasomnia: A Case Report. Cureus, 16(6), e62696. 10.7759/cureus.62696 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Guo, R., Vaughan, D. T., Rojo, A. L. A., & Huang, Y. H. (2023). Sleep-mediated regulation of reward circuits: Implications in substance use disorders. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology, 48(1), 61–78. 10.1038/s41386-022-01356-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Halász, P., & Szűcs, A. (2020). Sleep and epilepsy link by plasticity. Frontiers in Neurology, 11, 911. 10.3389/fneur.2020.00911 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Halász, P., Bódizs, R., Parrino, L., & Terzano, M. (2014). Two features of sleep slow waves: Homeostatic and reactive aspects–from long term to instant sleep homeostasis. Sleep Medicine, 15(10), 1184–1195. 10.1016/j.sleep.2014.06.006 [DOI] [PubMed] [Google Scholar]
  19. Halász, P., Kelemen, A., & Szűcs, A. (2012). Physiopathogenetic Interrelationship between Nocturnal Frontal Lobe Epilepsy and NREM Arousal Parasomnias. Epilepsy Research and Treatment, 2012, 312693. 10.1155/2012/312693 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Halász, P., Simor, P., & Szűcs, A. (2024). Fearful arousals in sleep terrors and sleep-related hypermotor epileptic seizures may involve the salience network and the acute stress response of Cannon and Selye. Epilepsy & Behavior Reports, 25, 100650. 10.1016/j.ebr.2024.100650 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Halász, P., Szűcs, A., Mutti, C., & Parrino, L. (2022). Disorders of arousal and sleep-related hypermotor epilepsy—overview and challenges night is a battlefield of sleep and arousal promoting forces. Neurological Sciences, 43(2), 927–937. 10.1007/s10072-021-05857-0 [DOI] [PubMed] [Google Scholar]
  22. Han, Y., Yuan, K., Zheng, Y., & Lu, L. (2020). Orexin receptor antagonists as emerging treatments for psychiatric disorders. Neuroscience Bulletin, 36(4), 432–448. 10.1007/s12264-019-00447-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Hanif, U., Cairns, A., Mysliwiec, V., Bettinardi, R. G., Elbaz, M., Gimenez, U., & Mignot, E. J. M. (2024). Associations between self‐reported parasomnias and psychiatric illness in 370,000 patients with sleep disorders. Psychiatry and Clinical Neurosciences, 78(11), 667–677. 10.1111/pcn.13723 [DOI] [PubMed] [Google Scholar]
  24. Hauglund, N. L., Andersen, M., Tokarska, K., Radovanovic, T., Kjaerby, C., Sørensen, F. L., Bojarowska, Z., Untiet, V., Ballestero, S. B., Kolmos, M. G., Weikop, P., Hirase, H., & Nedergaard, M. (2025). Norepinephrine-mediated slow vasomotion drives glymphatic clearance during sleep. Cell, 188(3), 606–622. e17. 10.1016/j.cell.2024.11.027 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Holoyda, B. J., Sorrentino, R. M., Mohebbi, A., Fernando, A. T., & Friedman, S. H. (2021). Forensic evaluation of sexsomnia. The Journal of the American Academy of Psychiatry and the Law, 49(2), 202–210. 10.29158/JAAPL.200077-20 [DOI] [PubMed] [Google Scholar]
  26. Horacek, J., Bubenikova-Valesova, V., Kopecek, M., Palenicek, T., Dockery, C., Mohr, P., & Höschl, C. (2006). Mechanism of action of atypical antipsychotic drugs and the neurobiology of schizophrenia. CNS Drugs, 20(5), 389–409. 10.2165/00023210-200620050-00004 [DOI] [PubMed] [Google Scholar]
  27. Horisawa, S., Kim, K., Murakami, M., Nishitani, M., Kawamata, T., & Taira, T. (2024). Efficacy and safety of zolpidem for musician’s dystonia. Journal of Movement Disorders, 17(4), 425–429. 10.14802/jmd.24121 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Hrozanova, M., Moen, F., & Pallesen, S. (2019). Unique predictors of sleep quality in junior athletes: The protective function of mental resilience, and the detrimental impact of sex, worry and perceived stress. Frontiers in Psychology, 10, 1256. 10.3389/fpsyg.2019.01256 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Hublin, C., Kaprio, J., Partinen, M., & Koskenvu, M. (2001). Parasomnias: Co-occurrence and genetics. Psychiatric Genetics, 11(2), 65–70. 10.1097/00041444-200106000-00002 [DOI] [PubMed] [Google Scholar]
  30. Idir, Y., Oudiette, D., & Arnulf, I. (2022). Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: The old and the new. Journal of Sleep Research, 31(4), e13596. 10.1111/jsr.13596 [DOI] [PubMed] [Google Scholar]
  31. Ingravallo, F., Poli, F., Gilmore, E. V., Pizza, F., Vignatelli, L., Schenck, C. H., & Plazzi, G. (2014). Sleep-related violence and sexual behavior in sleep: A systematic review of medical-legal case reports. Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine, 10(8), 927–935. 10.5664/jcsm.3976 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Inkelis, S. M., Hasler, B. P., & Baker, F. C. (2020). Sleep and alcohol use in women. Alcohol Research: Current Reviews, 40(2), 13. 10.35946/arcr.v40.2.13 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Irfan, T., Ulfat, M., Bashir, S., Khalid, S., Mehdi, F., & Tanveer, M. (2021). Impact of sleeping habits, physical activity and sleeping hours on Insomnia among patients visiting tertiary care hospitals, Lahore. Pure and Applied Biology, 10(3), 819–825. 10.19045/bspab.2021.100084 [DOI] [Google Scholar]
  34. Jamesa, J., Avilaa, J. A., Spaethb, A. M., Langlebend, R. N. A. D., & Aston-Jonesa, G. (2021). The insomnia-addiction positive feedback loop: Role of the orexin system. The Orexin System Basic Science and Role in Sleep Pathology. 117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Janszky, J., Ebner, A., Szupera, Z., Schulz, R., Hollo, A., Szücs, A., & Clemens, B. (2004). Orgasmic aura-a report of seven cases. Seizure, 13(6), 441–444. 10.1016/j.seizure.2003.09.005 [DOI] [PubMed] [Google Scholar]
  36. Kulkarni, A. M., Gayam, P. K. R., & Aranjani, J. M. (2024). Advances in understanding and management of Erdheim-Chester disease. Life Sciences, 348, 122692. 10.1016/j.lfs.2024.122692 [DOI] [PubMed] [Google Scholar]
  37. Lee, J. H., Lee, J. E., Harsh, V., & Clayton, A. H. (2022). Pharmacotherapy for Sexual Dysfunction in Women. Current Psychiatry Reports, 24(2), 99–109. 10.1007/s11920-022-01322-7 [DOI] [PubMed] [Google Scholar]
  38. Licis, A. K., Desruisseau, D. M., Yamada, K. A., Duntley, S. P., & Gurnett, C. A. (2011). Novel genetic findings in an extended family pedigree with sleepwalking. Neurology, 76(1), 49–52. 10.1212/WNL.0b013e318203e964.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Liu, Z., Wang, Y., Cai, L., Li, Y., Chen, B., Dong, Y., & Huang, Y. H. (2016). Prefrontal cortex to accumbens projections in sleep regulation of reward. The Journal of Neuroscience: The Official Journal of the Society for Neuroscience, 36(30), 7897–7910. 10.1523/JNEUROSCI.0347-16.2016 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Loddo, G., Baldassarri, L., Zenesini, C., Licchetta, L., Bisulli, F., Cirignotta, F., Mondini, S., Tinuper, P., & Provini, F. (2020). Seizures with paroxysmal arousals in sleep-related hypermotor epilepsy (SHE): Dissecting epilepsy from NREM parasomnias. Epilepsia, 61(10), 2194–2202. 10.1111/epi.16659 [DOI] [PubMed] [Google Scholar]
  41. Loddo, G., Fragiacomo, F., Mainieri, G., Mondini, S., Buzzi, G., Calandra-Buonaura, G., & Provini, F. (2022). Disorders of arousal in 4 older men: Evidence from clinical practice. Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine, 18(1), 129–136. 10.5664/jcsm.9516 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Lopez, R., Lefevre, L., Barateau, L., Micoulaud-Franchi, J. A., Dauvilliers, Y., & Schenck, C. H. (2022). A series of 8 cases of sleep-related psychogenic dissociative disorders and proposed updated diagnostic criteria. Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine, 18(2), 563–573. 10.5664/jcsm.9654 [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Ma, F. (2022). Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). Encyclopedia of gerontology and population aging. : Springer. p. 1414–1425. [Google Scholar]
  44. Mainieri, G., Loddo, G., Baldelli, L., Montini, A., Mondini, S., & Provini, F. (2023). Violent and Complex Behaviors and Non-Restorative Sleep Are the Main Features of Disorders of Arousal in Adulthood: Real Picture or a More Severe Phenotype? Journal of Clinical Medicine, 12(1), 372. 10.3390/jcm12010372 [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Mainieri, G., Loddo, G., Provini, F., Nobili, L., Manconi, M., & Castelnovo, A. (2023). Diagnosis and management of NREM sleep parasomnias in children and adults. Diagnostics, 13(7), 1261. 10.3390/diagnostics13071261 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Mangan, M. A., & Reips, U.-D. (2007). Sleep, sex, and the Web: Surveying the difficult-to-reach clinical population suffering from sexsomnia. Behavior Research Methods, 39(2), 233–236. 10.3758/bf03193152 [DOI] [PubMed] [Google Scholar]
  47. Martins-de-Passos, T. O., Mesas, A. E., Beneit, N., Díaz-Goñi, V., Peral-Martinez, F., Cekrezi, S., Martinez-Vizcaino, V., & Jimenez-Lopez, E. (2024). Are Sleep Parameters and Chronotype Associated with Eating Disorder Risk? A Cross-Sectional Study of University Students in Spain. Journal of Clinical Medicine, 13(18), 5482. 10.3390/jcm13185482 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Matsui, K., Komada, Y., Nishimura, K., Kuriyama, K., & Inoue, Y. (2020). Prevalence and associated factors of nocturnal eating behavior and sleep-related eating disorder-like behavior in Japanese young adults: Results of an internet survey using Munich parasomnia screening. Journal of Clinical Medicine, 9(4), 1243. 10.3390/jcm9041243 [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Merino, D., Gérard, A. O., Van Obberghen, E. K., Ben Othman, N., Ettore, E., Giordana, B., Viard, D., Rocher, F., Destere, A., Benoit, M., & Drici, M.-D. (2022). Medications as a trigger of sleep-related eating disorder: A disproportionality analysis. Journal of Clinical Medicine, 11(13), 3890. 10.3390/jcm11133890 [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Miyazaki, Y., Sako, W., Asanuma, K., Izumi, Y., Miki, T., & Kaji, R. (2012). Efficacy of zolpidem for dystonia: A study among different subtypes. Frontiers in Neurology, 3, 58. 10.3389/fneur.2012.00058 [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Mohammadkhani, A., Mitchell, C., James, M. H., Borgland, S. L., & Dayas, C. V. (2024). Contribution of hypothalamic orexin (hypocretin) circuits to pathologies of motivation. British Journal of Pharmacology, 181(22), 4430–4449. 10.1111/bph.17325 [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Mohebbi, A., Holoyda, B. J., & Newman, W. J. (2018). Sexsomnia as a Defense in Repeated Sex Crimes. The Journal of the American Academy of Psychiatry and the Law, 46(1), 78–85. [PubMed] [Google Scholar]
  53. Montini, A., Loddo, G., Baldelli, L., Cilea, R., & Provini, F. (2021). Sleep-Related Hypermotor Epilepsy vs Disorders of Arousal in Adults: A Step-Wise Approach to Diagnosis. Chest, 160(1), 319–329. 10.1016/j.chest.2021.01.059 [DOI] [PubMed] [Google Scholar]
  54. Morgenthaler, T. I., & Silber, M. H. (2002). Amnestic sleep-related eating disorder associated with zolpidem. Sleep Medicine, 3(4), 323–327. 10.1016/s1389-9457(02)00007-2 [DOI] [PubMed] [Google Scholar]
  55. Morgenthaler, T. I., Silber, M. H., ALu, M.-L., & Shen, W. W. (2004). Sleep-related eating disorder induced by risperidone. The J Clinical Psychiatry, 65(2), 19728. [DOI] [PubMed] [Google Scholar]
  56. Mutti, C., Bernabè, G., Barozzi, N., Ciliento, R., Trippi, I., Pedrazzi, G., Azzi, N., & Parrino, L. (2020). Commonalities and Differences in NREM Parasomnias and Sleep-Related Epilepsy: Is There a Continuum Between the Two Conditions? Frontiers in Neurology, 11;11, 600026. 10.3389/fneur.2020.600026 [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Mutti, C., Malagutti, G., Maraglino, V., Misirocchi, F., Zilioli, A., Rausa, F., Pizzarotti, S., Spallazzi, M., Rosenzweig, I., & Parrino, L. (2023). Sleep pathologies and eating disorders: A crossroad for neurology, psychiatry and nutrition. Nutrients, 15(20), 4488. 10.3390/nu15204488 [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Nzwalo, H., Ferreira, L., Peralta, R., & Bentes, C. (2013). Sleep-related eating disorder secondary to zolpidem. BMJ Case Reports, 2013, bcr2012008003. 10.1136/bcr-2012-008003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Parrino, L., Halasz, P., Szucs, A., Thomas, R. J., Azzi, N., Rausa, F., Pizzarotti, S., Zilioli, A., Misirocchi, F., & Mutti, C. (2022). Sleep medicine: Practice, challenges and new frontiers. Frontiers in Neurology, 13, 966659. 10.3389/fneur.2022.966659 [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Pfaus, J. G. (2009). Pathways of sexual desire. The Journal of Sexual Medicine, 6(6), 1506–1533. 10.1111/j.1743-6109.2009.01309.x [DOI] [PubMed] [Google Scholar]
  61. Poceta, J. S. (2011). Zolpidem ingestion, automatisms, and sleep driving: A clinical and legal case series. Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine, 7(6), 632–638. 10.5664/jcsm.1468 [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Pressman, M. R. (2007). Factors that predispose, prime and precipitate NREM parasomnias in adults: Clinical and forensic implications. Sleep Medicine Reviews, 11(1), 5–30. 10.1016/j.smrv.2006.06.003 [DOI] [PubMed] [Google Scholar]
  63. Pressman, M. R. (2023). Forensic evaluation of a single episode of a disorder of arousal in a sleepwalking defense: Cognitive function versus prior clinical history. Sleep Science (Sao Paulo, Brazil), 16(3), e354–e61. 10.1055/s-0043-1773787 [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Rémillard, G. M., Andermann, F., Testa, G. F., Gloor, P., Aubé, M., Martin, J. B., Feindel, W., Guberman, A., & Simpson, C. (1983). Sexual ictal manifestations predominate in women with temporal lobe epilepsy: A finding suggesting sexual dimorphism in the human brain. Neurology, 33(3), 323–330. 10.1212/wnl.33.3.323 [DOI] [PubMed] [Google Scholar]
  65. Rossi, J., Gales, A., Attali, V., Leu-Semenescu, S., Dodet, P., Groos, E., & Arnulf, I. (2023). Do the EEG and behavioral criteria of NREM arousal disorders apply to sexsomnia? Sleep, 46(7), zsad056. 10.1093/sleep/zsad056 [DOI] [PubMed] [Google Scholar]
  66. Sateia, M. J. (2014). International Classification of Sleep Disorders (ICSD-3). Chest, 146(5), 1387–1394. 10.1378/chest.14-0970 [DOI] [PubMed] [Google Scholar]
  67. Scatton, B., Claustre, Y., Dennis, T., & Nishikawa, T. (1986). Zolpidem, a novel nonbenzodiazepine hypnotic. II. Effects on cerebellar cyclic GMP levels and cerebral monoamines. The Journal of Pharmacology and Experimental Therapeutics, 237(2), 659–665. 10.1016/S0022-3565(25)24905-9 [DOI] [PubMed] [Google Scholar]
  68. Schenck, C. H. (2024). Two Cases of Sleep-related Dissociative Disorder with Episodes of Nocturnal Eating. Sleep Science (Sao Paulo, Brazil), 17(3), e325–e334. 10.1055/s-0044-1780498 [DOI] [PMC free article] [PubMed] [Google Scholar]
  69. Schenck, C. H. (2015). Update on sexsomnia, sleep related sexual seizures, and forensic implications. NeuroQuant, 13, 518–541. [Google Scholar]
  70. Schenck, C. H., Arnulf, I., & Mahowald, M. W. (2007). Sleep and sex: What can go wrong? A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences. Sleep, 30(6), 683–702. 10.1093/sleep/30.6.683 [DOI] [PMC free article] [PubMed] [Google Scholar]
  71. Shapiro, C. M., Trajanovic, N. N., & Fedoroff, J. P. (2003). Sexsomnia - a new parasomnia? The Canadian Journal of Psychiatry, 48(5), 311–317. 10.1177/070674370304800506 [DOI] [PubMed] [Google Scholar]
  72. Sharma, R., Parikh, M., Mishra, V., Zuniga, A., Sahota, P., & Thakkar, M. (2022). Sleep, sleep homeostasis and arousal disturbances in alcoholism. Brain Research Bulletin, 182, 30–43. 10.1016/j.brainresbull.2022.01.022 [DOI] [PubMed] [Google Scholar]
  73. Soca, R., Keenan, J. C., & Schenck, C. H. (2016). Parasomnia overlap disorder with sexual behaviors during sleep in a patient with obstructive sleep apnea. Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine, 12(8), 1189–1191. 10.5664/jcsm.6066 [DOI] [PMC free article] [PubMed] [Google Scholar]
  74. Tassinari, C. A., Cantalupo, G., Högl, B., Cortelli, P., Tassi, L., Francione, S., Nobili, L., Meletti, S., Rubboli, G., & Gardella, E. (2009). Neuroethological approach to frontolimbic epileptic seizures and parasomnias: The same central pattern generators for the same behaviours. Revue Neurologique, 165(10), 762–768. 10.1016/j.neurol.2009.08.002 [DOI] [PubMed] [Google Scholar]
  75. Toscanini, A. C., Marques, J. H., Hasan, R., & Schenck, C. H. (2021). Sexsomnia: Case based classification and discussion of psychosocial implications. Sleep Science (Sao Paulo, Brazil), 14(2), 175–180. 10.5935/1984-0063.20200057 [DOI] [PMC free article] [PubMed] [Google Scholar]
  76. Trajanovic, N. N., Mangan, M., & Shapiro, C. M. (2007). Sexual behaviour in sleep: An internet survey. Social Psychiatry and Psychiatric Epidemiology, 42(12), 1024–1031. 10.1007/s00127-007-0258-0 [DOI] [PubMed] [Google Scholar]
  77. Van Eeden, A. E., Van Hoeken, D., & Hoek, H. W. (2021). Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current Opinion in Psychiatry, 34(6), 515–524. 10.1097/YCO.0000000000000739 [DOI] [PMC free article] [PubMed] [Google Scholar]
  78. Vasiliu, O. (2023). An integrative model as a step toward increasing the awareness of eating disorders in the general population. Frontiers in Psychiatry, 14, 1184932. 10.3389/fpsyt.2023.1184932 [DOI] [PMC free article] [PubMed] [Google Scholar]
  79. Vasiliu, O. (2024). Current evidence and future perspectives in the exploration of sleep-related eating disorder–a systematic literature review. Frontiers in Psychiatry, 15, 1393337. 10.3389/fpsyt.2024.1393337 [DOI] [PMC free article] [PubMed] [Google Scholar]
  80. Walsh, C., Mitchell, L., Hrozanova, M., Kotoulas, S.-C., Derry, C., Morrison, I., & Riha, R. L. (2022). NREM Sleep Parasomnias Commencing in Childhood: Trauma and Atopy as Perpetuating Factors. Clocks & Sleep, 4(4), 549–560. 10.3390/clockssleep4040043 [DOI] [PMC free article] [PubMed] [Google Scholar]
  81. Winkelman, J., Herzog, D., & Fava, M. (1999). The prevalence of sleep-related eating disorder in psychiatric and non-psychiatric populations. Psychological Medicine, 29(6), 1461–1466. 10.1017/s0033291799008272 [DOI] [PubMed] [Google Scholar]

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