LAUSR

Sexsomnia is a variant of confusional arousal, a NREM parasomnia (NREMP), typically consisting of sexual behaviors manifesting upon partial arousal from deep NREM sleep; however, its pathophysiology is not well understood, and literature is limited. We present a series of patients with non-dominant hand sexsomnia behaviors that may reveal important new clues about the neurophysiologic mechanisms of sexsomnias. Case 1: 22 y/o right-handed (RH) female, no history of NREMP, or snoring. Presenting complaint (PC): 8-year history of sleep masturbatory behavior (MB) including partial awakening from MB with bloody fingers (left hand) during her menstrual period in the setting of delayed sleep phase disorder. Case 2: 30 y/o ambidextrous male with a history of NREMP. PC: MB involving the left hand, observed by bed partner (BP) in the setting of weight gain and apneas. PSG: AHI 17/h and PLMI 23/h. Case 3: 33 y/o RH female with a history of NREMP. PC: left-handed sleep MB observed by BP in the setting of multiple sclerosis with C2-3 and C4 right posterolateral demyelinating lesions on C-spine MRI. Case 4: A 44 y/o RH male with OCD, depression, and no history of NREMP. PC: bilateral MB and dream enactment behaviors observed by BP, in the setting of sertraline. Events resolved upon switching to quetiapine. Case 5: A 59- y/o RH female with multiple system atrophy (MSA) and RBD, no previous NREMP. PC: sleep MB, noted by BP involving the left hand in the setting of worsening dysautonomia. Dream enactment occurred bilaterally. PSG: AHI 34/h, PLMI: 70/h and REM sleep without atonia. Spells improved with melatonin and PAP. This case series highlights a pattern of adult sleep MB involving the non-dominant (left) hand in 4/5 cases and the left hand in one ambidextrous patient. There was no evidence of gender predilection. We speculate that sexsomnia originates from central pattern generators in the brainstem and spinal cord, as opposed to the cerebral cortex (which would likely involve the dominant hand). The lack of involvement of cerebral motor control is further substantiated by amnesia for sexsomnia events.