Long Article Thread

[Dr_Strabismus]

This thread is for pasting long newspaper articles, so you can link to them from other threads.

(Well, it's useful for me, anyway).

 

[Dr_Strabismus]

New Scientist Article about Sexsomnia

28 October 2006
From New Scientist Print Edition.

Jessica Marshall


THE first time it happened, Lisa Mahoney woke up to her boyfriend trying to have sex with her. "What are you doing?" she said, pushing him off.

"You started it," he said.

A few years later, a friend of hers crashed in her bed one night. The next morning he told her that she had made sexual advances toward him in her sleep.

Now, eight years after the first incident, Mahoney has a different boyfriend. She attacks him nearly every night they share a bed, aggressively trying to initiate sex - and remembers none of it in the morning. At first it was a joke: "Lucky guy," she would say. But her boyfriend says she's violent and "scary", and after more than six months of it, it has stopped being funny. "It really bothers me that I can't control it," she says. "It scares me because I don't think it has anything to do with the partner. It's just something that's inside of me."

Although relatively little is known about sleep sex, or sexsomnia, Mahoney, who lives in a small town in Pennsylvania, is not alone. A survey of sexsomniacs conducted in 2005 by Nik Trajanovic, a researcher at the sleep and alertness clinic at Toronto Western Hospital, Canada, and colleagues concluded it is much more common than medical case reports alone suggest. The researchers say that it is impossible to say how many people experience the disorder because people rarely report it, and doctors typically don't ask about it. But sleep sex is probably not as common as sleepwalking - which affects 2 to 4 per cent of adults, says Trajanovic.

The need for a clear way to diagnose and treat sexsomnia is becoming more urgent. Many of the first examples to come to light involved men who faced charges of sexual assault, and sexsomnia is an increasingly common defence in such cases. So we need foolproof ways to separate the perjurers from the patients. The trouble is that little is known about it, and it is hard to study scientifically.

In 1996 Colin Shapiro, now director of the sleep and alertness clinic at Toronto Western Hospital, published the first diagnosed cases of sexsomnia as a distinct condition. The researchers reported they had found more and more people who seemed to be sexsomniacs, and realised they might have a previously unrecognised disorder on their hands. There have been only a handful of published reports since then: the particularly personal and embarrassing nature of the problem has helped to keep it hidden.

While sleep sex has many things in common with sleepwalking - both are classed as parasomnias, disorders that involve partial arousal during sleep - it has some characteristic differences. Most obviously, sleep sex involves sexual arousal, and sexsomniacs tend to stay in their bed rather than walk about. Episodes of sexsomnia can happen at any time during the night, while sleepwalking tends to happen in the first third of the night, according to a paper published by Shapiro et al in 2003. Another distinction, Shapiro notes, is that sexsomnia - perhaps not surprisingly - is more likely than other parasomnias to involve someone else.

Mortifying behaviour
"Most of the time sleep sex occurs between people who are already partners," says Mark Pressman, a sleep specialist at Lankenan Hospital in Wynnewood, Pennsylvania. The partners of sexsomniacs react in a variety of ways. "Sometimes they hate it. Sometimes they tolerate it. On rare occasions you have stories of people liking it better than their waking sex," he says. And these are unassuming, ordinary people, whose waking sex lives are generally normal, he adds. Sexsomnia was believed to happen to people acting out their dreams as a result of underlying psychological problems, but that is now known to be false. "There's no evidence that it's related to personality or previous sexual behaviour," says Pressman.

What people do in sexsomnia covers the spectrum of commonplace sexual activity. One woman was alerted to her husband's problem when she realised he was snoring loudly during the act of intercourse. Another case report, published in the journal Psychosomatic Medicine by Christian Guilleminault, describes a woman who masturbated in her sleep; if disturbed in the act she would start again later in the night.

A number of cases describe aggressive behaviour. A man who masturbated regularly and violently while asleep had "persistent bruising on his penis" and "groin soreness". Even more troublingly, the aggression can be directed toward a partner, who may in some cases charge the instigator with sexual assault.

Mahoney's concerns over her own behaviour led her to www.sleepsex.org, a website created in 1999 by Michael Mangan, a psychologist at the University of New Hampshire in Durham. Mangan's site includes links to published research on sleep sex and allows people to write in with their experiences. "I'm getting them every day," he says. Most people write in because they want their behaviour to stop. Though some respondents worry about aggressive behaviour, others are merely mortified at what they are doing. One man described how he fell asleep and started masturbating in his dentist's chair.

To get a clearer idea of who suffers from sexsomnia, Mangan, Trajanovic and Shapiro developed a survey that they posted on the Sleepsex website. Clinical case reports have been dominated by young men, many of whom were referred to a sleep expert in legal cases, some of them accused of sexually assaulting minors, and the team wondered whether these cases were an accurate sampling of people with the condition.

Not a dream
Of the 219 respondents that the team judged to be reliable (discounting over-the-top answers), aged between 15 and 67, one-third were women. This coincides with the general percentages for related sleep disorders such as sleepwalking, says Trajanovic. The prevalence of sexsomnia in both sexes suggests that, like sleep walking, the condition is related to irregular brain activity and is not a psychological or sexual problem that occurs predominantly in young men, as early reports implied.

Trajanovic presented the results at a meeting of the US-based Associated Professional Sleep Societies in Salt Lake City earlier this summer. The findings are not authoritative, he cautions, as an internet survey does not allow for clinical confirmation of sleep sex and selects strongly for people who are actively looking for information about their behaviour. Still, people's reluctance to come to a clinic and talk about their sex lives - and abnormalities therein - make the approach reasonable, says Peter Buchanan of the sleep investigation unit at Royal Prince Alfred Hospital in Sydney, Australia. Even if no firm conclusions can be drawn from the study, it gives a general idea of the problem. Then again, it also highlights how little anyone really knows about sexsomnia.

Most sleep researchers consider sexual behaviour during sleep as a variant of sleepwalking, because the two conditions share a number of characteristics. In both, a person is stuck between sleep and wakefulness. Both originate from non-REM sleep - the deep stage of sleep, without dreams. Stress, sleep deprivation and alcohol or drugs make sleepwalking or sexsomnia more likely in those who are disposed to them. Amnesia about what a person does while asleep is typical. Sleepwalking runs in families, and there is some evidence of a family component for sexsomnia too: Mahoney's sister and brother, for instance, have both reported episodes, though less frequently. Trajanovic's web survey also found a higher-than-average incidence of mental illness in sexsomniacs, and the same is true of sleepwalkers.

Acknowledging these similarities, the 2005 edition of the International Classification of Sleep Disorders lists "abnormal sexual behaviour during sleep" as a variant of "confusional arousal" - essentially, sleepwalking without leaving the bed. This is the first time sleep sex has been listed in this authoritative reference book, albeit under the umbrella of another sleep disorder.

Shapiro wants to go a step further. There are good reasons to classify sexsomnia as a unique parasomnia that is distinct from confusional arousal, he says. For example, Trajanovic's survey identified body contact with a partner as the leading trigger of sleep sex (see Graph), something that has not been associated with sleepwalking or confusional arousal. So while Shapiro agrees that sexsomnia has similar patterns and triggers to sleepwalking, he argues that classifying it separately will help researchers show how widespread it is and will raise awareness of it among doctors, many of whom are still in the dark about the condition.

As with sleepwalkers, sleep drivers and some sleep eating cases, a sexsomniac's brain is partly awake and partly asleep. There are as yet only wisps of evidence about what is going on in the minds of people with these conditions. Reproducing even the simplest of these behaviours during an overnight stay in a sleep lab is difficult enough, and on top of that there is the difficulty of scanning the brain of a roving patient.

Only one image of a sleepwalking brain has ever been captured. Claudio Bassetti of University Hospital Zurich, Switzerland, and colleagues injected radioactive tracer into a volunteer's bloodstream during a sleepwalking episode. The tracer concentrates in areas of the brain that are active at the time of injection and stays detectable for about 12 hours afterwards, so when the sleepwalker woke up the next day the team was able to use a brain scanner to create an image of which areas had been active during the event. They compared this image with one collected from undisturbed deep sleep on another night. The comparison showed that the prefrontal cortex - responsible for memory, judgement and learning - stayed inactive during the sleepwalking episode, as in normal sleep, but the posterior cingulate cortex, which can trigger motor activity and emotion, was switched on. The study fits with other evidence, says Antonio Zadra of the University of Montreal in Canada: for instance, the electrical activity in the brains of sleepwalkers shows a combination of wave patterns characteristic of waking and deep sleep. Sexsomnia shows the same patterns.

Legal quandary
Given the similarities between sleepwalking and sleep sex, what determines whether a person goes fumbling down the hallway or between the sheets? "I would love to know," says Pressman. More than 90 per cent of respondents to Trajanovic's web survey reported multiple episodes of sleep sex, but only a quarter reported that they suffered from other parasomnias such as sleepwalking. So while the two can go hand in hand, they clearly don't have to. Trajanovic notes that the posterior cingulate cortex is very close to the brain's sexual arousal centre, so it is plausible that sexsomniacs experience activation of a larger region of the brain than sleepwalkers do, allowing both sexual and motor activity to occur - but this theory has not been tested.

Though just 7 per cent of the people who responded to Trajanovic's online survey said sleep sex had got them in trouble with the law, less than in clinical reports of sexsomnia, increasing numbers of criminal cases are making headlines. Six sleep researchers contacted by New Scientist had each been asked to testify in several cases, and a number of the cases did not ring true to their ears as characteristic of sexsomnia. In several instances, alcohol was claimed to have been a trigger of sleep sex, although to the researchers, drunken lust seemed a more likely explanation.

Pressman, however, has been persuaded in a couple of cases to speak for the defence. In one instance the accused, who had a well-established history of sleepwalking, was confused after waking up in his daughter's room, and after discovering what he'd done, turned himself in. The man was acquitted of molestation on the grounds that he had been asleep: despite this, he moved out of the house, terrified he would repeat the behaviour.

Shapiro has also testified as a defence witness in the case of Jan Luedecke, who in 2005 was acquitted of charges of sexual assault against a woman Luedecke had met the night of the incident. Luedecke claimed that after drinking he fell asleep on a couch and had no idea he had had sex until he woke up, went to the bathroom and found he was wearing a condom. This may sound bizarre, but Shapiro points out that if people can drive motor cars in their sleep, why should putting on a condom be so surprising? The woman said she woke up on the couch with Luedecke having sex with her. He had had sleep sex with four previous girlfriends.

Not everyone buys sexsomnia as a defence. "We don't think it adds up," says Kathleen Piovesan of the Canadian Association of Sexual Assault Centres in Vancouver. As for Luedecke's acquittal, she adds, "This dismisses any responsibility. He's done this to five women. Clearly this man is dangerous to women."

Finding a way to separate the real cases from the fakes might help convince the doubters. While it is often conceivable that a person could have committed a sexual act while asleep, "trying to prove after the fact that that's what was going on is nearly impossible", says Mark Mahowald of the Minnesota Regional Sleep Disorders Center in Minneapolis. So Trajanovic is now working out a procedure for diagnosing sexsomnia in legal situations. He won't be revealing the details, though, to prevent people from learning how to fool his test.

For those who suspect they may be predisposed to sexsomnia, reliable diagnosis will at least lead to the possibility of treatment, which is what Mahoney is now looking for. Addressing triggering factors - such as stress, sleep deprivation and any other underlying sleep disorders like sleep apnoea that may show up in a sleep study - may reduce or eliminate the behaviour. If that's not enough, her doctor may prescribe benzodiazepines, used for treating insomnia and sleepwalking. But as yet there's no cure. Mahoney worries about endangering children she may have one day, and although her boyfriend is understanding, she has read about cases where the behaviour has wrecked relationships. "I don't want this foolish condition to hurt us in the long run," she says.

 

[sincerely_helene]

28 October 2006
From New Scientist Print Edition.

Jessica Marshall


THE first time it happened, Lisa Mahoney woke up to her boyfriend trying to have sex with her. "What are you doing?" she said, pushing him off.

"You started it," he said.

A few years later, a friend of hers crashed in her bed one night. The next morning he told her that she had made sexual advances toward him in her sleep.

Now, eight years after the first incident, Mahoney has a different boyfriend. She attacks him nearly every night they share a bed, aggressively trying to initiate sex - and remembers none of it in the morning. At first it was a joke: "Lucky guy," she would say. But her boyfriend says she's violent and "scary", and after more than six months of it, it has stopped being funny. "It really bothers me that I can't control it," she says. "It scares me because I don't think it has anything to do with the partner. It's just something that's inside of me."

Although relatively little is known about sleep sex, or sexsomnia, Mahoney, who lives in a small town in Pennsylvania, is not alone. A survey of sexsomniacs conducted in 2005 by Nik Trajanovic, a researcher at the sleep and alertness clinic at Toronto Western Hospital, Canada, and colleagues concluded it is much more common than medical case reports alone suggest. The researchers say that it is impossible to say how many people experience the disorder because people rarely report it, and doctors typically don't ask about it. But sleep sex is probably not as common as sleepwalking - which affects 2 to 4 per cent of adults, says Trajanovic.

The need for a clear way to diagnose and treat sexsomnia is becoming more urgent. Many of the first examples to come to light involved men who faced charges of sexual assault, and sexsomnia is an increasingly common defence in such cases. So we need foolproof ways to separate the perjurers from the patients. The trouble is that little is known about it, and it is hard to study scientifically.

In 1996 Colin Shapiro, now director of the sleep and alertness clinic at Toronto Western Hospital, published the first diagnosed cases of sexsomnia as a distinct condition. The researchers reported they had found more and more people who seemed to be sexsomniacs, and realised they might have a previously unrecognised disorder on their hands. There have been only a handful of published reports since then: the particularly personal and embarrassing nature of the problem has helped to keep it hidden.

While sleep sex has many things in common with sleepwalking - both are classed as parasomnias, disorders that involve partial arousal during sleep - it has some characteristic differences. Most obviously, sleep sex involves sexual arousal, and sexsomniacs tend to stay in their bed rather than walk about. Episodes of sexsomnia can happen at any time during the night, while sleepwalking tends to happen in the first third of the night, according to a paper published by Shapiro et al in 2003. Another distinction, Shapiro notes, is that sexsomnia - perhaps not surprisingly - is more likely than other parasomnias to involve someone else.

Mortifying behaviour
"Most of the time sleep sex occurs between people who are already partners," says Mark Pressman, a sleep specialist at Lankenan Hospital in Wynnewood, Pennsylvania. The partners of sexsomniacs react in a variety of ways. "Sometimes they hate it. Sometimes they tolerate it. On rare occasions you have stories of people liking it better than their waking sex," he says. And these are unassuming, ordinary people, whose waking sex lives are generally normal, he adds. Sexsomnia was believed to happen to people acting out their dreams as a result of underlying psychological problems, but that is now known to be false. "There's no evidence that it's related to personality or previous sexual behaviour," says Pressman.

What people do in sexsomnia covers the spectrum of commonplace sexual activity. One woman was alerted to her husband's problem when she realised he was snoring loudly during the act of intercourse. Another case report, published in the journal Psychosomatic Medicine by Christian Guilleminault, describes a woman who masturbated in her sleep; if disturbed in the act she would start again later in the night.

A number of cases describe aggressive behaviour. A man who masturbated regularly and violently while asleep had "persistent bruising on his penis" and "groin soreness". Even more troublingly, the aggression can be directed toward a partner, who may in some cases charge the instigator with sexual assault.

Mahoney's concerns over her own behaviour led her to www.sleepsex.org, a website created in 1999 by Michael Mangan, a psychologist at the University of New Hampshire in Durham. Mangan's site includes links to published research on sleep sex and allows people to write in with their experiences. "I'm getting them every day," he says. Most people write in because they want their behaviour to stop. Though some respondents worry about aggressive behaviour, others are merely mortified at what they are doing. One man described how he fell asleep and started masturbating in his dentist's chair.

To get a clearer idea of who suffers from sexsomnia, Mangan, Trajanovic and Shapiro developed a survey that they posted on the Sleepsex website. Clinical case reports have been dominated by young men, many of whom were referred to a sleep expert in legal cases, some of them accused of sexually assaulting minors, and the team wondered whether these cases were an accurate sampling of people with the condition.

Not a dream
Of the 219 respondents that the team judged to be reliable (discounting over-the-top answers), aged between 15 and 67, one-third were women. This coincides with the general percentages for related sleep disorders such as sleepwalking, says Trajanovic. The prevalence of sexsomnia in both sexes suggests that, like sleep walking, the condition is related to irregular brain activity and is not a psychological or sexual problem that occurs predominantly in young men, as early reports implied.

Trajanovic presented the results at a meeting of the US-based Associated Professional Sleep Societies in Salt Lake City earlier this summer. The findings are not authoritative, he cautions, as an internet survey does not allow for clinical confirmation of sleep sex and selects strongly for people who are actively looking for information about their behaviour. Still, people's reluctance to come to a clinic and talk about their sex lives - and abnormalities therein - make the approach reasonable, says Peter Buchanan of the sleep investigation unit at Royal Prince Alfred Hospital in Sydney, Australia. Even if no firm conclusions can be drawn from the study, it gives a general idea of the problem. Then again, it also highlights how little anyone really knows about sexsomnia.

Most sleep researchers consider sexual behaviour during sleep as a variant of sleepwalking, because the two conditions share a number of characteristics. In both, a person is stuck between sleep and wakefulness. Both originate from non-REM sleep - the deep stage of sleep, without dreams. Stress, sleep deprivation and alcohol or drugs make sleepwalking or sexsomnia more likely in those who are disposed to them. Amnesia about what a person does while asleep is typical. Sleepwalking runs in families, and there is some evidence of a family component for sexsomnia too: Mahoney's sister and brother, for instance, have both reported episodes, though less frequently. Trajanovic's web survey also found a higher-than-average incidence of mental illness in sexsomniacs, and the same is true of sleepwalkers.

Acknowledging these similarities, the 2005 edition of the International Classification of Sleep Disorders lists "abnormal sexual behaviour during sleep" as a variant of "confusional arousal" - essentially, sleepwalking without leaving the bed. This is the first time sleep sex has been listed in this authoritative reference book, albeit under the umbrella of another sleep disorder.

Shapiro wants to go a step further. There are good reasons to classify sexsomnia as a unique parasomnia that is distinct from confusional arousal, he says. For example, Trajanovic's survey identified body contact with a partner as the leading trigger of sleep sex (see Graph), something that has not been associated with sleepwalking or confusional arousal. So while Shapiro agrees that sexsomnia has similar patterns and triggers to sleepwalking, he argues that classifying it separately will help researchers show how widespread it is and will raise awareness of it among doctors, many of whom are still in the dark about the condition.

As with sleepwalkers, sleep drivers and some sleep eating cases, a sexsomniac's brain is partly awake and partly asleep. There are as yet only wisps of evidence about what is going on in the minds of people with these conditions. Reproducing even the simplest of these behaviours during an overnight stay in a sleep lab is difficult enough, and on top of that there is the difficulty of scanning the brain of a roving patient.

Only one image of a sleepwalking brain has ever been captured. Claudio Bassetti of University Hospital Zurich, Switzerland, and colleagues injected radioactive tracer into a volunteer's bloodstream during a sleepwalking episode. The tracer concentrates in areas of the brain that are active at the time of injection and stays detectable for about 12 hours afterwards, so when the sleepwalker woke up the next day the team was able to use a brain scanner to create an image of which areas had been active during the event. They compared this image with one collected from undisturbed deep sleep on another night. The comparison showed that the prefrontal cortex - responsible for memory, judgement and learning - stayed inactive during the sleepwalking episode, as in normal sleep, but the posterior cingulate cortex, which can trigger motor activity and emotion, was switched on. The study fits with other evidence, says Antonio Zadra of the University of Montreal in Canada: for instance, the electrical activity in the brains of sleepwalkers shows a combination of wave patterns characteristic of waking and deep sleep. Sexsomnia shows the same patterns.

Legal quandary
Given the similarities between sleepwalking and sleep sex, what determines whether a person goes fumbling down the hallway or between the sheets? "I would love to know," says Pressman. More than 90 per cent of respondents to Trajanovic's web survey reported multiple episodes of sleep sex, but only a quarter reported that they suffered from other parasomnias such as sleepwalking. So while the two can go hand in hand, they clearly don't have to. Trajanovic notes that the posterior cingulate cortex is very close to the brain's sexual arousal centre, so it is plausible that sexsomniacs experience activation of a larger region of the brain than sleepwalkers do, allowing both sexual and motor activity to occur - but this theory has not been tested.

Though just 7 per cent of the people who responded to Trajanovic's online survey said sleep sex had got them in trouble with the law, less than in clinical reports of sexsomnia, increasing numbers of criminal cases are making headlines. Six sleep researchers contacted by New Scientist had each been asked to testify in several cases, and a number of the cases did not ring true to their ears as characteristic of sexsomnia. In several instances, alcohol was claimed to have been a trigger of sleep sex, although to the researchers, drunken lust seemed a more likely explanation.

Pressman, however, has been persuaded in a couple of cases to speak for the defence. In one instance the accused, who had a well-established history of sleepwalking, was confused after waking up in his daughter's room, and after discovering what he'd done, turned himself in. The man was acquitted of molestation on the grounds that he had been asleep: despite this, he moved out of the house, terrified he would repeat the behaviour.

Shapiro has also testified as a defence witness in the case of Jan Luedecke, who in 2005 was acquitted of charges of sexual assault against a woman Luedecke had met the night of the incident. Luedecke claimed that after drinking he fell asleep on a couch and had no idea he had had sex until he woke up, went to the bathroom and found he was wearing a condom. This may sound bizarre, but Shapiro points out that if people can drive motor cars in their sleep, why should putting on a condom be so surprising? The woman said she woke up on the couch with Luedecke having sex with her. He had had sleep sex with four previous girlfriends.

Not everyone buys sexsomnia as a defence. "We don't think it adds up," says Kathleen Piovesan of the Canadian Association of Sexual Assault Centres in Vancouver. As for Luedecke's acquittal, she adds, "This dismisses any responsibility. He's done this to five women. Clearly this man is dangerous to women."

Finding a way to separate the real cases from the fakes might help convince the doubters. While it is often conceivable that a person could have committed a sexual act while asleep, "trying to prove after the fact that that's what was going on is nearly impossible", says Mark Mahowald of the Minnesota Regional Sleep Disorders Center in Minneapolis. So Trajanovic is now working out a procedure for diagnosing sexsomnia in legal situations. He won't be revealing the details, though, to prevent people from learning how to fool his test.

For those who suspect they may be predisposed to sexsomnia, reliable diagnosis will at least lead to the possibility of treatment, which is what Mahoney is now looking for. Addressing triggering factors - such as stress, sleep deprivation and any other underlying sleep disorders like sleep apnoea that may show up in a sleep study - may reduce or eliminate the behaviour. If that's not enough, her doctor may prescribe benzodiazepines, used for treating insomnia and sleepwalking. But as yet there's no cure. Mahoney worries about endangering children she may have one day, and although her boyfriend is understanding, she has read about cases where the behaviour has wrecked relationships. "I don't want this foolish condition to hurt us in the long run," she says.

Bump!

 

[Dr_Strabismus]

No no NO, you're missing the point.

 

[sincerely_helene]

Oh. unbump