Dennis Rosen M.D.

Sleeping Angels

Rape, or a medical disorder?

Rape, or a medical disorder?

Posted May 11, 2009

When I first started learning about sleep medicine, one of my mentors explained to me that sleep disorders can be broken down into three categories: difficulties falling or staying asleep, difficulties waking up or staying awake, and things that go bump in the night, i.e. strange things that happen to a person while asleep.

I was reminded of this last week when a friend emailed me something he had seen on the internet about a court case that had come before the Northern Territory Supreme Court in Darwin, Australia last summer in which a 48 year old man who stood accused of "gross indecency and intercourse without consent" with a female houseguest, pleaded not guilty to the charges, claiming that he was not aware of what he was doing at the time, and was actually suffering from a form of parasomnia known as "sexsomnia". A person suffering from this disorder, according to his lawyers and an expert witness who was brought in to testify on his behalf, has a tendency to engage in sexual activities while asleep, without being at all aware of what he is doing.

The defendant, it turned out, had a long history of sleepwalking. According to testimony from his estranged wife "he would sleepwalk on a monthly basis, walking into his son's room and urinat[e] in a basket or in the bathroom sink", and that there had been "one occasion [where he had] tried to grope her when she believed him to be asleep". The jury took less than an hour to find the defendant not guilty, and the verdict prompted changes in the Australian legal code to prevent the summoning of expert legal witnesses by the defense legal team without giving the prosecution ample opportunity to investigate the witnesses' credibility and to challenge the testimony effectively.

Sexsomnia (or Sleep Related Abnormal Sexual Behaviors, as it is called in the International Classification of Sleep Disorders 2) is only a recently recognized diagnosis, with the first series of patients engaging in sexual activity while sleeping published in 1996 by a Canadian group in the journal Sleep Research. It is considered to be a type of parasomnia, though there is evidence that sexual activity during sleep can have many different underlying causes (for those interested, I have placed a link to an very good review article at the end of this post). Its presence has been argued successfully in court in a number of cases in several different countries, resulting in the exoneration of defendants accused of rape and indecent assault.

What are parasomnias, anyways? Parasomnias are unusual behaviors that occur in a person while the brain is in a mixed state of both sleep and wakefulness. These generally occur when a person is cycling through sleep and emerges only partially out of deep (or slow wave) sleep, so that he or she is not quite awake and not quite asleep. When looking at the brainwave patterns of someone during a parasomnia, one can see that both slow wave and wake patterns are present, suggesting that part of the brain remains in deep sleep while part of the brain is awake. They usually occur in the first third of the night, which is when most of deep sleep is concentrated. Other examples of parasomnias include sleep walking, sleep talking, night terrors, confusional arousals, and sleep eating.

Because a person is not fully awake during the parasomnia, he will often do things that appear to be random. He may mumble incoherently, or wander around to various rooms in the house, sometimes even leaving the house, often exhibiting behaviors that are atypical and bizarre, such as urinating in vases or coat closets. The person will have no recollection of any of this upon awakening in the morning, and can become quite defensive when confronted about this.

When parents are confronted with night terrors in a child, they are often quite disturbed by them, as she will cry inconsolably for between 15-30 minutes, often shouting our unintelligible words or phrases, and appearing deeply agitated and traumatized. Despite their best attempts to comfort their child, nothing but the passage of time seems to help. When asked about her awakening and screaming the night before, she will not remember any of it, and will not know what the parents are talking about. The best strategy to employ when a child sleep walks has a night terror or a confusional arousal is to guide her back to bed and to make sure that she is safe, and not to try and awaken her from it, rather letting it pass on its own. In addition, making sure that the child is not sleep deprived, and has a regular schedule and bedtime routine, will reduce the frequency of the occurrences. Most children outgrow them, and only rarely are medications necessary.

For more information on sleep related abnormal sexual behaviors, readers are referred to an excellent review article, entitled:

Sleep and Sex: What Can Go Wrong? A Review of the Literature on Sleep Related Disorders and Abnormal Sexual Behaviors and Experiences, by Carlos H. Schenck, MD, Isabelle Arnulf, MD, PhD, Mark W. Mahowald, MD
http://www.journalsleep.org/Articles/300603.pdf

Best,

Dennis

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Dennis Rosen, M.D.

Learn how to help your child get a great night’s sleep with my new book:

The Harvard Medical School Guide to Successful Sleep Strategies for Kids: Helping Your Child Sleep Well and Wake Up With a Smile!

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