# Left hand sleep masturbation in a right-handed male patient with sexsomnia

Mathilde Brice, Ana-Zenovia Gales, Valérie Attali, Mahaut Chauvin, Isabelle Arnulf

► To cite this version:

Mathilde Brice, Ana-Zenovia Gales, Valérie Attali, Mahaut Chauvin, Isabelle Arnulf. Left hand sleep masturbation in a right-handed male patient with sexsomnia. Sleep Medicine, 2026, 141, pp.108823. 10.1016/j.sleep.2026.108823. hal-05493430

HAL Id: hal-05493430

https://hal.sorbonne-universite.fr/hal-05493430v1

Submitted on 4 Feb 2026

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

<figure><img src="image_1.png" /></figure>

Distributed under a Creative Commons CC BY 4.0 - Attribution - International License
<figure><img src="image_2.png" /></figure>

<figure><img src="image_3.png" /></figure>

# Left hand sleep masturbation in a right-handed male patient with sexsomnia

Mathilde Brice<sup>a,b</sup>, Ana-Zenovia Gales<sup>a</sup>, Valérie Attali<sup>a,c</sup>, Mahaut Chauvin<sup>a</sup>,
Isabelle Arnulf<sup>a,d,*</sup>

## ARTICLE INFO

### Keywords:

NREM parasomnia

Sexsomnia

Gabapentin

Obstructive sleep apnea

Masturbation

Confusional arousal

## ABSTRACT

Sexsomnia is a NREM parasomnia characterized by involuntary sexual behavior during confusional arousal. Video examples are rare. Here we present the case of a man who was accused of sexually assaulting his girlfriend during the night but had no memory of doing so. During a video polysomnography, he masturbated in his sleep with his left hand during the N2 and N3 sleep stages, confirming sexsomnia. However, he always masturbated with his right hand when awake. Treatment with gabapentin did not alleviate sexsomnia and triggered obstructive sleep apnea, which improved when the treatment was replaced with paroxetine. The effect of paroxetine on sexsomnia was unknown. This case supports the concept of automatic behavior in sexsomnia.

## 1. Introduction

Sexsomnia is a NREM parasomnia involving involuntary sexual behaviors during confusional arousals [1]. Sexsomnia behaviors include self-oriented behaviors, such as masturbation, spontaneous orgasm, sexual vocalization, genital touching, and coital-like pelvic movements, as well as behaviors oriented toward a bed partner, such as fondling, initiating and engaging in sexual intercourse, and sexual molestation and assault. Video examples are rare. Here, we present a case of a right-handed man who masturbated in his sleep using his left hand. Additionally, treating sexsomnia with gabapentin triggered obstructive sleep apnea (OSA), which subsided when the treatment was switched to paroxetine.

## 2. Case report

A 24-year-old man, heterosexual, with no medical history and a body mass index of 30.1 kg/m², was referred by his primary care physician for excessive daytime sleepiness. The Epworth sleepiness score was 16/24. He needed 2 to 3 naps/day. He reported occasional snoring and no nocturia. Additionally, he reported amnestic nocturnal sexual behaviors for 6 years, occurring 1–2 times/week, usually early in the night while

asleep. The behaviors included self-masturbation, fondling and having assaulted once his girlfriend. She filed a complaint to the police. He sleep-talked, but had no sleep terrors and no sleepwalking (except in childhood). He did not take any drug or substance.

During two consecutive nights of videopolysomnography (Fig. 1a; Suppl. Table), a mild (apnea-hypopnea index [AHI] during night #1: 9) or absent (AHI during night 2: 4) OSA was observed. The multiple sleep latency test revealed subnormal latency (9.4 min) and five sleep onset periods in REM. There were multiple slow-waves arousals during N3 sleep, no rapid-waves arousals and an N3 arousal index of 3.7 and 4.7. Of these, 2/7 and 0/8 were caused by hypopnea, respectively. The indexes were higher than the normative value of 2.5 [2]. Slow wave arousals were also observed in N2 sleep (Fig. 2). They were associated with masturbation too. He was advised to improve his sleep hygiene, counseled to minimize factors that promote NREM parasomnia and the severe consequences of sexsomnia, and prescribed gabapentin 300 mg 1 h before bedtime. The patient reported improvement with gabapentin, noting reduced sleepiness and improved attention. However, he could not evaluate his sexsomnia because he slept alone. Seven months later, a videopolysomnography revealed an increased AHI of 21.8, as well as continued Masturbation (Fig. 1b). Gabapentin was switched to paroxetine (Fig. 1c). Gabapentin was switched to paroxetine (Fig. 1c), the AHI

<footnote><sup>a</sup> Sleep Clinic, Pitie-Salpetriere Hospital, DMU APPROCHES, Assistance Publique-Hôpitaux de Paris- Sorbonne Université, Paris, France</footnote>

<footnote><sup>b</sup> Centre Hospitalier Forcilles, Fondation Cognac-Jay, Férolles-Attily, France</footnote>

<footnote><sup>c</sup> Sorbonne Université, INSERM, UMRS1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France</footnote>

<footnote><sup>d</sup> Paris Brain Institute (ICM), DreamTeam, Paris, France</footnote>

<footnote>* Corresponding author. Service des pathologies du sommeil, Hôpital Pitié-Salpetrière, 83 boulevard de l'Hôpital, 75013, Paris, France.
E-mail address: isabelle.arnulf@aphp.fr (I. Arnulf).</footnote>
<figure><img src="image_4.png" /><figcaption>b: March 2025 – Treatment with gabapentin 300 mg/d</figcaption></figure>

<figure><img src="image_5.png" /><figcaption>c: June 2025 – Treatment with paroxetine 10 mg/d</figcaption></figure>

<figure><img src="image_6.png" /><figcaption>**Fig. 1.** Hypnograms of the nights: a) without treatment (diagnostic night); b) treated with gabapentin 300 mg before bedtime; c) treated with paroxetine 10 mg before bedtime. From top to bottom: time of night; hours elapsed since recording onset; epoch numbers; sleep stages (R = REM sleep in red, W = wake, 1 = N1, 2 = N2, 3 and 4 = N3). The vertical arrows indicate behavioral events, including touching his genitals or masturbating. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)</figcaption></figure>

decreased to 10/hour, and there were no more slow-wave arousals (no video, and the patient still slept alone). At no time, not even in the sleep laboratory, did the patient recall any behavior or mental content during sleep. His former girlfriend withdrew her complaint.

### 3. Video analysis

During slow-wave arousals in N2 and N3 sleep and during rapid-wave arousals in N2 and REM sleep, the patient placed his left hand inside his pants and touched his genitals on both nights. Additionally, during N2 and N3 slow-wave arousals, he exhibited movements suggestive of masturbation (two instances) always using his left hand (Video 1, Fig. 2). The patient later confirmed that he always masturbates

with his right hand while awake. His laterality quotient on the Edinburgh Handedness Inventory was 25/100, indicating functional ambidexterity with a preference for the right hand.

Supplementary data related to this article can be found online at http://doi.org/10.1016/j.sleep.2026.108823

### 4. Discussion

Masturbation during sleep has been described, and illustrated in rare instances [2,3]. In this case, the patient met the criteria for sexsesnia. Indeed, his girlfriend reported that he masturbated, fondled her, and raped her while he was asleep. He had no memory of these behaviors. Additionally, we observed masturbation episodes during slow-wave
<figure><img src="image_7.png" /><figcaption>**Fig. 2.** An extract of videopolysomnography showing sleep-related masturbation during N3 sleep. From top to bottom: Hypnogram, with the red vertical bar indicating the extracted section. Left panel: Infrared video showing the patient lying on his back with his left hand inside his trousers,rubbing his阴茎. The exact moment in the video is indicated by a vertical red arrow on the EEG. Note that the patient's face is covered for confidentiality reasons, but his eyes are closed during the behavior. Right panel: From top to bottom: left and right electrooculography, then EEG (8 channels), then chin electromyography (EMG). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)</figcaption></figure>

arousals. His childhood sleepwalking was a predisposing factor for sexsomnia, and hypopneas occasionally triggered masturbation [2]. He also touched his genitals during REM sleep arousals. However, he did not masturbate or experience REM sleep without atonia. Therefore, a parasomnia overlap disorder is ruled out. Recently, Avidan et al. pointed to a surprising laterality shift in masturbation during sleep (right-handed men and women using their left hand) [4]. They suspected that brainstem central pattern generators of behaviors (different from cortical generators of voluntary movements) are at play during sleep-associated masturbation. One may wonder whether they would use a direct and not crossed motor neuron pathway. Our case supports this initial finding, particularly since the patient confirmed that he only used his right hand to masturbate while awake. This case also illustrates the high risk of forensic consequences associated with sexsomnia, as evidenced by the police complaint of sexual assault that was later withdrawn [5]. Here, visible masturbation in video-polysomnography has significant legal relevance.

Additionally, this case provides information about the medical
treatment of sexsomnia, for which there is no consensus yet. Gaba-
pentin, often used to treat NREM parasomnia [6,7], was ineffective in
this case. Plus, it worsened OSA, as already reported [8,9]. Clonazepam
is commonly used to treat parasomnias, including sexsomnia, but it can
also worsen OSA [2,5]. Paroxetine can reduce sexsomnia [10], and does
not worsen OSA. However, since the patient slept alone and video-
polysomnography was not performed while taking paroxetine, its effect
on sexsomnia could not be evaluated. If gabapentin had been effective
against sexsomnia, an alternative treatment for the emerging OSA could
have been considered. This case illustrates the clinical and forensic
importance of evaluating sexsomnia with videopolysomnography, as
documented herein.

CRediT authorship contribution statement

**Mathilde Brice:** Writing – original draft, Methodology, Investiga-
tion, Formal analysis, Data curation, Conceptualization. **Ana-Zenovia**
**Gales:** Writing – review & editing, Methodology, Investigation, Formal

analysis. **Valérie Attali:** Writing – review & editing, Methodology, Investigation. **Mahaut Chauvin:** Writing – review & editing, Methodology, Investigation, Formal analysis. **Isabelle Arnulf:** Writing – review & editing, Supervision, Methodology, Investigation, Conceptualization.

**Declaration of competing interest**

The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.

**Appendix A. Supplementary data**

Supplementary data to this article can be found online at https://doi.
org/10.1016/j.sleep.2026.108823.

**References**

[1] American Academy of Sleep Medicine. The international Classification of Sleep Disorders, third ed. Text Revision. Darien, IL: American Academy of Sleep Medicine; 2023.

[2] Schenck CH, Arnulf I, Mahowald MW. Sleep and sex: what can go wrong? A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences. Sleep 2007;30:683-702.

[3] Yeh S, Schenck C. Sexsomnia: a case of sleep masturbation documented by video-polysomnography in a young adult male with sleepwalking. Sleep Sci 2016. In press.

[4] Avidan AY, Hasan R, Badami V, Schenck CH. Hand dominance shift during sleep in sexsomnia: a clue to pathophysiology? J Clin Sleep Med 2025;21:937-41. https://doi.org/10.5664/jcsm.11554.

[5] Schenck CH. Update on sexsomnia, sleep related sexual seizures, and forensic Implications. NeuroQuantology 2015;13:518-41.

[6] van Mierlo P, Hermans LWA, Arnulf I, Pijpers A, Overeem S, van Gilst MM. Validation of the Dutch translation of the Paris Arousal disorders severity scale for non-REM parasomnias in a 1-year and 1-month version. J Clin Sleep Med 2022;18: 1135-43. https://doi.org/10.5664/jcsm.9830.

[7] Idir Y, Oudiette D, Arnulf I. Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: the old and the new. J Sleep Res 2022:e13596. https://doi.org/10.1111/jsr.13596.

[8] Piovezan RD, Kase C, Moizinho R, Tufik S, Poyares D. Gabapentin acutely increases the apnea-hypopnea index in older men: data from a randomized, double-blind,
placebo-controlled study. J Sleep Res 2017;26:166-70. https://doi.org/10.1111/jsr.12495.

[9] Revol B, Jullians-Desayes I, Cracowski J-L, Meno A, Tamisier R, Mallaret M, et al. Gabapentinoides et syndrome d'apnées du sommeil (SAS): un signal de

pharmacovigilance [ Gabapentinoids and sleep apnea syndrome (SAS): a pharmacovigilance signal]. Med Som 2019;16:36-7 (abstract).

[10] Dubessy AL, Leu-Semenescu S, Attali V, Maranci JB, Arnulf I. Sexsomnia: a specialized Non-REM parasomnia? Sleep 2017;40. https://doi.org/10.1093/sleep/zsw043.