(179) WHAT DO WE KNOW ABOUT SEXSOMNIA INDUCED BY THE USE OF ZOLPIDEM?
Authors: Braga C , Brasileiro M , Germino P 
Published: December 2024

Abstract

Introduction
Parasomnias are abnormal events that occur during any period of sleep, both in REM and non-REM sleep phases. Sexsomnia is a non-REM sleep parasomnia, considered a subtype of sleepwalking, involving amnestic sexual behaviors, which can have medicolegal repercussions and cause significant distress to the individual and their partner, predominantly occurring in the first half of the sleep period. This complex behavior during sleep is associated with various triggering factors in predisposed individuals, such as sleep deprivation, physical contact with the partner, and the use of medications, including Zolpidem.

Objective
The aim of this study is to raise awareness of the occurrence of Zolpidem-induced sexsomnia and methods for its prevention.

Methods
To achieve this objective, a narrative review of the scientific literature was conducted.

Results
The increasingly frequent use of Zolpidem presents potential for various harmful psychiatric events, including parasomnias, among them sexsomnia, in which patients may exhibit sexual behaviors during sleep, often without consent, directed towards regular sexual partners, occasional partners, or even individuals with whom they do not have a sexual relationship, such as relatives or friends. This condition can lead to marital, health, and legal problems, especially in severe cases or those involving children. Its prevalence is likely underestimated, as it is not frequently disclosed to physicians, due to patients’ feelings of embarrassment, as well as those of their partners. It is important to point out that the occurrence of complex sleep behaviors may be facilitated by the use of Zolpidem, even at therapeutic doses. However, some factors may increase the likelihood of these episodes, such as higher doses and concurrent use of medications that increase its plasma levels, use of serotonergic antidepressants, or central nervous system depressants. Zolpidem should not be prescribed to patients with a personal history of sleepwalking or related disorders and should be discontinued if such symptoms arise. Even for patients without a previous history of complex sleep behaviors, some measures are recommended for prevention, including: using the lowest possible dose for the shortest period; avoiding medications that reduce Zolpidem elimination; avoiding concurrent use with sedatives and alcohol; ensuring that any comorbid sleep disorders are treated; never taking higher doses than prescribed; avoiding Zolpidem after intense physical activity, alcohol consumption, and sleep deprivation.

Conclusions
Zolpidem and other Z-drugs are contraindicated in patients with a history of sleepwalking, as they are at risk of recurrence of complex behaviors during non-REM sleep, which can lead to physical harm to the patient and others. Furthermore, sexual behaviors during sleep should be investigated more frequently before and after the prescription of potentially triggering medications. The topic is embarrassing and may have legal implications for the patient, which could cause the patient not to spontaneously discuss the issue. Therefore, it is important to actively inquire about patients’ personal and family history of sleep disorders before prescribing zolpidem. Further studies are necessary, as sexsomnia has not yet been reported in the literature as frequently as other parasomnias, predominantly through case series or case reports.

Disclosure
No.