BACKGROUND: Sexsomnia, a subtype of non-REM (NREM) parasomnia, consists of atypical sexual behaviors during sleep and presents with diagnostic and therapeutic challenges due to its under-recognition and overlap with other sleep and psychiatric disorders. Thus, its early diagnosis is quite challenging and important.

CASE REPORT: A 29-year-old man presented with a 2-year history of abnormal nocturnal sexual behaviors including pelvic thrusting, masturbation, and attempted intercourse during sleep reported by his partner, consistent with sexsomnia. All episodes occurred with complete amnesia. The symptoms intensified during periods of anxiety, occupational stress, and long work hours. The behaviors caused distress for his partner, resulting in a strain on their relationship. The patient reported a history of childhood sleep terrors and a family history of parasomnia. He exhibited no significant medical comorbidities or signs of obstructive sleep apnea, as supported by low STOP-BANG and Epworth Sleepiness Scale scores. Polysomnography and neurological imaging results were unremarkable. Initial therapy with fluoxetine (20 mg/day), melatonin (3 mg nightly), and clomipramine (25 mg nightly) was unsuccessful, but self-administered valerian root supplementation achieved a 90% reduction in symptoms due to its GABAergic effects. Subsequent treatment with vortioxetine (20 mg daily) led to complete remission, continued during a 3-month follow-up period.

CONCLUSIONS: This report emphasizes the importance of individualized approaches in diagnosing and managing sexsomnia. The patient’s positive response to valerian root highlights the potential role of natural supplements in managing selected cases. It further highlights the need for increased clinical awareness and future research into natural and behavioral interventions for sleep-related sexual disorders.

Keywords: fluoxetine, Sleep Paralysis, Sleep Wake Disorders