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While you may be familiar with sleepwalking and sleep talking, sleep sex (sexsomnia), in which someone might engage in sexual behaviors while asleep, might be a new term for you.
Learn more about the symptoms, risk factors, and treatment options available for this serious sleep disorder, also known as a parasomnia.
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What is sexsomnia?
Sometimes called sleep sex, sexsomnia is an abnormal sleep behavior, referred to as a parasomnia in which people who are asleep might moan, masturbate, or engage in, or attempt to engage in, sexual intercourse with others. They usually have no memory of these actions (Ariño, 2014).
The initiation of sexual intercourse during sexsomnia is more common in men than women, and it appears to be most common in younger adult men (Muza, 2016). Estimates are that somewhere between 67% and 81% of sexsomniacs are men (Dubessy, 2017). With that being said, there is little insight into how common it actually is (Muza, 2016).
It’s thought that many sexsomniacs and their partners are not aware the condition is a medical issue and don’t bring it up with their doctors. Meanwhile, many health professionals are likewise unaware that sexsomnia is a sleep disorder and may not be capable of making a diagnosis (Toscanini, 2021).
One research effort involving patients at a sleep study center for sleep disorders—obviously a subset of the entire population—determined that about 7.6% of them had sexsomnia. However, the study, presented at a meeting of the Associated Professional Sleep Societies, has not been published in a peer-reviewed journal (Chung, 2010).
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The legalities of sexsomnia
Sexsomnia can be relatively harmless in some cases, but in others, episodes can involve sexual assault, leading to legal implications. Like sleepwalking, people who initiate sleep sex typically don’t remember what they’ve done, something that the legal system is trying to navigate.
Because sexsomnia was added as a formal mental disorder to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), it’s “increasingly likely” that “nocturnal sex offenses” related to sleep sex could end up in court, according to a legal journal. Already, through 2012, there were nine known legal cases involving sleep sex (Holoyda, 2021).
Symptoms of sexsomnia
Symptoms of sexsomnia include (Dubessy, 2017):
- Sex-related utterances
- Pelvic thrusting
- No memory of the behaviors in the morning
The episodes usually start in the first few hours after going to sleep, during what’s called the “slow-wave sleep” portion of the sleep cycle called non-rapid eye movement (NREM). They can recur multiple times during the night (International Society for Sexual Medicine, n.d.).
In one case study, a couple visited a sleep clinic to seek help. The woman complained that her 37-year-old husband had snored nightly, loudly, for 13 years. She said they’d also regularly had intercourse in the middle of the night for several years—always initiated by him—but he’d never remembered it the following day. She called the sex, in which he’d also perform oral sex on her, “wild” but not violent (Khawaja, 2017).
Sexual activity linked to sexsomnia can also, at times, veer into sexual assault. A study of 17 people with this sleep disorder (including 12 men) found behaviors ranging from masturbation and fondling the partner to sexual intercourse (including orgasms). They also included three intra-conjugal rapes (nonconsensual sex with a spouse), two assaults on family members, and one rape of a friend (Dubessy, 2017).
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Sexsomnia risk factors
The causes are poorly understood, though some small studies and a fair number of case reports add up to a general sense that there are often underlying conditions, including high levels of stress or other parasomnias like sleep apnea, that contribute to sexsomnia.
There are underlying risk factors that may put people at a higher risk of experiencing sexsomnia. These include:
- Other sleep disorders like sleepwalking, obstructive sleep apnea, and restless legs syndrome. One study of 41 people with sexsomnia found 73% had a history of some other parasomnia (Khawaja, 2017; Muza, 2016).
- Night terrors, another non-rem parasomnia that involves intense fear and can cause people to scream in their sleep (Dubessy, 2017)
- Daytime stress and sleep deprivation, including among shift-workers (Dubessy, 2017)
- There’s some evidence that sexsomnia may be made worse in people with Parkinson’s disease with impulse control disorder (Singh, 2018).
- Alcohol is known to contribute to various sleep disorders and might cause or worsen sexsomnia, but there are few studies on this (Kumar, 2020; Dubessy, 2017; Maschauer, 2017).
Some medications, including sleep medicines, could contribute to sexsomnia, but there’s almost no research on the possibility (Muza, 2016; Singh, 2018).
Sexsomnia diagnosis and treatments
To diagnose sexsomnia, a sleep-center expert or psychiatrist would review a person’s history of parasomnia, as well as stress and any other mental health issues. They might do a formal polysomnography, or sleep study, observing a person overnight by monitoring with video or recording brain activity with an electroencephalogram (EEG) (Holoyda, 2021).
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A bed partner will likely be asked to explain their bed mate’s history of sleep sex behavior and other parasomnias, if any (Singh, 2018).
A healthcare provider may aim to treat an underlying condition. Here are a few treatments that providers use when trying to treat sexsomnia:
Addressing sleep apnea
You’ll remember the man mentioned earlier who said he’d been initiating sleep sex with his wife for years and had no recollection of it. In this one case study, the man began using a mandibular advancement device, which alters the position of the jaw and tongue to alleviate sleep apnea, and his sleep sex was put to rest. A subsequent switch to a continuous positive airway pressure (CPAP) machine also worked to keep the sexsomnia at bay (Khawaja, 2017).
Psychotherapy is also recommended in some cases, but little is known about its effectiveness (Toscanini, 2021).
Several cases of sexsomnia have been treated with clonazepam, an anti-seizure medication. But there’s been no formal scientific analysis of the effectiveness. Various cases studies have found it to be effective for some people but not for others. In one case, the antidepressant medication paroxetine was said to have eliminated an individual’s sexsomnia symptoms (Kumar, 2020; Dubessy, 2017).
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Improving sleep hygiene
As with other parasomnias, experts recommend good sleep hygiene as one way to curb sexsomnia (International Society for Sexual Medicine, n.d.). Here are some of the known ways to achieve a better night’s sleep:
- Step up your physical activity and improve your diet.
- Adhere to a regular sleep schedule.
- Avoid alcohol and nicotine, and limit caffeine intake to the morning or midday.
- Avoid stressful activities like work and social media in the evening
- Turn off screens an hour or more before you go to bed.
- Avoid long or late-afternoon naps.
As case studies suggest, sexsomnia can be a serious problem, even a legal one. At best, it’s an indication of sleep troubles. At worst, it can harm others. If your partner initiates sleep sex, they may be unaware and might not believe it when you tell them. If you think you have it, then you’re already a step closer to solving the problem. In either case, seeking professional help for yourself or your loved one is wise.
- Ariño, H., Iranzo, A., Gaig, C., & Santamaria, J. (2014). Sexsomnia: parasomnia associated with sexual behaviour during sleep. Neurologia (Barcelona, Spain), 29(3), 146–152. doi: 10.1016/j.nrl.2013.01.013. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23664055/
- Chung, S. (2010). Study Finds that Sexsomnia is Common in Sleep Center Patients. Retrieved Aug. 25, 2021, from https://aasm.org/study-finds-that-sexsomnia-is-common-in-sleep-center-patients/
- Dubessy, A. L., Leu-Semenescu, S., Attali, V., Maranci, J. B., & Arnulf, I. (2017). Sexsomnia: a specialized non-REM parasomnia? Sleep, 40(2), doi: 10.1093/sleep/zsw043. Retrieved from https://academic.oup.com/sleep/article/40/2/zsw043/2666486
- Holoyda, B., Sorrentino, R., Mohebbi, A., Fernando, A., Friedman, S. (2021) Forensic evaluation of sexsomnia. Journal of the American Academy of Psychiatry and the Law. doi: 10.29158/JAAPL.200077-20. Retrieved from http://jaapl.org/content/early/2021/02/12/JAAPL.200077-20
- International Society for Sexual Medicine (n.d.) What is sexsomnia? Retrieved Aug. 26, 2021, from https://www.issm.info/sexual-health-qa/what-is-sexsomnia/
- Khawaja, I. S., Hurwitz, T. D., & Schenck, C. H. (2017).Sleep-related abnormal sexual behaviors (sexsomnia) successfully treated with a mandibular advancement device: a case report. Journal of Clinical Sleep Medicine, 13(4), 627–628. doi: 10.5664/jcsm.6560. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359341/
- Kumar, V., Grbach, V. X., & Castriotta, R. J. (2020). Resolution of sexsomnia with paroxetine. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 16(7), 1213–1214. doi: 10.5664/jcsm.8478. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32672534/
- Martynowicz, H., Smardz, J., Wieczorek, T., Mazur, G., Poreba, R., Skomro, R., et al. (2018). The co-occurrence of sexsomnia, sleep bruxism and other sleep disorders. Journal of Clinical Medicine, 7(9), 233. doi: 10.3390/jcm7090233. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30142877/
- Maschauer, E. L., Gabryelska, A., Morrison, I., McKeown, R., Fairley, D., Roguski, A., et al. (2017). Alcohol as a trigger affecting symptom severity and frequency of slow wave sleep disorders. Journal of Clinical Sleep Medicine, 13(9), 1111. doi: 10.5664/jcsm.6738. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566469/
- Muza, R., Lawrence, M., & Drakatos, P. (2016). The reality of sexsomnia. Current opinion in pulmonary medicine, 22(6), 576–582. doi: 10.1097/MCP.0000000000000321. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27607155/
- Schenck, C.H. (2015) Update on sexsomnia, sleep related sexual seizures, and forensic implications. NeuroQuantology, 13(4), 518–541. doi:10.14704/nq.2015.13.4.873. Retrieved from https://www.researchgate.net/publication/288685573_Update_on_Sexsomnia_Sleep_Related_Sexual_Seizures_and_Forensic_Implications
- Singh, S., Kaur, H., Singh, S., & Khawaja, I. (2018). Parasomnias: a comprehensive review. Cureus, 10(12), e3807. doi: 10.7759/cureus.3807. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402728/
- Toscanini, A. C., Marques, J. H., Hasan, R., & Schenck, C. H. (2021). Sexsomnia: case based classiﬁcation and discussion of psychosocial implications. Sleep science (Sao Paulo, Brazil), 14(2), 175–180. doi: 10.5935/1984-0063.20200057. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8340885/