Sexsomnia: What is sleep sex?

By Jennifer Huizen

Reviewed by Janet Brito, PhD, LCSW, CST

Sexsomnia or sleep sex occurs when an individual engages in sexual acts while asleep.

Most available research has found that sexsomnia episodes occur mostly during non-rapid-eye-movement (NREM), the dreamless, deepest stage of the sleep cycle.

Sexual dreams are not considered a type of sexsomnia because they do not involve physical actions or behaviors aside from arousal and ejaculation.

What is sexsomnia?

Sexsomnia is considered a type of parasomnia, an abnormal activity, behavior, or experience that occurs during deep sleep. But many of the facts about sexsomnia, such as its exact cause, the variety of symptoms, and its prevalence, are not understood.

Sexsomnia is a relatively new condition, with the first official case reported in 1986. And according to a 2015 study, only 94 cases of sleep sex have been documented worldwide.

Sexsomnia is also very difficult to study long-term because it takes place randomly during the night.

Symptoms

Sexsomnia often causes self-touching or sexual motions, but it can also cause an individual to seek sexual intimacy with others unknowingly. Sexsomnia may also occur at the same time as other parasomnia activities, such as sleepwalking or talking.

Sometimes it is a partner, roommate, or parent, who first notices symptoms of the condition. Sexual partners might also notice that their partner has an abnormally heightened level of sexual aggression and decreased inhibitions randomly in the night.

Common symptoms of sexsomnia episodes include:

• fondling or rubbing
• moaning
• heavy breathing and elevated heart rate
• sweating
• masturbating
• pelvic thrusting
• initiating foreplay with someone else
• sexual intercourse
• spontaneous orgasm
• no recollection or memory of sexual events
• blank or glassy stare during events
• unresponsive to outside environment during events
• inability or difficulty waking during events
• denial of activities during the day when fully conscious
• sleepwalking or talking

Aside from the physical symptoms that occur during episodes, sexsomnia can have harmful emotional, psychosocial, and even criminal consequences.

Triggers

As with other parasomnias, such as sleepwalking, it seems sexsomnia is caused by a disruption while the brain is moving between deep sleep cycles. These disturbances are often called confusion arousals (CAs).

Though the causes of sleep sex remain unknown, research shows the condition has clear risk factors, primarily medical conditions, lifestyle habits, jobs, and medications that interfere with sleeping patterns.

Triggers considered to increase the likelihood of sexsomnia include:

• lack of sleep
• extreme exhaustion
• excessive alcohol consumption
• use of illegal drugs
• anxiety
• stress
• poor sleeping conditions (too light, noisy, or hot)
• poor sleep hygiene or schedule
• shift work, especially high-stress jobs, such as military or hospital work
• travel
• sharing a bed with someone, regardless of their relationship with the person

Obstructive sleep apnea is linked to many of the documented cases of sexsomnia, likely because it causes disruptions during deep sleep.

Some people who develop sexsomnia in adulthood engage in other parasomnia behaviors, most commonly sleepwalking, or did in childhood.

Medical conditions considered risk factors for sexsomnia include:

• obstructive sleep apnea (OSA)
• restless leg syndrome
• gastroesophageal reflux disease (GERD)
• irritable bowel syndrome (IBS)
• a history of other parasomnia activities, such as sleepwalking or talking
• Crohn's disease
• colitis
• ulcers
• migraine headaches
• types of epilepsy and other seizure disorders
• head trauma
• medications for anxiety and depression, specifically escitalopram (SSRI)
• sleep-related dissociative disorder, a condition often related to childhood sexual trauma
• Parkinson's disease

Link to drugs, alcohol, and medication

When sexsomnia is related to the use of alcohol or illegal drugs, treatment involves immediately stopping use or reducing the drug to a safe level of use.

People experiencing sleep sex as a side effect of prescription medications may need to stop taking the drugs or change the dosage.

In many cases though, the benefit of the medication outweighs the side effects, so treatment may focus on reducing the impact of sexsomnia symptoms.

Treatment and management

It seems that the best way to treat the condition is to maintain a healthy, regular, sleep-wake schedule.

In most reported cases, symptoms of sexsomnia were reduced or resolved when individuals got more consistent, high-quality sleep.

The actual effect of treatment on sexsomnia is poorly understood because the symptoms are difficult to track long-term.

Sexsomnia medications

In some reported cases, off-label medications designed and approved for the treatment of other conditions have been used to manage sexsomnia.

Treating underlying conditions that cause sleep disruption, such as sleep apnea, may also reduce or resolve cases of sexsomnia.

Medical treatment options for sexsomnia include:

• anti-anxiety and antidepressant medications, such as duloxetine and clonazepam
• nasal continuous positive airway pressure (CPAP) therapy
• antacids and proton-pump inhibitors (PPIs). These are available over-the-counter or online.
• mild sedative medications
• mouth guards, bite plates, or mandibular advancement devices. Speak to a medical professional before purchasing

Lifestyle changes

In nearly every described case of sexsomnia, at least part of the treatment process involved lifestyle adjustments. As many of the symptoms of sexsomnia negatively impact other people, the best way to treat it tends to be nighttime isolation.

Some people with sexsomnia reduced problematic symptoms by locking themselves in their bedroom alone at night or placing an alarm system on their bedroom door.

Psychological management

Seeing a psychiatrist or psychologist may also reduce feelings of embarrassment and shame associated with sexsomnia.

People with sexsomnia may also significantly reduce emotional and psychosocial symptoms by undergoing group counseling sessions with the person negatively impacted by symptoms.

In most documented cases, sexsomnia symptoms have alarmed or angered the conscious bed partner.

A 2007 study concluded, however, that during sexsomnia episodes some partners were less hurried, gentler, and more focused on satisfying their partner.

Diagnosis

Sexsomnia was only recently classified medically, so there is no standard diagnostic process for the condition.

A psychiatrist, often one specializing in sleep disorders, may diagnose sexsomnia by reviewing individual medical history and asking questions about symptoms. However, the most widely accepted diagnostic method for sexsomnia is video-polysomnography (vPSG).

During vPSG, an individual is attached to physiological devices, such as heart rate, breathing, and motion monitors, and videotaped while they sleep.

Currently sleep sex is classified as a type of parasomnia in the Diagnostic Statistical Manual of Mental Disorders (DSM-5).

The International Classification of Sleep Disorders, Third Edition (ICSD-3), also classifies sexsomnia as a type of non-REM parasomnia.

Complications

Some people feel ashamed or embarrassed to learn they have done things they do not remember doing, especially sexual acts.

Sexsomnia can also make the question of consent difficult, given the individual initiating or engaging in the sexual act is technically unconscious. Several court cases have involved charges of sexual misconduct relating to sleep sex with a variety of outcomes.

Although a person's medical history and other evidence will be carefully examined in court, determining responsibility remains complicated and controversial.

SOURCE: MEDICAL NEWS TODAY