Sexsomnia, known by layman terms as "sleep sex," was once reported by nearly eight percent of patients at a sleep disorders center, and was more prevalent in men versus women, according to American Academy of Sleep Medicine. The first known case of sexsomnia was reported in 1986, and worldwide, only 94 cases have been documented, according to a 2015 study. It is a disorder that is believed to be unreported.
What Is Sexsomnia?
What is the sexsomnia? Characterized as a parasomnia, sexsomnia is a complex sleep disorder involving sexual behaviors during sleep, particularly during non-rapid eye movement (NREM) sleep. Parasomnias occur in between sleep stages, where you act out awake-like behaviors even when you are still asleep. With parasomnias, your brain is caught in between sleep phases.
With sleep sex, the individual is not typically aware they are engaging in sexual activity during sleep. After the event, the person displaying sleep sex behaviors will experience amnesia and fall back asleep with no recollection the event even occurred.
What Are the Signs and Symptoms of Sexsomnia?
Sexsomnia, also referred to as sexual behavior in sleep (SBS), presents differently from person to person. However, there are a variety of common behaviors individuals display during a sleep sex event. These common behaviors and signs of sexsomnia include:
- Talking dirty
- Pelvic thrusting
- Sexually fondling a bed partner
- Having an orgasm
- Participating in foreplay with a bed partner
- Engaging in sexual intercourse
- Having vacant, glassy eyes during these behaviors
- Sleep-related violence (SRV)
These behaviors may be more assertive than would otherwise be had the individual been awake. Additionally, these behaviors may be aggressive, violent and/or harmful to the bed partner. Some sexsomnia events may produce physical effects such as lacerations or genital bruising.
Sometimes a sleep sexsomnia event can result in sexual assault. If the latter is the case, bed partners, roommates or family members concerned about assault or aggressive behavior may want to sleep in separate bedrooms with locks until the situation is resolved.
What Are the Causes of Sexsomnia?
The precise causes of sexsomnia have not been determined, which could be due to it being a relatively new condition and unreported. Further, it may be an idiopathic parasomnia, meaning it spontaneously arises without any identified neurological dispositions.
That said, there are several sleep-sex factors that have been reported as associated with sexsomnia:
- Sleeping pill use. Using sleeping pills has been associated with sleep sex, as well as other sleep disorders such as sleep walking, sleep eating, sleep talking and even sleep driving. Because these sleep-related behaviors may increase in frequency and intensity at higher dosages, it's important for patients to follow the sleeping pill dosage prescribed by their physician.
- A history of parasomnia. People who have other parasomnias, like sleep walking, or a history of having them, seem to have more of an inclination toward sexsomnia than those who never have had a parasomnia disorder. Sexsomnia and NREM Stage 3 sleep may be related to automatic behaviors and partial awakening as a result of other sleep disorders, such as restless legs syndrome (RLS) and obstructive sleep apnea (OSA).
- Substance abuse. People who abuse substances, including alcohol, may have sleep disturbances and fragmented sleep, leaving them more prone to parasomnia.
- Stress and anxiety. Experiencing stress or anxiety is believed to be a sexsomina trigger.
- A history of depression. While having depression may also induce sexsomnia symptoms, sleep sex can also lead to mental health issues such as depression.
- Sleep-related epilepsy. In this disorder seizures occur during sleep, and may cause a person to act out sexual arousal, including displaying pelvic thrusting behaviors and having organisms.
- Shift work. Because shift work can lead to fragmented sleep and sleep deprivation, it may induce sleep sex episodes in some people.
- Sleep apnea. Sleep apnea disorders, like obstructive sleep apnea (OSA), disrupt deep sleep. Cases of sexsomnia have been reported in sleep apnea patients.
- Exhaustion and/or fatigue. Being exhausted or having fatigue, whether chronic or acute, can produce sexsomnia episodes.
- Traveling. Traveling can cause disruptions in sleep and increase stress and anxiety - all of which can trigger a sexsomnia event.
- Poor sleeping conditions. Noise, light or temperatures that are too cold or too warm can cause poor sleep quality, leading to fragmented sleep, sleep deprivation and sleep-sex incidents.
- A history of certain medical conditions. Some medical conditions have been associated with sexsomnia including irritable bowel syndrome (IBS), Crohn's disease, gastroesophageal reflux disease (GERD), ulcerative colitis (UC), migraines, Parkinson's disease, head trauma and ulcers.
How Is Sexsomnia Diagnosed?
To diagnose sexsomnia, the patient completes a sleep study overnight at a sleep center. In some cases, the physician may request a multiple night sleep study in order to get a more comprehensive account of their sleep sexsomnia behaviors. Further, if a sexsomnia incident doesn't occur during a sleep study, the doctor may request additional studies.
During the sleep study, an extended EEG or electroencephalogram is recorded to rule out seizures. A polysomnogram (PSG) with extended EEG can rule out epileptic disorders and monitor spontaneous arousals when the patient is experiencing slow-wave sleep. A PSG measures brain waves, breathing patterns, heart rate and leg and eye movement.
In addition to the sleep study, descriptions from bed partners can solidify a sexsomnia diagnosis. In some cases, explicit descriptions from a bed partner are enough for a diagnosis without the need for a sleep study.
How Is Sexsomnia Treated?
Sexsomnia can be successfully treated. Treatment depends on the underlying cause, if known, and includes:
- Treating sleep apnea. Positive sexsomnia results have been reported in sleep apnea patients being treated with an oral appliance for sleep apnea or using continuous positive airway pressure (CPAP).
- Taking antidepressants. If the patient has a depressive disorder, an antidepressant, such as a selective serotonin reuptake inhibitor (SSRI), can increase the serotonin levels in the brain and treat sexsomnia.
- Controlling substance use and/or abuse. Reducing the use of alcohol or drugs may reduce or eliminate the sleep sex episodes.
- Managing stress or anxiety. If stress or anxiety is believed to be a sexsomnia trigger, the patient should incorporate stress or anxiety-relieving techniques into their lifestyle.
- Improve sleep hygiene. If sexsomnia frequency and intensity is exacerbated in individuals due to poor quality of sleep, improved sleep hygiene may help. Examples include taking a warm bath before bed, writing in a sleep journal, going to bed and waking at the same time each day and sleeping in a dark, quiet, cool room.
- Special alarms. Designed to wake a patient during a sexsomnia episode, special alarms may wake a person to make them aware of the sleep-sex behavior.
Seeing a psychologist. People who know they have a sleep-sex disorder, even if they aren't aware that the behavior is occurring, may feel shame or embarrassment. Talking to a psychiatrist or another mental health professional may be beneficial.
The goal of this article is to make sleep technologists aware of this rarely talked about disorder, provide information about its causes and symptoms and provide knowledge of treatment options. A knowledgeable sleep technologist can provide education and support for patient with this uncommon disorder.