Understanding Sexsomnia

Introduction

People who experience sleep disorders exhibit unusual or unexpected behaviours during the sleep cycle. These behaviours might include problems falling or staying asleep, unusual movements, making sounds or even getting up out of bed and acting out different activities whilst sleeping. 

Sexsomnia is a rare type of sleep disorder that involves people engaging in sexual behaviours while they are asleep. It is sometimes referred to as sleep sex.

What is Sexsomnia?

Parasomnias or sleep disorders are most common in children although they are thought to affect up to 10% of the adult population as well. Common sleep disorders include sleepwalking (somnambulism), restless legs syndrome, insomnia, sleep apnoea, night terrors and narcolepsy. 

If you experience abnormal behaviour during your sleep cycle you may talk, walk or even eat whilst still being asleep. In the case of sexsomnia, the abnormal sleep-related behaviours are sexual in nature.  

Sexsomnia is a rare and often misunderstood form of parasomnia which can leave sufferers feeling ashamed and distressed. This can lead them to resist reaching out for help as they do not want to admit they have this kind of delicate issue. Some people with sexsomnia do not even know that they have the condition until someone else notices it. It can also have a negative effect on the partners of people with sexsomnia who may suffer frightening and unwanted sexual advances during the night, even though their partner is asleep. 

People with sexsomnia may take part in different sexual behaviours during their sleep cycle. It is thought that sexsomnia is a non-REM sleep disorder, meaning that the behaviours do not occur during the deep sleep periods of rapid eye movement (REM). Non-REM sleep disorders (sometimes called arousal disorders) have symptoms that involve physical or verbal activity. 

People who are showing symptoms of sleep sex may:

• Make sexual noises or movements
• Touch themselves
• Attempt to engage in sexual behaviour with others

It is important to note that people who have sexsomnia are completely unaware of these behaviours, they do not recognise what they are doing at the time and are unlikely to remember what they have done once they are awake.  

Having sexsomnia can result in physical and emotional trauma to the sufferer themselves and to others. The condition may also raise concerns around consent and sexual aggression in relationships.

Causes and Triggers

Research into parasomnias is ongoing and experts do not fully understand why some people develop sexsomnia.

Cases of sexsomnia may be brought on due to:

• Medical reasons
• Lifestyle triggers
• Environmental triggers

Although the reasons why people develop symptoms of sexsomnia vary between people, some common triggers include:

• Drugs or alcohol
• Stress
• Anxiety
• Depression
• Sleep deprivation

You may be more likely to develop sexsomnia if you also suffer from a separate parasomnia. The most commonly reported parasomnias that people with sexsomnia are thought to have are NREM parasomnias followed by obstructive sleep apnoea (OSA).

Symptoms and Diagnosis

Sexsomnia manifests itself in different ways and the symptoms may vary from person to person. However, some behaviours that people with sexsomnia exhibit may include:

• Sexual arousal
• Fondling/touching
• Masturbation
• Sexual noises (such as moaning)
• Making sexual movements (such as pelvic thrusting)
• Sexual aggression
• Sexual assault/attempted rape
• Trying to initiate sex with someone

A key feature of sexsomnia is that when any of the above behaviours occur, it is during the sleep cycle and the person is unaware of their actions and unable to control themselves.

If you suspect a sexsomnia episode in someone, other signs to look out for include:

• The person is hard to wake up
• Acting out of character sexually (such as becoming aggressive)
• Unresponsive to conversation or the environment
• The person has no memory of their actions once awake
• Trauma or abrasion to genitals or other parts of the body due to aggressive actions/ excessive touching during sleep

Sometimes people may mislabel their sexsomnia as something else, such as having a ‘wet dream’ where a male ejaculates during sleep. Unlike sexsomnia, wet dreams are a totally normal part of development in adolescents and they can also be experienced by adults. 

People with parasomnias often have problems with their circadian rhythm that regulates the normal sleep/wake cycle and they may:

• Feel tired frequently
• Fail to feel rested despite having what should have been a full night’s sleep
• Wake up feeling disorientated and/or confused

If you are concerned about your health or worried that you may have sexsomnia you can book an appointment to speak to your GP initially. Due to the nature of sexsomnia, you may want to take your sleep partner with you (if you have one) so that they can talk about any behaviours that they have noticed. Your GP should listen to any concerns raised and will make a plan about how to move forward. They will ask questions about:

• Your physical health
• Your mental health
• Your symptoms
• Any parasomnias you have been diagnosed with previously
• Your family history
• Any medication you take
• Whether you take recreational drugs or drink alcohol

After considering your answers, your GP may make recommendations or refer you to a specialist. You may be referred to a special sleep centre to take part in a sleep study (also known as a polysomnogram). During the sleep study you will be observed while you sleep and readings and measurements will be taken using specialist equipment. Observations will include:

• Your brain waves
• Heart rate
• Breathing
• Eye movements

You may also be referred for additional tests such as a video electroencephalogram (EEG) or sleep EEG, which are tests that measure your brain activity. During the test, electrodes are placed against your scalp which attach to a machine that measures the electrical signals in your brain. EEGs are used by clinicians to assess how well your brain is working. These tests are typically used to diagnose brain conditions, for example epilepsy.

To get further insight into how your brain is working or to rule out other conditions, you may be referred for other tests before you are diagnosed with parasomnia, such as:

• CT scan
• MRI scan
• Neurological examination

Who’s at Risk?

Although more research into sexsomnia is needed, experts consider that people who suffer from other types of parasomnias or have underlying medical conditions may be more likely to exhibit signs of the condition. 

Some risk factors for developing a parasomnia, such as sexsomnia, may include the following:

• Sleepwalking or REM sleep behaviour disorder
• Obstructive sleep apnoea
• Sleep-related seizures
• Kleine-Levin syndrome
• Insomnia (where it is chronic/severe)
• Restless legs syndrome
• Narcolepsy
• Persistent sexual arousal syndrome
• Bruxism or teeth grinding

You may also be at a greater risk of developing sexsomnia if you have:

• A neurological disorder
• A head injury
• Irregular sleep/wake cycles
• A family history of parasomnia

Sexsomnia is more common in men than women, with men being up to three times more likely to develop the condition. 

Alcohol and drugs (including prescribed or over the counter medication) can disrupt our sleep/wake cycles and affect our cognitive functioning and may trigger episodes of parasomnia.

Treatment and Management

In many cases, the best way to treat sexsomnia is to treat the underlying cause of the problem. This might include:

• Treating depression or anxiety with medication and/or therapy
• Practising good sleep hygiene and maintaining a routine
• Reducing stress
• Identifying and avoiding triggers

If you are experiencing sexsomnia in addition to another parasomnia, then treating the other parasomnia may reduce the symptoms of sleep sex that you exhibit. Your treatment plan will depend on the type of parasomnia you have, but may include:

• A sleep apnoea machine (such as a continuous positive airway pressure (CPAP) machine or a mandibular advancement device (MAD))
• Medication or anticonvulsant therapy to control seizures
• The most common medication prescribed to treat sexsomnia is benzodiazepine (such as clonazepam)

Some clinical evidence suggests that taking selective serotonin reuptake inhibitors (SSRIs) has successfully treated sexsomnia. SSRIs are often effective in treating depression and anxiety, therefore if you have either of these conditions then they may be an effective option for you. However, it is also important to note that at least one case of SSRI-induced sexsomnia has been reported. 

Some trial and error may be needed in order to find a treatment or combination of treatments that work for you. 

It is also important to look after your mental and physical health if you have sexsomnia. This means trying to get regular exercise, eating a healthy balanced diet and staying hydrated. If you are having problems sleeping, you may find gentle, relaxing activities will help you, such as:

• Yoga
• Meditation
• Mindfulness
• Deep breathing

If sexsomnia is taking its toll on your mental health or is causing trouble in your relationship you may want to consider trying therapy or counselling. 

The most important part of treating sexsomnia is that you reach out for help and engage with the advice of your clinicians. If someone you love has sexsomnia, try to offer support and understanding rather than judgement but do make sure that you put in any necessary safeguards to keep you both safe and healthy.

Living with Sexsomnia

Taking the important steps of getting a diagnosis and engaging with treatment are the first stages of learning to live with sexsomnia. It can be an awkward, embarrassing and distressing topic to talk about and sleep sex behaviours can leave people feeling ashamed and with low self-esteem. 

Here are some tips to help you cope with having sexsomnia:

• Learn to be honest about your condition, especially with new partners
• Be kind to yourself rather than judgemental
• Take any medication as prescribed and adhere to your treatment plan as far as possible
• Practise good sleep hygiene
• Keep a sleep journal or diary to note any changes in behaviour or new symptoms
• Avoid any known or potential triggers including drugs or alcohol
• Consider attending counselling to deal with the psychological or emotional toll that the condition can have

If you know that you have sexsomnia and may have an episode during the night, it is important that you take any safeguarding measures necessary to protect yourself and others. Safeguarding measures may include:

• Locking doors
• Sleeping in a room alone
• Avoiding falling asleep around strangers or minors
• Using movement alarms or sensors

Myths and Misconceptions

Sex remains a taboo subject amongst some communities and unusual conditions related to sex or sexual dysfunctions can result in harmful misconceptions and stereotypes. It is important that we treat sexual problems (including sexsomnia) as health issues and that we do not spread misinformation and make unnecessary judgements. 

Some common myths about sexsomnia debunked:

Some further points to note about sexsomnia:

• During sexsomnia episodes, some people may act out behaviours that are outside of their usual sexual behaviour whilst others act out their usual sexual behaviour
• Eyes may be open or closed during sexsomnia (even if the eyes are open the person is not awake and may display a ‘vacant’ look)
• It is possible to reach orgasm during sexsomnia
• Men are more likely to attempt intercourse during sexsomnia, whilst women are more likely to masturbate

Sexsomnia is a rare type of abnormal sleep behaviour. Most people have no idea what they are doing whilst sleeping and it often leads to shame and embarrassment once they discover that they have been behaving sexually whilst asleep, particularly if the behaviour is aggressive or upsets others. It is most frequently associated with other parasomnias but episodes can also be brought on by medical, environmental or lifestyle triggers. In most cases sexsomnia can be managed, therefore it is important to receive proper diagnosis and treatment for your disorder.