Sexsomnia: What Is Sleep Sex?

What Is Sexsomnia?

Sexsomnia is a part of a larger class of sleep disorders called parasomnias in which unusual sensations or behaviors occur, such as sleepwalking or talking. Episodes occur during the non-REM phase of sleep, a state between deep sleep and wakefulness. The sleeper may appear to be awake but is unaware of nor in control of their actions, and doesn’t remember engaging in the sexual acts.

According to a 2010 report by the American Association of Sleep Medicine, 7.6% of patients at a sleep center exhibited symptoms of sexsomnia, though fewer are expected to in the general population. Sexsomnia occurs more frequently in men than women.¹ People with sexsomnia often experience feelings of embarrassment or shame and their partners are often alarmed by symptoms.

Sexsomnia Symptoms

The two key features of sexsomnia are engaging in sexual behaviors while asleep and being unaware and unable to control doing so. Symptoms of sexsomnia include a range of sexual behaviors from moaning to sexual aggression and can be exhibited alone or towards another person. These behaviors can co-occur with other parasomnias such as sleepwalking and sleeptalking. The most common behavior exhibited by women with sexsomnia is masturbation.

Because the sleeper is unaware of their behavior it can be difficult to identify symptoms of sexsomnia unless they are witnessed by another person. Since symptoms are often first noticed by another person, sexsomnia symptoms can contribute to additional problems such as emotional disturbances, fatigue during the day, strain in interpersonal relationships, and in extreme cases, legal consequences.²

Common symptoms of sleep sex episodes include:³

• Fondling
• Moaning
• Masturbating
• Spontaneous orgasm
• Sexual intercourse
• Pelvic thrusting
• Heavy breathing
• Sweating
• Initiating foreplay with someone else
• Unresponsiveness to outside events
• Blank or glassy stare during events
• Inability or difficulty waking during events
• Denial of activities when fully conscious

What Triggers Sexsomnia?

Causes of sexsomnia are mostly unknown but are similar to other parasomnias in that episodes occur during a disruption while the brain is moving between deep sleep cycles. This disruption causes a confusional arousal during which the sleeping person appears awake but engages in unusual behavior.³ Additionally, various environmental and internal factors can trigger a sexsomnia episode.

Psychological factors that increase risk of a sexsomnia episode include extreme exhaustion, anxiety, and stress. Environmental factors such as too much light, heat, or noise in the sleeping space, traveling, and shift work in high-stress jobs also increase the likelihood of a sexsomnia episode. Excessive alcohol consumption and drug use are additional risk factors.²

Common triggers that increase the risks of sexsomnia include:

• Exhaustion
• Lack of sleep
• Illegal drug use
• Excessive alcohol use
• Anxiety
• Poor sleep hygiene and schedule
• Rotating shift work
• Stress
• Poor sleeping conditions
• Travel across time zones
• Sharing a bed
• Depression
• Psychotropic medications
• Someone turning in lights, touching the sleeper, or making noise

Medical Condition Risk Factors of Sexsomnia

Some medical conditions can also increase the likelihood that someone develops sexsomnia as they provoke or worsen sleep disturbances.⁴ One such condition is obstructive sleep apnea (OSA) as the frequent respiratory events contribute to abnormal arousals.⁵ OSA and non rapid eye movement (NREM) parasomnias such as sleepwalking or sleep terrors are the most commonly reported comorbidities with sexsomnia.⁶

Medical conditions considered possible risk factors of sexsomnia include:

• Obstructive sleep apnea
• Restless leg syndrome
• Irritable bowel syndrome
• Migraine headaches
• Gastroesophageal reflux disease (GERD)
• Other parasomnias
• Crohn’s disease
• Colitis
• Ulcers
• Epilepsy and other seizure disorders
• Head trauma

Sexsomnia Diagnosis

Sexsomnia is included in the fifth addition of the diagnostic and statistical manual of mental disorders (DSM-V). It can be diagnosed by a medical or mental health professional. If you suspect you are experiencing sexsomnia, discuss your symptoms with your primary care doctor or therapist. They will likely refer you to a sleep specialist to obtain further information and determine the appropriate diagnosis.

As amnesia is one of the features of sexsomnia, reporting symptoms can be difficult. Many also underreport symptoms due to shame. These factors can interfere with getting the appropriate diagnosis and treatment. It can be helpful for you and your provider if you keep a written log of symptoms either you, a sleep partner or a relative has noticed to help you get the help you need.

Coping With Sexsomnia

Lifestyle changes and practicing good sleep hygiene also help to address sexsomnia symptoms. Maintaining a consistent sleep-wake schedule, reducing noise or other stimuli that cause sleep disruptions, managing stress, and reducing drug and alcohol use can all improve sexsomnia symptoms. Since treatment is not always immediately available, sleeping in another room and locking the bedroom door can reduce safety concerns caused by sexsomnia symptoms.

Sexsomnia can be treated both medically and with lifestyle changes. Treatments target the underlying conditions and causes of the sleep disruptions and include medications, psychotherapies, and devices that control breathing such as a continuous positive airway pressure machine (CPAP). One study showed as high as 97.2% of participants gained control of their symptoms with treatment.⁷

Treatment options for sexsomnia include:

• Continuous Positive Airway Pressure (CPAP) device for sleep apnea
• Medications for restless legs syndrome
• Medications for heartburn
• Selective serotonin reuptake inhibitors (SSRIs) to treat depression and anxiety
• Improving sleep environment
• Mandibular advancement device
• Psychotherapy (e.g. CBT or MBSR)

How to Find Help for Sexsomnia

It can be difficult at first but talking to loved ones and doctors is the first step to getting help with symptoms of sexsomnia. Finding an in-person or online therapist for yourself and loved ones can help cope with sexsomnia and related feelings. You can easily begin your search for a provider with an online therapist directory.

Many people feel shame or embarrassment about having a sleep sex condition even though they are not in control of their behavior. Working with a sex therapist minimizes the risk of working with a provider who experiences their own shame and avoidance of sexual behaviors that could exacerbate rather than reduce your own negative feelings about your symptoms and impede your ability to get the treatment you need.

In My Experience

In my experience, stigma persists around mental health and sexuality despite the ubiquitous nature of both subjects and this can make it difficult for individuals to seek help. Even though sexsomnia isn’t something everyone experiences, if you do you are certainly not alone. I also find that not everyone who experiences symptoms of sexsomnia, sleepers and loved ones alike, are bothered by symptoms. If that applies, enjoy the late-night surprise. If you are bothered by symptoms, be honest about them and seek help. Effective treatment is available!