What Is Sexsomnia?by Martin Reed Patient Advocate
Sexsomnia is characterized by sexual vocalizations, masturbation, fondling, intercourse, or attempted intercourse during sleep — often followed by morning amnesia. It is categorized as a parasomnia and is officially described as “sleep-related abnormal sexual behaviors” by the International Classification of Sleep Disorders (Third Edition).
Little is understood about the mechanisms behind sexsomnia, and that’s partially because few cases are reported or investigated. In 2007, a review identified 31 published cases of sexsomnia. An additional 22 cases were found in a 2015 review, and a total of 41 cases were identified by the Sleep Disorders Centre run by Guy's and St. Thomas' NHS Foundation Trust in London between 2008 and 2014.
These findings led researchers to publish a study to further investigate the disorder and to compare the sleep of sexsomnia patients with that of healthy sleepers and sleepwalkers. The study was published in the journal SLEEP in 2017.
Researchers recruited three groups of participants. The first group was made up of 17 patients with sexsomnia who were referred to a sleep disorders unit between 2008 and 2016. Participants were only admitted to the sexsomnia group after being diagnosed by two sleep neurologists following a medical interview with the patients and their bed partners (if available) and by video-polysomnography for one or two consecutive nights.
The second group was made up of 89 participants who had received a diagnosis of sleepwalking and sleep terrors. The third group was made up of 15 healthy participants and served as the control group.
Of those in the sexsomnia group, the study found:
71 percent were men; 29 percent were women
47 percent had a history or current diagnosis of sleepwalking or sleep talking
12 percent experienced sleep terrors
Researchers noted that 35 percent of sexsomnia patients had no evidence of previous or current sleepwalking, sleep terrors, or sleep talking; none had any history of sexual abuse.
The average age of those with sexsomnia was 37, and the average age at onset of sexsomnia was 32.
Most patients experienced a single episode of sexsomnia per night — and this normally occurred in the first third of the evening. However, one in four patients reported two or more episodes within a single night, including during the morning hours. Three participants reported occasional episodes of sexsomnia during daytime naps.
Compared with healthy sleepers, those with sexsomnia:
Had a longer total sleep time
Experienced more frequent awakenings during the N3 (deep sleep) stage
Had a higher arousal index and a higher periodic leg movement index
Sexual behavior during sexsomnia episodes
Of those in the sexsomnia group, nearly one-half experienced amnestic masturbation or amnestic sexual intercourse, “amnestic” meaning they could not remember doing these things; 65 percent fondled their bed partner.
The study found that only three out of the 17 participants had any awareness of their behavior or any recall of their behavior in the morning.
Bed partners reported that their partners acted less inhibited and less gentle when sex occurred during a sexsomnia episode.
What triggers sexsomnia?
Two out of three participants in the sexsomnia group were able to identify factors they felt increased the frequency of sexsomnia episodes. These were:
Stressful daytime events
Evening alcohol consumption
Insufficient daytime sexual activity
Reuniting with a partner after a long trip
How common is sexsomnia?
Sexsomnia appears to be a rare disorder — but the fact that many sexsomnia episodes are not remembered may mean the disorder is more common than we think. The authors of this study suggested that rather than being a rarity, sexsomnia may simply be under-recognized.
Researchers pointed to a population-based survey in Norway that found seven percent of 1,000 adults had performed sexual acts during sleep in their lifetime (and almost 3 percent had done so in the past three months).
The lack of awareness surrounding sexsomnia is particularly concerning due to the very serious consequences associated with the disorder. Researchers found that the behaviors associated with sexsomnia led to 43 percent of sexsomnia patients committing a sexual assault.
How to treat sexsomnia
Although this study didn’t set out to investigate treatment options for sexsomnia, its authors claimed that paroxetine (a selective serotonin reuptake inhibitor) increased slow wave sleep, decreased awakenings, and may decrease erections. They also reported that clonazepam is the most widely used drug for parasomnias, including sexsomnia. It appears to be successful, but can come with side effects such as sleep-disordered breathing and next-day grogginess.
Researchers found that most sexsomnia episodes could be stopped if the bed partner did not respond or pushed the patient away. Therapy that includes counseling on factors that may cause sexsomnia (such as sleep deprivation, alcohol consumption, and lack of sex during the day) may also help.
If you think you may be experiencing sexsomnia, reach out to your health care provider for help.