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Sexsomnia: What sleep sex is.

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?

Man-sleeping-and-snoring-overhead-view

Sexsomnia is when a person enagages in sexual activity while sleeping.

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

Exhausted and tired doctor, stressed and anxious because of shift work.

Sleep deprivation, stress, and shift-work may all trigger sexsomnia.

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

Woman taking medication pills with glass of water.

Some medications may be recommended to treat sexsomnia, including mild sedatives and antidepressants.

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:

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.

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Top Five weird things you might do in your sleep

Have you ever woken up in the morning to the sight of a disgruntled partner, upset that you gave them a long speech in your sleep? This is one example of the many strange things we can do while we’re supposed to be oblivious to the world. Read on for our top five picks.

sleeping woman

What do you do while you are asleep?

Although it is not clear exactly how many people experience parasomnias, or sleep disorders, it is likely that you — or someone you know — have faced at least one such event at some point.

Parasomnias are often associated with unsettling actions or behaviors, made all the more strange for being acted out in a person’s sleep, while they are completely unconscious.

However, although some of the strange things that we do in our sleep may be connected with the presence of a sleep disorder, others are, in fact, normal physiological occurrences that are extremely common.

In this Spotlight, we look at five of the strangest things some people do while they’re fast asleep.

1. Sleep talking

Sleep talking, or somniloquy, is a common physiological phenomenon, and it is reportedly more frequent in children and adolescents, though it is not an unusual occurrence in adults.

As Shelly Weiss notes in the book Parasomnias, episodes of sleep talking don’t tend to last very long, and they don’t, in fact, always include intelligible speech.

Sleep talking is usually brief and infrequent, but can range from a person making a few sounds during sleep that are brief and unintelligible, to full phrases with understandable content or even frequent and long speeches which sound hostile or angry.”

A recent study conducted by Dr. Isabelle Arnulf of the Pitié-Salpêtrière Hospital in Paris, France, investigated what sleep talkers are likely to say, and found that, in 10 percent of cases, sleep speech is rich in swear words and negative content.

woman lying next to sleep talking man in bed

Scientists say that sleep talkers often swear and deliver angry speeches.

In fact, swear words featured 800 times more often during sleep discourse than they normally did in an individual’s daytime talk.

Dr. Arnulf notes that this may be because sleep talking likely occurs in response to a negative dream situation that makes such impulsive and unguarded speech excusable.

Weiss explains that sleep talking episodes can occur at any stage of sleep and that they are “only disturbing to others,” that is, to bed partners.

And I can confirm — my partner’s sleep talking episodes, in which he usually expresses distress, never fail to unsettle me. But since he never remembers these occurrences the morning after, they don’t bother him at all.

But there are, according to Weiss, external situations that “may precipitate” sleep talking, so if you know that you — or your loved one — are prone to this, then eliminating these factors may help.

They include feverishness due to illness, experiencing stress and anxiety during day-to-day life, lack of sleep, or living with a sleep disorder.

2. Sleepwalking

Sleepwalking, or somnambulism, is perhaps the best-known type of parasomnia, having captured people’s imaginations for years, and featuring prominently in literature and movies.

somnambulist concept illustration

Sleepwalkers may engage in complex and sometimes dangerous behaviors.

This sleep disorder usually takes place during the stage three non-rapid eye movement (NREM) sleep; this is a “deep sleep” period in which brainwaves slow down, and breathing also becomes deep and slow-paced.

People cannot be easily woken at this stage, which is partly what makes sleepwalking so unsettling, as the somnambulist is physically active while still emerged in a deep state of slumber.

But the weirdness does not stop here.

Specialists Frank Ralls and Madeleine Grigg-Damberger write in Parasomnias that sleepwalkers may appear concomitantly awake and “not there” to anyone witnessing their actions:

[Sleepwalking] episodes often begin with the individual sitting up in bed, fumbling with bedclothes, looking about in a confused manner before getting out of bed and slowly beginning to walk around. The eyes are usually open, often wide open with a confused ‘glassy’ stare…”

Frank Ralls, Madeleine Grigg-Damberger

They also add that “[t]he person often walks toward sound, light, or a particular room,” and they may engage in complex behaviors, such as changing clothes, opening doors, or using the bathroom.

Sleepwalking behaviors

A related sleepwalking disorder is that of sleep-related eating, in which individuals get out of bed, make their way to the fridge, and have a snack, all without actually waking up.

The eating behavior is usually compulsive, and the person could wake up the next morning to find a mountain of incriminating — and shocking — evidence, in the form of dirty wrappers and food containers, as in this case study.

There are, however, some sleepwalking behaviors that are much more dangerous than overeating. One such example is that of sleep driving, in which a person drives a motorized vehicle technically on autopilot, while fully unconscious of their actions.

Some scientists blame these episodes on a short-circuitry caused by certain sleeping aids, the so-called “z-drugs” — zolpidem and zopiclone — though it is not entirely clear to what extent these are at fault.

Sleep texting?

Though no scientific studies have yet been conducted to address this issue, apparently sleep texting is not uncommon, especially among adolescents.

Over the past few years, various media outlets have reported cases of teenagers embarrassed to find out they had sent text messages to their friends or their crushes while asleep.

One young woman told The Atlantic that she woke up one morning to find that she had made plans to see her ex-boyfriend, which she didn’t remember and immediately regretted.

Sleep specialists have declared that this is a new feature in terms of sleep disorders, and the behavior is not yet listed in specialized textbooks.

The specialists blame it largely on the fact that many teenagers have poor sleep hygiene, having become glued to their smartphones, texting away late into the night, and allowing notifications to disturb their slumber.

3. Sleep starts

Many of you are probably familiar with the phenomenon of sleep starts, or “hypnic jerks.”

concept image of floating woman

Sleep starts are usually accompanied by the sensation of falling from a great height.

These are characterized by a sensation of falling from a great height, or tripping, which causes the body to jerk and the sleeper to wake up — literally “with a start.”

Weiss notes that sleep starts “frequently occur in normal people and at any age,” with a prevalence of approximately 60–70 percent in adults; they are not considered a type of sleep disorder.

Typically, the muscle contractions last for less than 1 second, and they occur as a person is about to transition to a state of sleep, or during a stage of light sleep.

Some less common accompanying sensations listed by Weiss include “an auditory sound such as an utterance,” and the terrifying perception of a “loud bang or flash of light,” also known as “exploding head syndrome.”

Although sleep starts are a normal occurrence, scientists suggest that certain factors may increase their likelihood. According to Weiss, these include, “fatigue, emotional stress, sleep deprivation, vigorous exercise, and stimulants such as caffeine and nicotine.”

4. Sexual acts

couple sharing an intimate moment in bed

A few individuals engage in erotic behaviors during sleep, which may spell out trouble if they also involve a bed partner.

Some of the most controversial unconscious acts performed during sleep are those of a sexual nature, especially when the individual attempts to involve an unwitting co-sleeper.

These acts are characteristic of a parasomnia known as “sexsomnia,” in which individuals “display sexual vocalizations, masturbation, fondling, or intercourse/attempted intercourse during sleep — followed by morning amnesia.”

Similarly to sleepwalking, sexsomnia takes place during the NREM stages of sleep, and, according to a case report published last month, “only 95 clinical cases” have been documented until now. The report authors also add that most of these cases feature male sleepers.

In some cases, sexsomnia is just an embarrassing occurrence, but in other, more extreme examples, the sleepers can end up sexually assaulting a sleeping partner.

But due to the fact that they remain unconscious throughout these acts, and they cannot remember them the following morning, violent sexual acts committed during sleep remain deeply challenging when brought to court.

The authors of one case report note that, in the instance that they evaluated, the patient affected by sexsomnia managed to gain some control over these night-time occurrences by attending psychotherapy sessions targeting stress management.

5. Acting out dreams

Finally, the parasomnia known as rapid eye movement (REM) sleep behavior disorder is, much like sleepwalking, characterized by the performance of fairly complex actions while in a state of sleep.

agitated man in bed

Some individuals act out their dreams, often responding to violent or unsettling dream content.

However, there are also several differences between the two sleep disorders.

As its name suggests, REM sleep behavior disorder takes place during the REM stage of sleep, when most of the dreaming happens.

Individuals with this behavior disorder tend to “act out” or physically respond to whatever takes place in their dreams, which isn’t always great news.

As Sujay Kansagra and Bradley Vaughn write in Parasomnias, “Dream content is […] reported to become more violent with [REM sleep behavior disorder] onset, and involves the subject being attacked or having to defend a position or others.”

Kansagra and Vaughn also note that most individuals with this disorder are over 50 years of age, though its incidence and prevalence rates are unclear.

Such troubled sleepers may make chaotic movements that correspond to their dream content, but fortunately, they are not usually physically violent, either toward themselves or others.

However, violent behavior is more often present in men than it is in women with REM sleep behavior disorder.

This parasomnia can be induced by an individual’s first use of antidepressant medication, but stimulants such as alcohol, coffee, and chocolate can also be at fault.

Moreover, Kansagra and Vaughn point out that more than 50 percent of individuals with narcolepsy — another sleep-related disorder — also report the symptoms of REM sleep behavior disorder.

If you or someone you know live with a sleep disorder and would like to learn more about it and how to manage it, you may find it useful to access the webpages on “sleep and sleep disorders” curated by the Centers for Disease Control and Prevention (CDC).

We picked linked items based on the quality of products, and list the pros and cons of each to help you determine which will work best for you. We partner with some of the companies that sell these products, which means we may receive a portion of revenues if you make a purchase using a link(s) above.

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