What is sexsomnia?

Sleep sex, also called sexsomnia is more common than people think.

There are many types of behaviours people can have during sleep. Some people sleep walk, others sleep talk. For some the behaviour has a sexual nature. It can be self-stimulation or trying to initiate sex with others whilst asleep. Whilst this may seem funny, and I’ve seen it joked about in the media, for those who have sexualised behaviours during sleep it can cause significant stress and worry about what might happen when they go to sleep. If their behaviour is misunderstood, or happens when sharing a house or bed with others, it can have legal consequences.

Why does sexsomnia occur?

Parasomnias that arise out of non-REM such as sleep walking, sleep talking and sleep sex occur via similar mechanisms. The brain doesn’t sleep as a single unit, and different parts of the brain can behave as if they are partially awake at times through the night. This is what happens with non-REM parasomnias. For a parasomnia to occur, there needs to be activation of the more primitive parts of the brain, such as the brain stem and parts that control automatic responses and behaviours, whilst other parts of the brain, such as the cerebral cortex remain deactivated. This results in someone having active muscles and being able to respond to simple inputs or questions, so they can carry out simple, basic or automatic behaviours, but not being conscious or having any recollection of what has happened.

Why some people walk whereas others have sexualised behaviours is not clear. It doesn’t appear to be a reflection of people’s underlying personality or true wishes, as sexualised behaviours during sleep occur in a range of people including those who are not usually sexually active. There is still a lot more research to be done in this area, as we don’t really understand why some people can have sexualised behaviours during sleep whereas others don’t.

What makes sexsomnia more likely to occur?

Non-REM parasomnias such as sexsomnia are usually made worse by 3 factors, 2 that increase sedation of the cortex (sleep deprivation and alcohol), and 1 that increases activation of the brain stem or arousal system (stress):

• Sleep deprivation – the more tired people are, the more likely parasomnias are to occur. I see some people who very predictably develop parasomnias during busy work periods or coming up to exams
• Alcohol or other sedatives – alcohol and other sedatives including some prescription medications and illicit substances such as marijuana can increase the risk of parasomnias. Alcohol has the effect of sedating the cerebral cortex and also activating the brain stem, which is the mechanism via which parasomnias occur.
• Stress – stress can increase the risk of parasomnias occurring. Often stress and sleep deprivation occur together, with work or study deadlines, and this combination can bring out parasomnias.

Once sexsomnia starts to cause problems such as disturbing a partner or causing stress in a relationship, people can be anxious or fearful of it continuing to occur. This increases the likelihood of it occurring more, so people can get in to a vicious cycle of escalating trouble with sexsomnia, which often is the trigger for them to get help and see a sleep specialist.

How is sexsomnia managed?

Reducing the likelihood of sexsomnia occurring and reducing it’s impact if it does occur requires a multi-pronged approach:

• Manage trigger factors – As sexsomnia can be triggered or made more frequent by trigger factors such as being sleep deprived, stress and sedatives such as alcohol, medications or drugs it’s important to manage these as best as possible. I’ll often enlist the help of a psychologist to help up-skill people in stress management techniques
• Look for and treat co-existent sleep disorders – As disturbed or fragmented sleep is one of the common associated features of sexsomnia it’s important to look at sleep quality. This is usually done with a clinical interview with a sleep specialist and measurement of sleep using a sleep study (polysomnography). If there is a sleep disorder present, such as insomnia, restless legs syndrome, sleep apnea or a circadian rhythm disorder treating that will often reduce symptoms of sexsomnia.
• Use of medication – benzodiazepines, such as clonazepam, can be very effective in reducing sexsomnia. Other medications can also be used such as temazepam or zolpidem. However, none of these medications can be taken with alcohol. This means people with sexsomnia are at particular risk when drinking alcohol, as it can make sexsomnia more likely to occur and they are not able to take medication to reduce it.
• Relationship counselling – Because of the nature of sexsomnia it can cause difficulties in relationships. If the behaviour is self-stimulation, partners can be disturbed by it or be concerned that it’s happening because of unsatisfied needs within the relationship. If the behaviour is initiating sex, partners can understandably feel intimidated or violated and working with a psychologist or counsellor can help.

If you have sexsomnia, it’s worth seeing a health professional like a sleep physician to look at factors that may be increasing the risk of events occurring and what can be done to reduce that risk.

Legal aspects of sexsomnia

I often get asked to provide expert opinions for court in cases where the defence is claiming that sexsomnia occurred. To say this is a controversial area is an understatement. It’s not just controversial legally, but also medically, as there are no ways of proving whether or not a particular episode was sexsomnia or not. So it usually comes down to legal debate and the accounts of the people involved as to what happened rather than medical evidence. There are a range of opinions as shown in the links below giving a few different perspectives.

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