What is Sexsomnia?
Sexsomnia, sometimes called sleep-related sexual behavior, involves episodes in which a person engages in sexual activity, alone or with another person, while asleep.
Sexsomnia behavior typically occurs during the deepest type of sleep, called phase III sleep. This phase usually occurs relatively early in the sleep period, typically within two hours of first falling asleep. Sleep disorders that happen during this period of sleep are called non-rapid-eye-movement (NREM) sleep disorders. Other NREM disorders include sleepwalking and sleep terrors.
Although people exhibiting the behavior may appear to be awake, they typically will not truly wake up during the episode. They will sometimes fall into a deep sleep after the incident (which may last several minutes), or they may wake during or after the incident. They are usually confused if they are awakened during an episode and generally have no memory of the event the next day.
Symptoms of Sexsomnia
Sexsomnic behaviors include performing sexual acts while asleep. Common symptoms of sexsomnia include:
- Engaging in sexual activity, including intercourse, with another person
- Fondling or sexually touching themselves or another person
- Making sex-related movements (e.g., pelvic thrusting)
- Making sex-related vocalizations
- Having an orgasm while asleep
- Acting more sexually aggressive or uninhibited than they would while awake
- Failing to acknowledge or respond to other people
- Appearing dazed or glassy-eyed
- Resisting being woken up
- Being confused if woken during the episode
- Not remembering the episode the next day
- Fatigue during the day caused by sleep disturbances
Potential Dangers of Sexsomnia
Sexsomnia is problematic because it often involves a person engaging in sexual activity with another person without that person’s consent. In some cases, the person experiencing the behavior may act aggressively or violently. Because of this, sexsomnic behavior can be a form of sexual assault and can result in legal trouble for someone with the disorder.
Sexsomnia as a diagnosis is controversial because it is sometimes used as a legal defense in sexual assault cases. This makes it imperative that mental health professionals understand the disorder and accurately diagnose it.
What Causes Sexsomnia?
The exact cause of sexsomnia and other NREM disorders is unknown, but they are sometimes associated with medical conditions, stress, and other external situations.
Some potential risk factors for sexsomnia include:
- Lack of adequate sleep
- Bad sleep environment (e.g., an unfamiliar place or one that is too noisy or bright)
- Ongoing emotional stress or anxiety
- Digestive issues
- Sleep apnea
- Other sleep disorders
- Alcohol use
- Sedative medications
- Restless legs syndrome
Is Sexsomnia Hereditary?
Research suggests a strong genetic component to the sleep disorders commonly associated with sexsomnia, including sleepwalking. Most people with sexsomnia also have a history of sleepwalking, sleep talking, or sleep terrors. The disorders often run in families. When a parent has experienced sleepwalking, almost half the time, their children will also sleepwalk. If both parents are sleepwalkers, their children will also be sleepwalkers nearly two-thirds of the time.
Scientists have not yet identified a gene or genetic mutation specifically associated with sexsomnia. Likely, some people are genetically predisposed to experiencing the disorder, but some external environmental factor usually triggers the terrors.
How Is Sexsomnia Detected?
Sexsomnia often affects young men, and some men with the disorder report having experienced sexsomnic episodes for many years before they were diagnosed. Early detection of the disorder may be difficult, especially in people who sleep alone, because the person experiencing the behavior generally doesn’t remember it in the morning, leaving it up to other people to notice the symptoms.
How Is Sexsomnia Diagnosed?
Doctors may take several different diagnostic steps when a patient is experiencing sexsomnia.
- Physical exam. A basic physical exam will screen for indications of medical conditions that could be causing the episodes.
- Blood tests. The doctor may order laboratory blood tests to rule out conditions, such as thyroid dysfunction, that may be causing the problems.
- Sleep diary. Your doctor may ask you to keep a log of your sleep over two weeks or so to look for patterns in your sleep behavior. You may also be asked to track other habits impacting your sleep, such as caffeine use.
- Sleep study. A study of your sleep patterns, which may be conducted at a sleep center, may be recommended if your doctor suspects that a condition such as sleep apnea could cause your sexsomnia.
If a doctor suspects that sexsomnia is the cause of the symptoms, they may refer the patient to a psychologist or psychiatrist. A mental health professional may diagnose the disorder using the criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.
How Is Sexsomnia Treated?
Common treatments for sexsomnia include:
- Education on sleep hygiene
- Stress management techniques
- Psychotherapy (especially in cases that result in legal charges)
- Reduction of risk to sleeping partners (e.g., sleeping separately and locking bedroom doors)
In some cases that do not respond to other interventions, doctors may recommend medications such as sedatives or antidepressants.
People who experience sexsomnic episodes can take steps to minimize the likelihood of episodes and prevent potentially harmful situations during them.
- Practice good sleep hygiene, including maintaining a regular sleep schedule and keeping a sleep space conducive to a good night’s sleep.
- Avoid alcohol and drug use.
- Take steps to minimize sources of stress or anxiety.
How Does Sexsomnia Progress?
Sexsomnia can lead to a wide variety of medical problems, quality-of-life complications, and mental health-related issues, including:
- Harm to others, including spouses and partners
- Legal jeopardy for the person experiencing sexsomnia
- Problems at work or school
- Relationship difficulties
- Anxiety or depression
How Is Sexsomnia Prevented?
Good sleep habits and a healthy lifestyle can help prevent sexsomnia and other sleep disorders. Steps you can take to ensure better sleep include:
- Stick to a regular sleep schedule (even on weekends)
- Don’t eat or drink close to bedtime
- Avoid stimulating activities (e.g., watching TV, using electronics) 30 minutes before bedtime
- Use your bedroom only for sleep
- Keep your bedroom dark and cool
- Get plenty of exercise
- Limit consumption of caffeine and alcohol
- Quit smoking
- Don’t take naps
- Try meditation or relaxation techniques
Sexsomnia Caregiver Tips
Some people who sleepwalk also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with sleepwalking:
- Depression is more common in adults with NREM sleep disorders.
- Anxiety disorders are also sometimes co-morbid with sexsomnia in adults.
- People with substance use disorders may be at increased risk of sexsomnia.
Sexsomnia Brain Science
Sexsomnic behaviors usually occur when a person is transitioning to deep sleep. Scientists believe that the episodes result from a mixed state in which parts of the brain are asleep and others are awake. In the case of sexsomnia, it’s possible that parts of the brain that control rational thought and memory, such as the neocortex and the hippocampus, are asleep, and the parts responsible for muscle movements and physical activity are awake.
The mixed-state theory helps explain why people generally don’t remember their sexsomnic episodes. During rapid eye movement (REM) sleep, the brain’s higher-level functions are more active, allowing for the creation of memories and vivid dream narratives. However, those parts of the brain are less active during the deep-sleep periods when sexsomnic episodes usually occur, resulting in the episodes leaving no lasting memory.
Title: Targeted Intervention for Insufficient Sleep Among Typically-Developing Adolescents (TAPAS)
Principal investigator: Jessica C. Levenson, PhD
University of Pittsburgh
Dr. Levenson’s research proposal aims to test the acceptability, feasibility, and preliminary outcomes of a sleep promotion program delivered to 13-15-year-olds who report insufficient sleep. First, Dr. Levenson will examine the feasibility and acceptability of the program through a randomized pilot trial (n=40) that uses a two-period, wait-list control design. Then, Dr. Levenson will test whether the program is associated with changes in sleep, motivation, and four outcome domains: academic functioning, attention, risk behavior, and affect. Such a broadly relevant program has the potential for enormous public health impact by improving sleep and facilitating healthy development across a range of domains among typically-developing adolescents who are highly vulnerable to adverse consequences.
This study has two sub-studies: one for youth who experience behaviorally insufficient sleep syndrome (BISS) and one for youth who obtain sufficient sleep. This includes a randomized controlled trial for youth who get insufficient sleep (BISS), and a universal education (UE) only intervention for youth who obtain sufficient sleep.
All participants will complete a pre-consent screen. Those with sufficient sleep will complete consent/assent and a full screening assessment, and they will watch a sleep education video (UE). If eligible for the sufficient sleeper study, the full screening assessment will also serve as a baseline assessment. Participants will complete a follow-up assessment about one month later.
Those who pre-screen as insufficient sleepers will complete consent/assent, complete a full screening process, and watch a sleep education video (UE). Those who remain eligible after the full screening process will complete a baseline assessment. Then, youth will be randomized to the TAPAS intervention or a wait-list control (monitoring only). After completing the post-period 1 follow-up assessment, those in the wait-list control group will switch to the other arm, via a cross-over design. Participants in the intervention-first group will continue to receive the intervention in Period 2 after post-period 1. After this period, participants will complete the post-period 2 follow-up assessment.
Title: Feasibility Study of Personalized Trials to Improve Sleep Quality
Stage: Not Yet Recruiting
Principal investigator: Karina Davidson, PhD, MASc
New Hyde Park, NY
This pilot study aims to assess the feasibility of using N-of-1 methods in a virtual research study of melatonin intervention for poor sleep quality. Participants (N=60) will be sent a Fitbit device and three smart pill bottles, with one containing 3 mg of melatonin, one containing 0.5 mg of melatonin, and the final bottle containing a placebo pill. The first two weeks will be a baseline period, where no supplement is assigned, but data are collected, including self-report of sleep quality and duration and accelerometer-derived sleep and activity data. After successfully completing the baseline period, participants will be randomized to six 2-week intervention blocks of a 3 mg dose of melatonin, a 0.5 mg dose of melatonin, and a placebo. At the end of the trial, participants will be asked to complete the System Usability Scale, a satisfaction survey (electronic or phone/video call if they are non-responders), and participate in a virtual interview (such as over Microsoft Teams or a phone call) to inform feasibility and acceptability of protocol requirements, study materials, and personalized reports.
Title: Telehealth Delivery of Treatment for Sleep Disturbances in Young Children With Autism Spectrum Disorder
Principal investigator: Cynthia Johnson, PhD
The Cleveland Clinic
Ninety children with Autism Spectrum Disorder (ASD), between the ages of 2 to less than 7, and their parents will be recruited for this ten-week randomized clinical trial. Participants will be randomized to five individually delivered sessions of Sleep Parent Training (SPT) or five individually delivered sessions of Sleep Parent Education (SPE). The programs will be delivered via a telehealth platform that includes parent-child coaching in real-time. In addition to baseline, outcome measures will be collected at week 5 (midpoint of trial) and week 10 (endpoint of trial), as well as follow-up at week 16, to determine the durability of the treatment.
This study will deliver an already initially tested manualized parent training program especially targeting bedtime and sleep disturbances, but delivered via a telehealth platform and enhancing the program using live parent coaching at bedtime. Utilizing REDCap automated survey invitations feature, investigators will provide reminders of the intervention recommendations and data collection requirements. In a randomized clinical trial of 90 children with ASD, ages 2 to less than seven years, a parent training program targeting sleep disturbance (Sleep Parent Training; SPT) will be compared to Sleep Parent Education (SPE). The investigators hypothesize that SPT will be superior in improving child sleep, child daytime functioning as well as parent well-being compared to SPE.