Is Sexsomnia Complicating Your Life?

 
Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.

 
 
Diagnosis | Symptoms | Epidemiology | Causes | Comorbid Conditions | Evaluation | Management 

Overview

Sleep-related sexual behavior, known as sexsomnia, occurs during the non-rapid eye movement phase of sleep (NREM), and is considered a confusional arousal variant. 

If you’re affected by this condition, you will unconsciously and involuntarily indulge in abnormal sexual behaviors during sleep. ^[1] 

Masturbation, sexual intercourse, and loud sexual sounds are some of the unintentional actions you may display. 

Persons around you may notice you exhibiting these behaviors 1-2 hours after falling asleep.

Quite often, if you have sexsomnia, you’re likely affected by another condition that hinders your sleep. Treating comorbidities can significantly reduce these unwanted sexual behaviors. ^[2]

Diagnosis 

Sleep-related sexual behavior is a relatively new medical classification, and as such, no standard diagnostic criteria or process has been established for the condition.

However, your doctor may use the general guidelines provided by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) for diagnosis.

To be diagnosed with sleep-related sexual behavior, your doctor will ask you questions and conduct other assessments to determine if you experience any of the signs and symptoms listed below.

DSM-5 Criteria for NREM Sleep Arousal Disorders and Sexsomnia Subtype of Sleepwalking:

Criterion A. Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode, accompanied by sleepwalking

Criterion B. No or little dream imagery is recalled

Criterion C. Amnesia for the episodes is present

Criterion D. Clinically significant distress or impairment

Criterion E. Disturbance is not attributable to the effects of a substance

Criterion F. Coexisting mental or medical conditions do not explain the episodes

If you exhibit any combination of the criterion outlined in the DSM-D guideline, you may be diagnosed with NREM sleep arousal disorder, sleepwalking type, with sleep-related sexual behavior (sexsomnia). ^[3]

For clarification, confusional arousals and sleepwalking are NREM parasomnias, with sleepwalking episodes often starting out as confusional arousal. What distinguishes the two disorders is that the patient becomes ambulatory when they sleepwalk.

Symptoms

If you are affected by sexsomnia, you may engage in sexual behaviors, either with another person or alone. Here are the more common signs and symptoms that you may display:

• Actions that imitate sexual intercourse, like pelvic thrusting
• Initiating sexual intercourse (this is an unconscious act and can be with a partner, roommate, or friend)
• Nocturnal erection or vaginal wetness
• Sexually touching the person in bed with you
• Masturbation
• Not remembering these behaviors after enacting them and having an out-of-touch look in your eyes while engaging in these behaviors

It’s typical for you to be unaware that you’re exhibiting these symptoms because you’re not in a conscious state while performing them. Moreover, you will not remember even carrying out these behaviors.^[4]

So if someone witnesses you engaging in these actions during sleep, it’s encouraged that you take them to your appointment, as they can provide valuable information to help with your diagnosis.^[5]

Epidemiology

Because sexsomnia has still not been studied and reported as much as the other sleep-related disorders, the exact number of people it affects worldwide or even within the United States is unknown.

In the few papers written about sleep-related sexual behavior, its prevalence is estimated from the overall occurrence of all sleep-related conditions.

As such, sexsomnia is approximated to affect about 2-6 percent of adults.

Also, sleep-related sexual behavior affects younger male adults more frequently than any other group.

Furthermore, researchers determined that persons diagnosed with sexsomnia are typically affected by other sleep-related disorders. ^[6-7]

Causes

As earlier mentioned, there’s minimal research on sleep-related sexual behavior. Consequently, your doctor may have difficulty pinpointing the condition’s specific cause as it’s unclear what induces it.

However, over the years, medical professionals and researchers have been able to identify some possible causes of sexsomnia, such as:

• Anxiety
• Excessive and prolonged alcohol consumption
• Lack of sleep and disrupted sleep patterns
• Some medications (for anxiety and depression)
• Illicit drug use (e.g., cocaine)
• Increased stress
• Comorbidities, like obstructive sleep apnea ^[8-9]
  
  

Common Comorbid Conditions

There are several specific conditions typically found in patients with sleep-related sexual behavior. They are referred to as comorbidities and can even be contributors to your development of sexsomnia.

Often, these conditions adversely affect your sleep pattern and quality. Below is a list of illnesses and one or more may be affecting you. 

•      Obstructive Sleep Apnea (OSA) – During sleep, your breathing may pause involuntarily for short periods, which is a typical symptom of OSA
•      Sleep Talking or Sleepwalking: With these conditions, you will carry out activities as though you are awake 
•      Migraines: Affected nighttime sleep causes insomnia and other sleep-related disorders ^[10]
•      Head Injuries: 30–70 percent of people affected by traumatic brain injury experience sleep disorders ^[11] 
  
  

Evaluation

To diagnose any sleep-related disorder, your doctor conducts a series of tests, including looking at the history of your health status to requesting that you keep a sleep diary. 

At this point, the persons around you who witness your sleep-related sexual behaviors are helpful. You can take them with you to your doctor’s appointment or have them write down what they’ve seen. 

A video-recorded sleep study that tracks your heart rate, brain waves, breathing patterns and other movements is often used. This test is called polysomnography. Typically, you stay overnight in a sleep center for this test.^[12]

Management

Episodes of sexsomnia can result in distress, affecting sleep during the night, and causing you to become extremely sleepy in the daytime. It may also cause you to injure yourself, your bed partner, and others who are within your environment. 

Your doctor’s approach to treatment is dependent on the suspected cause of the sleep-related sexual behavior. Additionally, treating the root cause is always the ideal and efficient way of managing a condition.

In one study, researchers used a mandibular advancement device (a device that opens the airway by moving the lower jaw forward) to treat the underlying cause, obstructive sleep apnea, which led to the cessation of sexsomnia-related events.^[13]

Sleep hygiene is another treatment modality often encouraged. It involves practices that induce sleep, such as making your bedroom dark, silent, and relaxing, as well as keeping tablets, computers, and smartphones in another room. However, data is unavailable regarding the effectiveness of this treatment option for sexsomnia.

Medication is generally used to target causes, like anxiety and migraine. Cognitive-behavioral treatment for insomnia and mindfulness-based stress reduction programs are ideal for treating sleep-related sexual behavior, as indicated by one study that examined NREM parasomnias: a treatment approach based on a retrospective case series of 512 patients.^[14]

Conclusion 

While sleep-related sexual behavior is a relatively newly identified condition, it shouldn’t be taken lightly. Sexsomnia can affect your job productivity and destroy your relationship with friends and family. 

Additionally, it is usually an indication of another condition. Therefore, we strongly urge you to seek medical attention for early diagnosis and treatment. 

Also, don’t despair if you are diagnosed with sexsomnia, as there are management modalities available to provide you with appropriate treatment.

References 

1. Marca, G. D., Dittoni, S., Frusciante, R., Colicchio, S., Losurdo, A., Testani, E., Buccarella, C., Modoni, A., Mazza, S., Mennuni, G. F., Mariotti, P., & Vollono, C. (2009). Abnormal Sexual Behavior During Sleep. The Journal of Sexual Medicine, 6(12), 3490–3495. https://doi.org/10.1111/j.1743-6109.2009.01371.x
2. Proserpio, P., Cossu, M., Francione, S., Gozzo, F., Lo Russo, G., Mai, R., Moscato, A., Schiariti, M., Sartori, I., Tassi, L., & Nobili, L. (2011). Epileptic motor behaviors during sleep: Anatomo-electro-clinical features. Sleep Medicine, 12, S33–S38. https://doi.org/10.1016/j.sleep.2011.10.018
3. Holoyda, B. J., Sorrentino, R. M., Mohebbi, A., Fernando, A. T., & Friedman, S. H. (2021). Forensic Evaluation of Sexsomnia. The journal of the American Academy of Psychiatry and the Law, 49(2), 202–210. https://doi.org/10.29158/JAAPL.200077-20
4. Ariño, H., Iranzo, A., Gaig, C., & Santamaria, J. (2014). Sexsomnia: Parasomnia associated with sexual behaviour during sleep. Neurología (English Edition), 29(3), 146–152. https://doi.org/10.1016/j.nrleng.2013.01.003
5. Khawaja, I. S., Hurwitz, T. D., & Schenck, C. H. (2017). Sleep-Related Abnormal Sexual Behaviors (Sexsomnia) Successfully Treated With a Mandibular Advancement Device: A Case Report. Journal of Clinical Sleep Medicine, 13(04), 627–628. https://doi.org/10.5664/jcsm.6560
6. Muza, R., Lawrence, M., & Drakatos, P. (2016). The reality of sexsomnia. Current Opinion in Pulmonary Medicine, 22(6), 576–582. https://doi.org/10.1097/mcp.0000000000000321
7. Martynowicz, H., Smardz, J., Wieczorek, T., Mazur, G., Poreba, R., Skomro, R., Zietek, M., Wojakowska, A., Michalek, M., & Wieckiewicz, M. (2018). The Co-Occurrence of Sexsomnia, Sleep Bruxism and Other Sleep Disorders. Journal of Clinical Medicine, 7(9), 233. https://doi.org/10.3390/jcm7090233
8. Bollu, P. C., Goyal, M. K., Thakkar, M. M., & Sahota, P. (2018). Sleep Medicine: Parasomnias. Missouri Medicine, 115(2), 169–175. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139852/
9. Viola-Saltzman, M., & Watson, N. F. (2012). Traumatic Brain Injury and Sleep Disorders. Neurologic Clinics, 30(4), 1299–1312. https://doi.org/10.1016/j.ncl.2012.08.008
10. Béjot, Y., Juenet, N., Garrouty, R., Maltaverne, D., Nicolleau, L., Giroud, M., & Didi-Roy, R. (2010). Sexsomnia: An uncommon variety of parasomnia. Clinical Neurology and Neurosurgery, 112(1), 72–75. https://doi.org/10.1016/j.clineuro.2009.08.026
11. Messina, A., Bitetti, I., Precenzano, F., Iacono, D., Messina, G., Roccella, M., Parisi, L., Salerno, M., Valenzano, A., Maltese, A., Salerno, M., Sessa, F., Albano, G. D., Marotta, R., Villano, I., Marsala, G., Zammit, C., Lavano, F., Monda, M., & Cibelli, G. (2018). Non-Rapid Eye Movement Sleep Parasomnias and Migraine: A Role of Orexinergic Projections. Frontiers in Neurology, 9. https://doi.org/10.3389/fneur.2018.00095
12. Berry RB, Quan SF, Abreu AR, et al for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.6, www.aasmnet.org, American Academy of Sleep Medicine, Darien, IL 2020. no abstract available
13. Meira e Cruz, M., & Soca, R. (2016). Sexsomnia and REM- predominant obstructive sleep apnea effectively treated with a mandibular advancement device. Sleep Science, 9(3), 140–141. https://doi.org/10.1016/j.slsci.2016.11.002
14. Drakatos, P., Marples, L., Muza, R., Higgins, S., Gildeh, N., Macavei, R., Dongol, E. M., Nesbitt, A., Rosenzweig, I., Lyons, E., d’Ancona, G., Steier, J., Williams, A. J., Kent, B. D., & Leschziner, G. (2019). NREM parasomnias: a treatment approach based upon a retrospective case series of 512 patients. Sleep Medicine, 53, 181–188. https://doi.org/10.1016/j.sleep.2018.03.021