Now available on
Amazon Kindle
Sexsomnia (Sleep Sex)
Lawrence Martin, M.D.
Clinical Professor of Medicine
Case Western Reserve University School of Medicine, Cleveland
Board Certified in Pulmonary and Sleep Medicine
Sleep Home Page /
Internet Sleep Links /
Books about sleep disorders (with links to Amazon.com) /
Drugs for Sleep & Awake /
Index of Dr. Martin's web sites
What is sexsomnia?
It is a parasomnia, similar to sleep walking,
where people commit sexual acts while while sleeping or during an
arousal from sleep. The perpetrator is not aware of his/her sexual
aggression.
The International Classification of Sleep Disorders, 2nd Edition,
states that parasomnias are "undesirable physical events or experiences
that occur during entry into sleep, within sleep or during arousals from
sleep...."basic drive states" can emerge in pathologic forms with the
parasomnias, as seen with sleep related aggression and locomotion, sleep related
eating disorder, and abnormal sleep related sexual behaviors [sexsomnia]." Note
that "arousals from sleep" in the definition of parasomnia means the subject is
still not awake and that the behavior displayed is automatic.
The ICSD
goes on to state that "Parasomnias often involve complex, seemingly purposeful,
and goal-directed behaviors, which presumably are performed with some personal
meaning to the individual at the time, despite the illogical and unsound nature
of the behaviors enacted outside the conscious awareness of the individual...Parasomnias
involve sleep related behaviors and experiences over which there is no
conscious deliberate control." (Italics added).
Sleep walking is the best example of this type of
parasomnia; sexsomnia and sleep eating are two other examples,
each much less common than sleep walking. Even rarer is the
parasomnia where sleep walkers have turned violent and
killed other people -
sleep murder. All these activities - simple sleep walking,
sleep walking with aggression,
sleep sex and sleep eating - are well-documented manifestations of abnormal
behavior while sleeping.
Does sexsomnia involve just intercourse, or any type of sex?
Any sexual activity.
A comprehensive literature review
published in 2007 indentified all the different types of sexual activity that
have been described while sleeping, including: sexual vocalizations/talking/
shouting, masturbation, fondling another person, sexual intercourse with and
without orgasm, and agitated/assaultive behaviors. "Females almost exclusively
engaged in masturbation and sexual vocalizations, whereas males commonly
engaged in sexual fondling and sexual intercourese with females." The authors
identifed 2 cases of sleep related homosexual behavior.
Do people who have "sleep sex" with another person remember the act
once they are awake?
No. This is characteristic of the parasomnia.
There is no memory of the event by the perpetrator. The victim relates
what happened.
How is the diagnosis made?
Like sleep walking,
sexsomnia is thought to occur during non-REM "deep sleep."
This is the same stage in which sleep walking and sleep
eating occur. (The other major stage, REM sleep, is where most
dreams occur, but not this type of parasomnia.) However, almost
all cases are based on the history provided by the victim of the sexual
aggression, and the perpetrator's assertion that he (or she, in some cases)
was sleeping and completely unaware of the act. There are a few cases
studied in the sleep lab, where brain waves prove the subject was sleeping
while becoming sexually aggressive.
Is sexsomnia a new condition?
It is a newly recognized condition,
only since the mid 1990s. The first paper was apparently
published in 1996 in Canada, by Drs. Colin Shapiro,
Nik Trajanovic and Paul Fedoroff. (All references
are listed below). A more recent and definitive medical
publication is "Sexsomnia: a new parasomnia?"
published in Canadian Journal of Psychiatry, June 2003.
In 2007 Dr. Carlos Schenck and colleagues published a
comprehensive literature review in the journal Sleep.
Is the public aware of this condition?
Not nearly as well as sleep walking,
about which everyone is aware to some extent.
The perpetrators are also unaware that they
could be 'having sex' while asleep.
According to information on
sleepsex.org,
"when one discovers their own [sexual aggression],
usually after being informed about
their behavior by a bed partner, they themselves
are unlikely to believe that could behave in such
a fashion. Often this is a source of conflict in
couples as it is embarrassing to accept it as fact.
Even when...a person complains he/she has been
fondled, etc. (by a person who clearly appeared
to be asleep) to a friend or health care provider
in an attempt to try to get some support and
to encourage their partner to treat his/her
[sexsomnia], these persons
cannot expect others to believe that they have
experienced unwanted
sexual contact initiated by a sleeping individual."
Is it a real problem? Don't people who sleep
together usually have sex?
For a small number of people and
their victims/partners, yes, it can be
a major problem. Undoubtedly many cases of
sexsomnia are unreported because they occur
between husband and wife, and are dealt
with internally, ie, without anyone outside the home aware of
the situation. But several cases have come forward that
show people can be harmed by the activity (see
Wikipedia article on Sleep Sex). The review
article mentioned above,
Sleep and Sex: What can go wrong?, notes that
"Forensic consequences were common, occurring
in 35.5% (11/31) of parasomnia cases, with most (9/11) involving
minors."
Is there treatment?
Yes, the same types of therapy used
to treat other parasomnias, like sleep walking
and sleep eating. They include
drugs and psychotherapy, plus avoiding
precipitating factors and ensuring a safe environment.
The medication type commonly used for treating parasomnias
are benzodiazepines, such as Valium (diazepam) or
Ativan (lorazepam). About half of the subjects
with sexsomnia have some significant
psychological problem (eg, anxiety stress disorder),
so treatment of this is essential as well.
Precipitating factors could be alcohol or
drugs taken for sleep, such as Ambien and Lunesta,
so a detailed history is vital to uncover and then
exclude what might be causing the problem.
As to environment, sleep walkers (who may or may
not have sexsomnia) can hurt themselves if there
are open bedroom windowns, stairs without gates or
nearby bodies of water. Closing off these areas
can help ensure a safe environment.
Finally, there may be co-existing sleep problems that
need treatment. Dr. Carlos Schenck, a pioneer in
this field, discusses a case of sexsomnia that
coexisted with obstructive sleep
apnea (OSA) in a 32 year old man (in
Casebook of Sleep Medicine, full reference below).
The OSA was causing 'confusional
arousals', which led him to sexually molest his wife almost every night,
and this was causing her great distress. He had no memory of
this activity, and the marriage was otherwise sound,
with no problems. Treatment of his OSA with CPAP effectively
treated the sexsomnia.
Has sexsomnia appeared in the lay media?
According to the
Wikipedia article on sleep sex, over the past
several years articles have appeared in
Cosmopolitan, Redbook, Details, Newsweek. Wikipedia also
mentions the following fictional cases that have been produced:
Where can I get more information about sexsomnia?
Books
Dr. Michael Mangan, a psychologist, has both a web site
(sleepsex.org) and a book
on the subject. His book is
Sleepsex: Uncovered,
Xlibris, 2001. From the publisher’s blurb on Amazon.com:
Sleepsex: Uncovered
is the first book to be published on sexual behavior that
occurs during sleep, sheds light on questions such as,
"How many people have sleepsex?"
What causes it?" What
be done about it if
it is a problem?""What are the legal implications of sleepsex?"
In plain language, Dr. Mangan summarizes what
sleep experts have written on sleepsex, and
provides a detailed and thoughtful analysis of over
60 persons´ first-hand experiences with sleepsex.
The following two books are comprehensive reviews of all of
sleep medicine, and discuss sexsomnia only briefly. The ICSD 2nd edition
includes sexsomnia in the section on parasomnias, portions of which are
quoted above. The Casebook presents a single case, discussed in detail (and
mentioned above), by Dr. Carlos Schenck at the University of Minn.
Dr. Schenck is a psychiatrist who has perhaps done the
most research on this diagnosis (see especially his 2007
review article, below).
The International Classification of Sleep Disorders, 2nd Edition.
American Academy of Sleep Medicine, Westchester, IL, 2005.
Casebook of Sleep Medicine. A learning companion to the ICSD.
American Academy of Sleep Medicine, Westchester, IL, 2008.
Web sites
Medical articles (in order of publication)
Shapiro CM, Fedoroff JP, Trajanovic N. Sexual
behavior in sleep: A newly described parasomnia. Sleep Research 1996;25:367.
Rosenfeld DS, Elhajjar AJ. Sleepsex: A variant of
sleepwalking. Archives of Sexual Behavior,
1998;27(3), 269-278.
Guilleminault C, Moscovitch A, Yuen K,
Poyares D.
Atypical sexual behavior during sleep.
Psychosom Med 2002;64:328-36.
Shapiro, CM, Trajanovic N, Fedoroff JP. Sexsomnia: A new parasomnia?
Canadian Journal of Psychiatry 2003;48:311-317.
Mangan MA.
A phenomenology of
problematic sexual behavior occurring in sleep.
Archives of Sexual Behavior,
2004;33(3), 287-93.
Schenck CH, Mahowald MW.
Rapid eye movement and non-REM sleep parasomnias.
Primary Psychiatry, 2005;12(8), 67-74.
Schenck CH. Uncontrolled intimacy: sexual sleep
disorders [case report]. Sleep Review 2007;8:24-28.
Mangan MA, Reips UD. Sleep, sex and
the Web. Behav Res Methods 2007;39:233-36.
Schenck CH, Arnulf I, Mahowald MW.
Sleep and sex: what can
go wrong? A review of the literature on sleep related disorders
and abnormal sexual behaviors and experiences. Sleep
2007;30:683-702.
-- A case of sexsomnia is in the episode "Role Model"
of the television series House, Season 1 Episode 17.
-- An episode of Law and Order: Special Victims Unit
(season 9, episode 2, aired October 2, 2007) called Avatar
featured a suspect with this disorder.
-- In Ralph Ellison's novel Invisible Man,
a farmer claims to have had sex
with his daughter while asleep (the novel was written in 1953,
decades before the condition was described).
sleepsex.org
Wikipedia article on sleep sex
Live Science: Have Sex While You Sleep
Discussion of treatment
Australian woman reported sleepwalking and having sex with strangers
Sleep Home Page /
Internet Sleep Links /
Books about sleep disorders (with links to Amazon.com) /
Drugs for Sleep & Awake /
Index of Dr. Martin's web sites
Forward any comments to:
drlarry437@gmail.com
Copyright © 2008-2012, Lawrence Martin, M.D.