Symptoms of Sexsomnia

Sexsomnia is a complex, atypical, and underreported parasomnia that is characterized by sexual behavior during sleep. Unlike other parasomnias, like REM sleep behavior disorder (RBD) and sleep paralysis (which also happens during REM sleep), sexsomnia occurs specifically during non-REM sleep. Once awake, a person generally has no recollection of the event that occurred.

Sexsomnia has led to clinical, interpersonal, and even legal consequences for those dealing with it. Discover how this condition affects individuals and how it can be diagnosed and treated.

What Are Parasomnias?

Parasomnias are sleep disorders that are characterized by abnormal behaviors or events during sleep. These behaviors, emotions, perceptions, or dreams occur unconsciously, but may be semi-purposeful, goal-oriented, or might have some meaning or importance to the person experiencing them.

Parasomnias can happen at any stage during sleep. For parasomnias that occur during REM sleep, actions and verbalizations might reflect the dream the person is having and eventually wake them up. Usually, the individual can recall their dream and their behavior. On the other hand, sexsomnia occurs during non-REM sleep.

During non-REM sleep parasomnias, after an event, the sleeper usually goes back to sleep and does not recall their behaviors. Other non-REM parasomnias include sleepwalking, sleep-related driving, and sleep-related eating disorders.

Signs and Symptoms of Sexsomnia

Sexsomnia presents differently from case to case. Common behaviors include:

• Moaning
• Vocalizations
• Dirty talk
• Masturbation
• Sexual fondling
• Sexual intercourse

These behaviors can be directed towards someone else, and in some cases, sexsomnia episodes have been reported as violent, harmful, and aggressive.

Sexsomnia events can lead to physical consequences, like genital bruising or lacerations, for both the person experiencing the episode and their bed partner. Sexsomnia can also have psycho-social consequences like shame, guilt, and depression. Some cases have resulted in the separation of partners or the necessity for individuals to distance themselves from the person dealing with sexsomnia.

Causes

The exact causes of sexsomnia are yet to be identified. Sexsomnia is less commonly described and reported, which could be a factor contributing to its mystery. Sexsomnia could also be an idiopathic parasomnia that arises spontaneously without any specified neurological dispositions.

Sexsomnia has been reported to be associated with some of the following characteristics:

• A history of parasomnias. Several individuals dealing with sexsomnia have also reported having a history of other parasomnias. A common parasomnia reported is sleepwalking. 
• Sleep fragmentation. Some cases report patients dealing with other sleep disorders like obstructive sleep apnea (OSA) and restless legs syndrome (RLS), which could cause arousal from non-REM sleep and cause partial awakening and automatic behaviors.
• Sleep deprivation.
• A history of substance abuse.
• A history of trauma or abuse.
• A history of depression.
• Use of sleeping pills. People have reported abnormal sleep-related behaviors, including sexsomnia, while using sleeping pills like Ambien.

Diagnosis and Treatment

The diagnosis of sexsomnia is completed by an overnight sleep study held at a sleep center. During the study, an electroencephalogram (EEG) is used to test brain activity in order to rule out possible seizures, and the remaining measures of the nocturnal polysomnogram (PSG) will monitor abrupt and spontaneous arousals during slow-wave sleep and rule out epileptic disorders. Behavior is closely watched and recorded.

Also, clear descriptions of sleep behaviors from bed partners are helpful in diagnosis. 

As sexsomnia is associated with other sleep disorders, addressing the underlying cause can lead to substantial improvement. Some cases have reported positive results from using continuous positive airway pressure (CPAP) or an oral appliance as a treatment for underlying obstructive sleep apnea. Antidepressants, like selective serotonin reuptake inhibitors that increase serotonin levels in the brain, as well as clonazepam have also been used to treat sexsomnia. Stress management for depression, better sleep hygiene, and reducing the use of substances (alcohol and drugs) that can exacerbate the condition have been beneficial in reducing symptoms.

Safety Precautions and Legal Defense

Because sexsomnia can involve a bed partner or an individual in close proximity, sexsomnia can have serious legal consequences.

After being accused of violating behavior, it may be necessary to have a formal sleep evaluation, including a diagnostic polysomnogram, to better understand the role of a sleep disorder in the incident. Consultation with medico-legal experts who are skilled in testifying in sleep forensic cases may also be helpful. The legal defense of sexsomnia can be difficult.

Safety precautions are highly recommended, especially if you have been prone to sleep-related behaviors previously. If you are sleeping in or around someone dealing with unresolved sexsomnia, choosing to sleep in another room or at a good distance away from the individual is recommended.

Like any parasomnia, it is encouraged to remove any dangerous objects, like weapons and sharp objects, from the sleep environment.

A Word From Verywell

Sexsomnia, characterized by sexual behavior when sleeping and total amnesia of the event, is a rarely reported and complex parasomnia. This parasomnia can have serious impacts on the person dealing with the condition and others around them. Addressing these underlying conditions has been shown to help reduce episodes of sexsomnia.

If you or a loved one experience symptoms of sexsomnia, please speak with a board-certified sleep specialist who can answer any questions and arrange the appropriate diagnostic testing and treatment.