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A 38-year-old man repeatedly tries to force his wife to have sex in the middle of the night, but has no memory of his actions when he wakes up.
A married woman in her 20s often takes off her clothes and masturbates, but remembers nothing when her partner awakens her.
For twelve years, a 31-year-old man masturbates while sleeping, sometimes injuring his groin. Ashamed by his unconscious behavior, he has avoided relationships for eight years.
All of this is clinically documented cases sleep sex, or sexsomniapart of a family of sleep disorders called parasomnias, which include sleepwalking, sleep talking, sleep eating, and night terrors.
Although it may seem like people are experiencing dreams, many parasomnias occur when the brain is not in a dream state, said Dr. Carlos Schenck, professor and senior psychiatrist at the University of Minnesota Hennepin County Medical Center.
“These are arousal disorders,” said Schenck, who has studied parasomnias for decades. “They occur most often during the slowest, deepest stage of sleep, called delta sleep. It’s as if an alarm or trigger goes off in your central nervous system and you go from basement to roof in the blink of an eye.
“Your cognition is deeply asleep and you’re not on the program, but your body is activated,” Schenck said. “This is dangerous because you start walking, running and doing all kinds of things without your mind being awake.”
Sexsomnia is difficult to study because, unless people harm themselves, many have no idea about their unconscious sexual activity until a bed partner tells them about it.
A 2010 study questioned 1,000 randomly selected adults in Norway and found that around 7% had experienced sexsomnia at least once during their lives, while almost 3% were currently living with the condition.
“There are some people who engage in sexual activities with their partners and it doesn’t bother either of them. So it’s possible that this is consensual for some,” said Jennifer Mundt, assistant professor of sleep medicine, psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine in Chicago.
“There are definitely cases where it is alarming for the partner and the person doing it once they realize what they have done.”
Sexsomnia can ruin lives
The episodes began in 2005, according to one woman’s husband. About twice a month, his wife moaned sexually and engaged in “dirty talk,” words she never used when awake, he told Schenck, who treated the woman and Published your anonymous affair in 2021.
Sometimes the woman would fondle her husband during the night and they would have sex until she became conscious and accused her husband of forcing her to have sex.
She also masturbated while calling other men names, including that of a co-worker, leading her husband to believe she was cheating on him. However, partners should not assume that people with sexsomnia are allowing a secret to escape their subconscious, Schenck said.
“The sleeping brain is wired very differently than the waking brain,” he said. “You are not conscious when you are sleeping, so you cannot reach any valid conclusion about the so-called lie or the truth in your sleep.”
The woman refused to believe her husband’s descriptions of her behavior for years, finally seeking professional treatment in 2015 after her 9-year-old son heard her moan sexually in her sleep.
“That was terrible, terrible,” Schenck said. “And what’s really disconcerting for these patients is that they have total amnesia. It’s the bed partner or family member saying, ‘You did this, why did you do that?’ and then the patient says: ‘I don’t remember anything’. So they are really embarrassed, full of shame, really sorry and totally unhappy.”
Sometimes people have even been arrested because of their behaviors. “There certainly can be legal consequences for sexual behaviors, especially with minors, and also for aggressive behaviors while sleeping,” Schenck said.
“There is a whole area of sleep forensics to deal with these issues,” he said. “They do very comprehensive assessments, case histories and interviews with family members and others to decide whether it is an excuse or something real.”
What triggers sexsomnia?
There is no way to predict that you will develop parasomnia. Some people who sleep, talk or walk as children develop sexsomnia or another parasomnia as adults, but many others do not, Schenck said.
“We don’t know the ultimate cause, but there is a genetic component,” he said. “If you have at least one first-degree relative with a parasomnia, you are more likely to develop one. So the more first- or second-degree relatives who have parasomnia, the more likely it is that the condition will persist into adulthood or recur.”
Having obstructive sleep apnea can also be a trigger. Also called OSA, obstructive sleep apnea it is a serious sleep illness in which breathing stops for 10 seconds to two minutes, many times an hour, every night. The condition occurs mainly in men, although more women are developing it.
“It is the breath holding or apnea from obstructive sleep apnea that triggers arousal, typically in men, which then triggers sexual behaviors during sleep,” Schenck said. “After diagnosing sleep apnea and treating the patient, treatment not only controls sleep apnea, but also controls secondary sexsomnia.”
There are medications such as clonazepam, a medication used for epilepsy, restless legs syndrome, and panic disorder, that can successfully control unwanted sexsomnia for many, but not all.
Medication didn’t help the 41-year-old woman Schenck treated after her son heard her, but quitting her stressful job did. She began sleeping soundly for six to seven hours without any recurrence of her sexsomnia.
“It’s very interesting because many people under stress become hyposexual, uninterested in sex,” Schenck said. “And for others, it’s the opposite. Therefore, there is no 100% absolute rule.”
Behavioral treatments are also available
Sexsomnia medications have side effects and can be addictive. People who don’t want to use drugs can try several behavioral approaches to manage the disease, said Northwestern’s Mundt, who published a review of such treatments in September 2023.
“From the literature and my own experience, it is definitely true that we can drastically reduce symptoms or possibly eliminate them for some people,” she said. “Others may have only partial improvement or no improvement at all, and that is when medication may be necessary.”
Education comes first, Mundt said, because many people don’t understand the stages of sleep and how sexsomnia is different from nightmares or acting out vivid dreams.
During the first and second stages of sleep, your body begins to slow down. Then comes the third stage – deep, slow-wave sleep, in which the body is literally repairing itself at the cellular level. Rapid eye movement sleep, called REM, occurs when dreaming occurs – in this final stage the body becomes paralyzed so that you cannot achieve your dreams and hurt yourself.
Because each sleep cycle lasts approximately 90 minutes, most adults need seven to eight hours of relatively uninterrupted sleep to get restful sleep, according to the study. US Centers for Disease Control and Prevention.
“Education itself is a treatment strategy because a lot of times it really helps reduce a person’s anxiety, and if we can reduce stress and anxiety, that helps,” Mundt said.
“Then I will focus on sleep hygiene, such as reducing caffeine or alcohol, maintaining a more consistent sleep schedule, keeping the bedroom cool, and eliminating ambient noise,” she said. “Relaxation techniques come next, and if we need more strategies, I can move on to hypnosis.”
Clinical hypnosis is nothing like a magician performing on an audience, Mundt said. Rather, it is to encourage a person to voluntarily enter a state of reverie or trance.
“It’s like you’re riding the bus and you’re looking out the window, and you don’t even see what’s in front of you because you’re so lost in thought,” she said.
A trance state is clinically useful because people are more open to new ideas, suggestions and images, such as seeing themselves sleeping calmly and peacefully at night, she said.
“In some ways, it’s similar to having a parasomnia episode,” Mundt said. “People vary in how easily they enter this trance state, but it can be very, very effective.”
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