“I perform sexual acts in my sleep. It can be very embarrassing,” a Reddit user posted in an AMA (ask me anything) forum. “I will sometimes wake up in the middle of it and realize I am jerking off a few feet away from my family.”
The user’s shocking admission elicited hundreds of responses, many as crass as one might imagine. But amidst mocking commenters were users who shared their own tales of sexual acts performed during sleep. The disorder wasn’t as singular as many believed.
Sexomnia, or sleep sex, is a parasomnia (sleep-movement disorder) in which people engage in sexual behavior while sleeping and have no memory of it after waking up. It is by no means common: As a parasomnia, sexsomnia is in the same family as disorders including sleepwalking, night terrors and sleep-eating, but it affects a far smaller percentage of the population. The disorder went largely unrecognized until the mid-to-late 1990s. In fact, sexsomnia only made it into the Diagnostic and Statistical Manual of Mental Disorders in 2014 and, even today, few studies on the disorder exist.
Sexsomnia affects three times as many men than women, perhaps in part because there’s a strong association of the disorder with sleep apnea.
“As far as we know, only two to six percent of people appear to suffer from parasomnias, and the percentage of those suffering from sexsomnia specifically is likely even smaller,” said Dr. Britney Blair, a clinical psychologist at the Stanford University School of Medicine and adjunct professor at the Stanford Sleep Medicine Center.
According to a 2010 study of sleep clinic patients at the University Health Network in Toronto, sexsomnia affects three times more men than women, perhaps partly because it’s strongly linked with the sleep-breathing disorder sleep apnea, says Dr. Robert S. Rosenberg, sleep medicine doctor and author of “The Doctor’s Guide to Sleep Solutions for Stress & Anxiety.” Sleep apnea statistically affects many more men than women.
In general, parasomnias are thought to run in families and be more common during childhood. Children might sleepwalk, sleep-talk or experience night terrors, but many grow out of it, says Blair.
And for reasons still unclear, people who suffer from one parasomnia are likely to suffer from others as well. Until recently, sleep sex was considered merely a “variant of sleepwalking,” as the two are so often related.
“It would appear that those with parasomnias, which predominantly arise from deep slow-wave sleep, such as sleepwalking, night terrors and sexsomnia, exhibit more slow wave sleep and more spontaneous arousals from slow wave sleep on [electroencephalograms] EEGs,” Rosenberg says.
In healthy sleepers, the body is paralyzed during REM sleep, the stage when most dreaming occurs. “Non-REM parasomnias typically happen outside that REM period,” says Blair.
“If we see arousals during non-REM or slow-wave sleep that indicate physiological activation, that could indicate the presence of a parasomnia. But there’s no specific test for sexsomnia.”
To help them determine whether a patient suffers from a parasomnia, sleep clinic physicians might ask patients to keep a sleep diary for two weeks, fill out questionnaires and undergo polysomnography, which refers to a battery of in-lab sleep tests that monitor muscle movement, eye movement, cardiovascular activity and brain waves during different stages of sleep.
“If we see arousals during non-REM or slow wave sleep that indicate physiological activation, that could indicate the presence of a parasomnia. But there’s no specific test for sexsomnia,” Blair explains. “‘This person has arousals or differing brain activity that’s abnormal during slow wave sleep’ is basically the most we can say.”’
The Toronto researchers also found that sexsomnia sufferers were twice as likely as other sleep clinic patients to have used illicit drugs. Alcohol and Ambien are sometimes associated with sleep sex episodes, but the popular sedative more often accompanies other sleep problems, such as sleepwalking, night terrors and sleep apnea, says Rosenberg.
In addition, “Sleep deprivation, stress, fever and medications need to be present in many cases to trigger the parasomnia,” Rosenberg says.
In a paper published in the journal Sleep in 2010, researchers surveyed more than 800 patients at a sleep disorder clinic and found that a little more than 7.5 percent of them, or one in 12, reported experiences with sexsomnia. The authors wrote that although sexsomnia was common among this population, only four out of 832 patients surveyed had mentioned it to their doctors.
The low numbers make sense. Many patients and even some doctors are too embarrassed to discuss the problem, some experts say, although a lack of education about sexsomnia has likely played as large a role in preventing people from seeking treatment for the disorder.
The Toronto researchers also found that sexsomnia sufferers were twice as likely as other sleep clinic patients to have used illicit drugs.
“It’s not that doctors are uncomfortable with the topic of sex,” says Rosenberg. “It’s that most of them have never heard of such a thing, since disorders of sleep gets almost no attention in medical school.”
Another theory says sexsomnia remains so mysterious because people don’t take it seriously when it happens. Some who have experienced the disorder admit that their partners are open to the unconscious encounters and even find them funny.
But sexsomnia can have serious consequences. Recipients of the unwanted advances can feel violated, and sufferers often feel guilt and even horror about making unwanted advances in their sleep state.
Some advances can be scarier than others. According to the results of a 2007 survey, for example, six percent of 217 respondents who said they’d had episodes of sexsomnia reported that they’d had sexual encounters with minors while asleep, “with legal repercussions occurring in most cases.”
Another theory about why sexsomnia remains so mysterious because that people often don’t take it seriously when it happens.
In a legal case decided last year, for instance, a Canadian was acquitted of molesting his daughter after using sexsomnia as a defense. The evidence showed a case of misplaced guilt, but who’s to know for sure?
A disorder as peculiar as sexsomnia can obviously create problems in relationships, causing everything from mild disagreements to divorce.
“Anecdotally, I can tell you that people might experience symptoms for a while before they come in for treatment,” says Blair. “Patients might not be aware of their nocturnal sexual behaviors until a bed partner complains that it’s unsettling.”
The good thing is there’s help. Despite the lack of solid medical research addressing sexsomnia, sleep physicians say that treatment for the disorder exists and can be effective.
“Another important thing is to address any other sleep disorders that might be happening, such as sleep apnea or insomnia, concurrently,” Blair says. “Sexual acting-out when you’re asleep can be made worse if sleep is interrupted in other ways or if sleep is wonky.”
And since stress is a significant impetus for the disorder, relaxation techniques can help, as can maintaining good sleep hygiene. Anti-anxiety drugs, dopamine agonists and sometimes SSRIs might also be effective.
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