People with this rare condition have sex while they’re asleep

By Katie Robinson | Fact-checked by Barbara Bekiesz
Published May 16, 2024

Key Takeaways

  • Sexsomnia, a rare sleep disorder characterized by sexual behavior during sleep, can lead to adverse psychosocial and medicolegal outcomes.

  • Diagnostic tools include physical, psychological, and neurological tests.

  • Behavioral and psychological treatments may help patients manage sexsomnia, but no formal practice guidelines exist.

Sexsomnia is a sleep disorder characterized by sexual behavior during sleep. Though rare, patients who experience sexsomnia can suffer adverse psychosocial and medicolegal consequences. 

Sexsomnia involves “various sexual activities that occur unconsciously during sleep,” explained the authors of a 2024 review published in Sleep Medicine Clinics.[] “[It] can profoundly affect well-being and relationships and can carry legal consequences.”

What is sexomnia?

Defined as a variant of confusional arousals, sexsomnia is part of a group of sleep disorders called non–rapid eye movement (NREM) parasomnias.[]

These include sleepwalking, sleep terrors, and sleep-related eating. However, episodes of sexsomnia can also present in sleep during REM.[]

Typically, NREM parasomnias occur during the transition from deep sleep to wakefulness in the first third of the night. Individuals appear awake but have little or no conscious awareness and are unlikely to recall the episode.

The estimated lifetime prevalence of sexsomnia is 7.1%, which is similar to the 6.9% prevalence of sleepwalking. However, unlike the onset of sleepwalking, which occurs during childhood, the onset of sexsomnia occurs in adulthood. 

Parasomnias can run in the family, but there are a limited number of genetic studies, and those that have been undertaken are inconclusive.

Clinical manifestations

Clinical manifestations of sexsomnia vary, but most frequently present as sexual intercourse or attempted intercourse. Masturbation is the main presentation in women. Pelvic thrusting, sexual vocalizations, or groping a bed partner may also occur. Aggression, violence, and spontaneous sleep orgasms have been reported, as noted by authors writing in Sleep Vigilance.

Disorders of arousal, observe authors of a review in the Journal of Sleep Research, can lead to various consequences.[]

“In addition to the risk of injury on themselves and others (including sexual assaults in sexsomnia), adults […] frequently suffer from excessive daytime sleepiness, pain, and altered quality of life,” they wrote.

Diagnosing sexsomnia

Physical and psychiatric evaluation can help diagnose sexsomnia, as can interviewing the patient and their bed partner, and recording and reviewing dream reports. Video-polysomnography may help diagnose unusual cases, identify possible triggering factors, and differentiate parasomnias from epilepsy.

Behavioral and cognitive evaluation, using electroencephalography (EEG) along with functional brain imaging, are also helpful diagnostic tools.

During parasomnia episodes, these neurological evaluations suggest a wake-like activation in motor and limbic regions but a continued (or increased) sleep intensity in the frontoparietal network.

Treatment options

Authors of a review in Sleep Medicine offer a perspective on treatment approaches: “Although there are no formal practice guidelines for the treatment of these disorders, nonpharmacological strategies are generally preferred as an initial step.”[] They pointed out that there is “little high-quality evidence for pharmacological treatment of NREM parasomnias. [...] Drugs are frequently not fully effective and have side effects, and patients should be informed that such medications are being used off-label.”

Certain medications can instigate NREM parasomnias, such as zolpidem, and therefore patients should be advised to discontinue their use. Patients should also seek treatment for comorbid sleep disorders, such as insomnia.

The Sleep Medicine review analyzed 72 publications (1909–2023), mainly case reports, on the behavioral and psychological treatments of NREM parasomnias. Hypnosis was used most commonly, followed by psychotherapy. Other interventions included sleep hygiene, education, relaxation, scheduled awakenings, sleep extension/scheduled naps, and mindfulness practices.

The authors acknowledged the retrospective and uncontrolled nature of the studies, together with inconsistent outcome measures. Still, they concluded that some evidence supported the benefit of specific approaches, such as multicomponent cognitive behavioral therapy, sleep hygiene, scheduled awakenings, and hypnosis.

What this means for you

Your patients with sexsomnia may experience adverse psychosocial and medicolegal effects. No formal guidelines exist for the management of this disorder, although relevant diagnostic tools, along with behavioral and psychological treatments, are available.

Read Next: This is how not having sex impacts your health
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