Sexsomnia: Sexual Somnambulism

Sexsomnia is a sleep disorder that can lead sufferers to masturbate rampantly or engage in sexual acts during sleep. It affects both men and women.

Sexsomnia, also known as sexual sleepwalking, usually occurs in young adults. It’s a sleep disorder in which the sufferer can masturbate or even have full-on sex while sleeping.

Studies that have documented some cases of sexsomnia have indicated that it can coexist with other disorders such as sleepwalking, which is characterized by carrying out activities while sleeping, such as walking or talking.

Confused awakenings, sleep apnea, or periodic leg movement disorder are conditions that could trigger it.

What is sexsomnia?

Sexsomnia is a complex disorder.
Affected people can’t control what happens after they sleep.

As we mentioned before, sexsomnia is a parasomnia or abnormal low-frequency sleep disruption. Those who suffer from it, usually more men than women, can even have sex while asleep. However, upon awakening there’s complete amnesia, what happened is not remembered.

According to a study on the characteristics of the condition, women develop a high tendency to masturbate. It’s also revealed that violence and aggression were present in 11 cases and that 73% of the 41 patients had a history of suffering from another type of parasomnia.

The complications of this condition are linked to a sexual component. In every other way, it’s very similar to sleepwalking, in which people who suffer from it are able to get out of bed, walk, talk or laugh. When they wake up they don’t remember what happened either.

Diagnosing this type of disorder requires a great effort on the part of a medical team, as it must be demonstrated that the behavior is due to an involuntary and unconscious action. This, taking into account the social burden it has, is usually a behavior that’s susceptible to being judged, not knowing that it may actually be due to a real health condition.

What causes sexsomnia?

You may well believe that sexsomnia is due to the presence of erotic dreams or fantasies. The truth is that this is very far from reality for those who suffer from it.

Being a sleep disorder, sexsomnia originates from a failure during the NREM phase of sleep, that is, in the first cycles of deep rest, where there are still conscious movements. In particular, these patients keep the areas that control vision, movement, and emotion active.

It’s likely that the reason why there are no memories of what happened is that the areas in charge of memory control and rational thinking remain in deep sleep.

A study that verified the episodes presented by three men and one woman indicates that, although the first three cases were amnesic, the fourth did fully remember the event.

Sleep phases

In order to better understand what happens to those who suffer from sexsomnia, it’s important to know how sleep works and the phases it divides into.

Sleep is a biological state of total inactivity, where the state of consciousness decreases. This occurs in the phases called REM and NREM, which alternate progressively during the night.

NREM or RNEM phase

This phase of sleep is divided into three specific stages:

  • Drowsiness: this stage leads to the disappearance of electrographic waves that are typically seen in the waking state. There’s still good muscle tone and eye movements are progressively decreasing.
  • Light sleep: during this stage, the electrographic rhythms decrease more, but there’s still a good muscle tone. For its part, eye movements are decreasing.
  • Deep sleep: this stage results in a significant decrease in the electrographic rhythm. There’s no longer a place for eye movements to occur and muscle tone begins to decrease.

REM phase or paradoxical sleep

Research tells us that REM sleep typically lasts as little as two hours within the entire cycle. If an electroencephalogram were performed during this phase, traces that indicate brain activity could be evidenced, similar to those that occur in the waking state, although this isn’t the case.

In the REM stage, rapid eye movements occur, muscle tone disappears and the diaphragm continues to maintain its tone, allowing good breathing. In addition, it’s regulated by the neural network in which different neurotransmitters are involved.

Causes of sexsomnia

The origin of sexsomnia is multifactorial.
Anxiety and other psychological disorders could be related to sexsomnia.

Because few people in the world suffer from this sleep disorder, it’s still difficult to identify its precise causes, as well as to establish a specific treatment.

However, a study in which four specific cases of sexual sleepwalking were observed determined that this disorder, in addition to occurring in adolescent men and women or young adults, is closely related to psychiatric comorbidities. Other causes that could be related are the following:

  • Anxiety
  • Stress
  • Fatigue
  • Insomnia
  • Alcohol consumption
  • Use of psychoactive substances
  • Intake of some drugs
  • Mental disorders
  • Basic sexual mental illnesses
  • Sexual actions such as child abuse or rape
  • Other disorders such as obstructive sleep apnea

Similarly, it’s believed that the slightest noise could start an episode, as well as the alteration of the sleep cycle.

Risks of suffering from sexsomnia

The greatest risks of sexsomnia for those who suffer from it lie in the mental and social impact. First of all, it’s not at all satisfactory to wake up one morning naked without any apparent explanation, which could be worse if you add to it waking up next to someone you don’t know or with whom you shouldn’t have contact of this type.

People with this disorder may be unaware of their sexual orientation during episodes. They can even inadvertently force someone to have sex. By staying asleep, patients act on mere impulse, so they can be aggressive. Those who masturbate can reach the point of hurting themselves.

On the other hand, socially, it’s a necessity to be able to diagnose this disorder accurately, since those who suffer from it could be affected by serious legal problems. Also, people who are a real threat could manipulate the system with the help of a bad diagnosis.

Diagnosis and treatment

According to research, sexsomnia is something relatively new, as it appeared on the medical radar in 1996, but it wasn’t until 2003 that this term was coined and in 2014 it was included in the Classification of Sleep Disorders III in where it was included as a parasomnia.

As we mentioned, this disorder is rare. The aforementioned research establishes that it affects men and women, at a ratio of eight to two. The lack of documented cases has made diagnosis and treatment difficult.

This disorder is so complex and strange that, according to an article published in the Journal of Clinical Sleep Medicine, by 2020 only 116 clinical cases of sexsomnia have been registered.

Diagnosis can be made by means of a polysomnography, a test that is often used to determine other sleep disorders and that reads the patient’s brain activity and eye movements during sleep.

Among the factors that are taken into account to offer the diagnosis, there are also questions about drug or substance use.

Treatment includes two possibilities: pharmacological and psychological therapy. To this are added sleep hygiene guidelines to avoid interruptions during the cycle and, in this way, minimize the chances of having repetitive episodes.

A complex pathology

It’s evident that this condition is difficult to diagnose, in addition to being closely related to important social and emotional problems. Once the suspicion is established, it’s best to go and see a mental health professional to receive the appropriate diagnosis.

  • Ariño, H., Iranzo, A., Gaig, C., & Santamaria, J. (2014). Sexsomnia. Una forma de parasomnia con conductas sexuales durante el sueño. Neurología, 29(3), 146-152.
  • Resende, C. M. D. C. Sexsomnia: Uma Realidade Escondida? (Doctoral dissertation).
  • Peñas-Martínez, M. L., Guerrero-Peral, A. L., Toledano-Barrero, A. M., Calleja-Sanz, A., Rojo-Martínez, E., Mayor-Toranzo, E., … & Merino-Hernando, S. (2008). Sexsomnia: descripción de un nuevo caso. Rev. neurol.(Ed. impr.), 331-332.
  • Sarisoy, G. y Ozdin, S. (2014). Sexomnia: una revisión. Psiquiatría y ciencias del comportamiento , 4 (2), 80.
  • Reyes Zúñiga, Margarita. (2018). Resúmenes del IX Encuentro Nacional de Medicina del Dormir. Neumología y cirugía de tórax, 77(4), 305-312. Recuperado en 05 de abril de 2021, de http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0028-37462018000400305&lng=es&tlng=es.
  • Velayos, J. L., Moleres, F. J., Irujo, A. M., Yllanes, D., & Paternain, B.. (2007). Bases anatómicas del sueño. Anales del Sistema Sanitario de Navarra, 30(Supl. 1), 7-17. Recuperado en 06 de abril de 2021, de http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1137-66272007000200002&lng=es&tlng=es.
  • Muza R, Lawrence M, Drakatos P. The reality of sexsomnia. Curr Opin Pulm Med. 2016 Nov;22(6):576-82. doi: 10.1097/MCP.0000000000000321. PMID: 27607155.
  • Pirzada, A., Almeneessier, A.S. & BaHammam, A.S. Abnormal Sexual Behavior During Sleep: Sexsomnia and More. Sleep Vigilance 3, 81–89 (2019). https://doi.org/10.1007/s41782-019-00057-5
  • Kumar V, Grbach VX, Castriotta RJ. Resolution of sexsomnia with paroxetine. J Clin Sleep Med. 2020;16(7):1213–1214.