Sleep Sex - Causes, Characteristic Features, Treatment, and Complications

What Is a Parasomnia?

A parasomnia is any sleep disorder that causes sleep disruption due to undesirable events. This may include talking and groaning in one’s sleep, abnormal movements or behavior like sleepwalking and teeth grinding, and unusual sexual activity. People displaying parasomnia act consistently with being fully awake when they are, in fact, asleep and unaware of their surroundings or behavior.

What Is Sleep Sex?

Sleep sex or sexsomnia is a type of parasomnia. Sleep sex is experienced as sexual behavior during sleep, including masturbation, fondling, and even penetrative sexual intercourse.

Who Is Affected by Sleep Sex?

Men and women may be affected, but men are thrice as likely to suffer from sexsomnia than women. Women who have the condition will usually masturbate during episodes.

Is Sleep Sex a Cause for Concern?

• Sleep sex can be alarming and cause stress and trauma, particularly in partners who may be at the receiving end of sexual attention.

• The people suffering from the disorder are often unaware that they have it. This can make accepting their behavior difficult and cause them to deny the need for treatment.

• People exhibiting sexsomnia may be convicted for sexual offenses due to lack of consent, which would be problematic if they are innocent. Sexsomnia is a disorder that requires treatment - it is not a voluntary behavior.

Sexsomnia is, therefore, a cause for concern and requires treatment.

What Causes Sleep Sex?

There are a variety of reasons for sleep sex:

1. Sleep-

• Irregular sleep.

• Sleep deprivation.

2. Psychological-

• Stress.

• Anxiety.

• Depression.

3. Substance Use-

• Excessive alcohol drinking.

• Recreational or prescription drugs that have not been prescribed.

4. Other-

• Certain therapeutic medications, particularly antidepressants and anti-anxiety medications.

• Extreme fatigue.

What Are the Risk Factors for Sexsomnia?

Risk factors for sexsomnia are usually medical conditions that can act as triggers and cause sleep deprivation or interference:

1. Sleep-Related Disorders-

• Sleepwalking.

• Sleep talking.

• Obstructive sleep apnea.

• Nocturnal seizures or sleep-related epilepsy.

• Sleep-related dissociative disorder.

2. Gastrointestinal Disorders-

• Gastroesophageal reflux disease (GERD).

• Irritable bowel syndrome (IBS).

• Colitis.

• Crohn’s disease.

• Gastric ulcers.

3. Neurological Disorders-

• Migraines.

• Epilepsy and seizure disorders.

• Parkinson’s disease.

• Willis-Ekbom disease or restless leg syndrome.

4. Injury-

• Head trauma.

5. Psychological-

• Anti-anxiety and antidepressant medications like Escitalopram.

What Are the Characteristic Features of Sleep Sex?

Sexsomnia may involve only the patient or may extend to sexual activity with another person unknowingly. In some cases, it may occur in tandem with other parasomnias like sleepwalking. The signs and symptoms typically noted are:

• Self-touching.

• Sexual movements.

• Moaning.

• Pelvic thrusts.

• Sexual aggression.

• Fondling, caressing, and rubbing.

• Masturbating.

• Spontaneous orgasm.

• Initiation of sexual intimacy with another person.

• Sweating.

• Increased heart rate.

• Heavy breathing.

• Sexual intercourse.

• Sleepwalking.

• Sleep talking.

• Glassy and vacant stare.

• Unresponsiveness.

• Difficulty waking up.

• Lack of recollection of the event.

• Refusal to accept the activities that occurred due to the amnesic nature of the events.

• Changes in sexual behavior from their usual sexual behavior when awake.

How Is Sleep Sex Diagnosed?

• When deciding to consult a doctor for sexsomnia, it is advisable to maintain personal records such as a written description of the events by a partner or observer.

• Journaling about sleep patterns is also a valuable way to correlate sleep with specific parasomnias.

While these may serve as necessary background information, clinical examination and diagnosis are also important:

• A psychiatrist specializing in sleep disorders may be able to diagnose sexsomnia through a detailed medical and symptomatic history.

• Sleep Study or Video-Polysomnography (vPSG) - This is the gold standard test for diagnosing sexsomnia. The procedure involves attaching physiological measurement devices to patients that measure heart rate, breathing patterns, motions, eye movements, leg movements, and brain waves. The patient is videotaped while asleep and hooked up to these devices. Any abnormal behavior is noted along with the parameters to indicate the sleep pattern and degree of unconsciousness while performing these activities.

How Is Sleep Sex Treated?

1. Self-Therapy-

• Sleep Patterns: The best way for the patient to prevent episodes is to get adequate sleep. A healthy and consistent sleep-wake cycle can completely resolve the issue or reduce it considerably.

• Sleep Conditions: One way to prevent trauma to others from patient episodes is to isolate oneself when sleeping. The patient may lock themselves in a room and sleep alone.

2. Physician’s Treatment-

Sleep sex may often be treated by association when underlying or concurrent conditions such as sleep apnea are treated. Treatment options may include:

• Sedatives: Mild sedatives may help.

• Anti-anxiety and Antidepressant Medications: Clonazepam and Duloxetine.

• Nasal continuous positive airway pressure (CPAP) therapy for sleep apnea.

• Dental devices like mouthguards and bite plates for sleep apnea.

• Medication for Underlying Gastric Conditions: Proton pump inhibitors (PPIs) and antacids.

• Therapy: Counseling and therapy may be required due to feelings of guilt, shame, and embarrassment. Group counseling is a good strategy, as are couples therapy when the patient’s partner is angered or traumatized by their behavior.

• Medication Changes: Some medications, including sleep medications, may cause parasomnias. Switching to alternative medicines may reduce or resolve symptoms.

What Are the Complications of Sleep Sex?

• Sleep sex can negatively impact the patient’s psychological health. It is often a matter of shame, mainly due to the sexual component of the disorder. It can lead to feelings of extreme guilt and shame.

• Sexsomnia is also shaky ground when it comes to consent. Sexual activity performed without permission can lead to criminal charges. While the question of culpability may arise due to the unconscious nature of the act, it is often difficult to prove innocence, and court rulings can go either way. In addition, the subject can give rise to serious controversy, making it even more complicated.

How Can Sleep Sex Be Prevented?

Taking steps to change one’s lifestyle and sleep patterns and obtaining support from family and friends are crucial to prevention.

1. Lifestyle Changes-

• Sleep Hygiene: Practice good sleep hygiene and sleep patterns. Set a proper time for sleeping and waking up, and maintain these consistently.

• Sleeping Environment: Start sleeping alone to avoid traumatizing partners or family members. Set up alarm systems to alert people to the presence or activities of the patient.

• Trigger Avoidance: Avoid consuming alcohol, prescription drugs that have not been prescribed, and recreational drugs. These substances worsen the condition.

2. Family Support-

Obtaining family support is a key to managing diseases such as sexsomnia. Communicate relevant issues to partners, friends, and family. Be honest about the situation and provide reassurance that treatment has been sought and is ongoing.

Conclusion:

Sexsomnia is potentially dangerous and embarrassing for both patients and their loved ones. It can be challenging to watch or deal with personally but rest assured that it is manageable. Dealing with sexsomnia may be fraught with complications and personal issues, but it is still not a reason for despair. It only needs patience, partner and family support, and non-judgmental understanding.