Sleep sex

Sexsomnia, also known as sleep sex, is a distinct form of parasomnia, an abnormal activity that occurs while an individual is asleep. Sexsomnia is characterized by individuals engaging in sexual acts during non-rapid eye movement (NREM) sleep. It is important to differentiate sexsomnia from normal nocturnal sexual behaviors, such as nocturnal emissions, nocturnal erections, and sleep orgasms, which do not occur during NREM sleep.

Sexsomnia may be present in individuals with other pre-existing sleep-related disorders. It has also been used as a criminal defense in court for alleged sexual assault and rape cases.

Classification

DSM-5 criteria

In the DSM-5, there are 11 diagnostic groups that comprise sleep-wake disorders. Sexsomnia is classified under NREM arousal parasomnia.

NREM arousal parasomnia

Parasomnia disorders are classified into the following categories:

• Arousal disorders
• Sleep-wake transition disorders
• Parasomnias associated with REM sleep

Symptoms

Symptoms of sexsomnia include, but are not limited to:

• Masturbation
• Fondling
• Intercourse with climax
• Sexual assault or rape

Causes

Sexsomnia can be caused by or associated with:

• Stress factors
• Sleep deprivation
• Consumption of alcohol or other drugs
• Pre-existing parasomnia behaviors

Risk factors

Sexsomnia affects individuals of all age groups and backgrounds but presents an increased risk for individuals who experience the following:

• Coexisting sleep disorders
• Sleep disruption secondary to obstructive sleep apnea
• Sleep-related epilepsy
• Certain medications

Effects

Individuals with sexsomnia may experience negative emotions such as anger, confusion, denial, frustration, guilt, revulsion, and shame. The effects of sexsomnia also extend to those in relationships with the patient, who may be the first to recognize the abnormal behavior.

Mechanism

Sexsomnia occurs during NREM sleep, which consists of three stages. Stage 3, also known as slow-wave sleep (SWS), is the most common stage for parasomnias to occur. During this stage, brain temperature, respiratory rate, heart rate, and blood pressure are measured at their lowest.

Diagnosis

A definitive diagnosis of sexsomnia is not possible, but several factors and clinical tests are considered to determine the presence of the condition.

Determining factors

Determining factors include, but are not limited to:

• A family history of somnambulism, or sleepwalking
• Prior episodes of somnambulism
• Disorientation when awoken
• Observed confusional or autonomic behavior
• Amnesia of episode
• Trigger factors the individual possesses
• Lack of regard to conceal episode
• The nature of the event compared to the individual's baseline character

Clinical tests

Clinical tests used for further study include:

• Electroencephalography (EEG)
• Polysomnography

Prevention

Since there is no FDA-approved medication specifically designed for the treatment of sexsomnia, health professionals attempt to treat the disorder through various approaches. The first line of prevention involves creating and maintaining a safe environment for all who are affected by the disorder. Precautionary measures include having the individual sleep in a separate bedroom and installing locks and alarms on doors.

Treatment

Treatment for sexsomnia may involve:

• Prescription medications
• Continuous positive airway pressure (CPAP)

Lifestyle changes

Research

Sexsomnia research findings first appeared in a 1996 publication by Colin Shapiro and Nik Trajanovic of the University of Toronto. In a recent study, 832 individuals were surveyed at a sleep disorder center, with 8% reporting sexual behaviors consistent with sexsomnia. Men reported these behaviors three times more frequently than women.

Society and culture

Sexsomnia has gained attention through exposure on television, news platforms, and social media outlets. It has been featured in popular TV series such as House, MD, Law and Order: Special Victims Unit, and Desperate Housewives.

Legal cases

Sexsomnia has been used as a defense in a number of legal cases involving sexual offenses. The Australasian Sleep Association has urged qualified physicians to contribute expert testimony in such cases to ensure the individual's claims are valid and not just an attempt to be released of sexual offense charges.

See also

• Automatism
• Nocturnal emission
• Parasomnia
• Sleep medicine
• Somnambulism
• Somniloquy

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