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.

Andersen ML, Schenck CH, Tufik S. Understanding sexual parasomnias: a review of the current literature on their nature, diagnosis, impacts, and management. Sleep Med Clin. 2024;19(1):21–41.

“[It] can profoundly affect well-being and relationships and can carry legal consequences.”

 

 

What is sexomnia?

 

 

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

Pyrgelis ES, Mavridis IN, Wimalachandra WSB, et al. Sexsomnia: a rare parasomnia with important medicolegal aspects. Sleep Vigilance. 2021;5:29–34.

 

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.

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.

Idir Y, Oudiette D, Arnulf I. Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: the old and the new. J Sleep Res. 2022;31(4):e13596.

 

“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.

 

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.”

Mundt JM, Schuiling MD, Warlick C, et al. Behavioral and psychological treatments for NREM parasomnias: a systematic review. Sleep Med. 2023;111:36–53.

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.”

 

 

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.