Sleeping thrills: A brief overview of sexsomnia

Over the last decade there have been an increasing number of papers published on sexsomnia (more commonly known as ‘sleep sex’). There have also been a lot of high profile media cases where women have claimed that their sexsomnia has ruined their lives or men who have been arrested for committing sexual assaults while asleep. Sexsomnia is a condition that is highly prevalent among sleepwalkers and is where people engage in sexual acts while still asleep and can include masturbating and fondling of either themselves or others, or oral sex and sexual intercourse with another person.

Sexsomniacs do not recall or remember anything that they did while asleep which raises interesting questions if criminal sexual acts are performed without the person being aware that they have even done anything wrong. Some in the field have claimed the disorder is relatively common but often goes unreported because of shame and embarrassment related to the condition. In addition to sleepwalking, other sleep-related disorders that sexsomniacs may suffer from include nightmares, bedwetting, and sleep apnea (abnormal breathing while asleep). Many of these behaviours are known as parasomnias (i.e., sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams and are events that occur intermittently or episodically during the night).

The first academic paper on sex during sleep was published in the mid-1990s in the journal Sleep Research by Canadian researchers Colin Shapiro, Nik Trajanovic and Paul Federoff (at the Universities of Toronto and Ottawa). They claimed that having sex during sleep could be conceptualized as a new type of parasomnia. Then, in 1998, the term ‘sleepsex’ was first used in a paper published in the Archives of Sexual Behavior by American neurologists Dr. David Rosenfeld and Dr A.J. Elhajjar. They described two case studies of people having sex while asleep. The more interesting second case concerned a sleepwalker who committed a sexual assault and used somnambulism as his legal defence. In 2003, the term ‘sexsomnia’ was first used by Shapiro, Trajanovic and Federoff in a case report published in the Canadian Journal of Psychiatry.

Unsurprisingly, sexsomniacs are often told by others that they are engaging in sex while asleep, and for many the disorder may not be problematic – particularly within the confines of a stable romantic relationship. According to a 2007 paper by Dr Michael Mangan (University of New Hampshire, USA) and Dr. Ulf Reips (Zurich University, Switzerland), some couples embrace sexsomnia, describing it as an exciting addition to their normal waking sex lives. The behaviour may have been going on a long time – sometimes years – before they seek medical help. Despite many people not believing that sexsomnia is a genuine medical condition, the condition has been confirmed by various sleep disorder specialists by video recording sufferers while they are asleep.

In 2007, Dr Carlos Schenck and co-workers (University of Minnesota Medical School, USA) reported in the journal Sleep, that bouts of sexsomnia can be triggered by such factors as physical contact with another person in bed (64%), stress (52%), fatigue (41%), alcohol use (14.6%), and drug abuse (4.3%). Sleep deprivation was also identified as a risk factor.

In 2003, Shapiro and his Canadian colleagues asserted that sexsomnia should be considered a distinct entity in the family of parasomnias, since there was were specific motor, and autonomic activation systems. However, they did make the point that it can be difficult to distinguish between typical sleepwalking and sexsomnia. They claimed that the uniqueness of the condition is the involvement of a partner (usually more than a witness). A recent 2011 review published in the Delhi Psychiatry Review pointed out the main differences between sleepwalking and sexsomnia:

• Sexsomnia originates in most cases from non-rapid eye movement sleep (whereas sleepwalking usually originates from slow wave sleep)
• Sexsomina can occur any time during sleep (whereas sleepwalking usually occurs in the first one-third of the night)
• Sexsomnia involves widespread autonomic activation (whereas in sleepwalking autonomic activation is largely limited to cardio-respiratory functions
• Sexsomnia involves frequent sexual arousal frequently (whereas in sleepwalking sexual arousal is not present)
• Sexsomnia bouts possibly exceed 30 minutes (whereas sleepwalking bouts are usually under 30 minutes)
• Sexsomnia can involve exceptional violence or injurious behaviour (whereas sleepwalking involves occasional violence, injury, and self-injury)
• Sexsomnia occurs predominantly in adults (whereas sleepwalking predominantly occurs in children)

These bullet point differences do at lest suggest that sexsomnia and sleepwalking may be distinct clinical entities. Shapiro and colleagues state that the main features of sexsomnia often include sexual arousal with autonomic activation (including nocturnal erection, vaginal lubrication, nocturnal emission, wet dreams, sweating, and cardio-respiratory response). However, there are some case studies reported in the literature that do not appear to have shown signs of sexual arousal. Despite these differences, most sleep experts consider sexsomnia to be a variant of sleepwalking, as most sexsomniacs also sleepwalk.

Based on a review of all the published case studies, Dr Andersen and her colleagues asserted that sleep sex somnambulism was a predominantly male disorder, but that the basis for male predominance in sexsomnia is not known. They further reported that females almost exclusively engaged in masturbation and sexual vocalizations, whereas males commonly engaged in sexual fondling and sexual intercourse with females.

Mangan and Reips carried out an online survey using visitors to the Sleepsex.org website (run by Dr. Mangan). Data were collected over a three-month period and generated 226 responses. Up until their 2007 study, only seven academic papers had been published with the number of sexsomniacs totaling 30 cases (the largest sample size being 11 people and six of these were reported in a previous paper by the same authors). Unfortunately, the focus of the paper was on how the internet can be used to collect data on little studied groups and as such presented very few of the results. They noted that adult sexsomniacs sometimes coming into contact with minors (in this survey 6%), and that the legal implications of reporting this are serious.

Using the same dataset, Nik Trajanovic, Michael Mangan and Colin Shapiro joined forces and published yet another paper from the Sleepsex.org data in the journal Social Psychiatry and Psychiatric Epidemiology. The results showed that females accounted for almost one-third of the sample (31%) and that the mean age of the total sample was just over 30 years of age. The participants typically reported multiple sexsomnia episodes that were typically ptriggered by body contact, stress and fatigue. A small number of participants reported that their sexsomniac behaviour had led to police and legal intervention (8.6% males and 3% females) some of which had involved minors (6% of the total sample). The authors claimed the study confirmed previous anecdotal evidence about the gender and age distribution, trigger factors, and medico-legal aspects.

An earlier 2004 paper by Dr Mangan published in the Archives of Sexual Behavior, examined first-person reports of individuals’ experiences of sexsomnia. Qualitative analysis of 121 sexsomniacs resulted in six distinct themes: (i) fear and a lack of emotional intimacy; (ii) guilt and confusion; (iii) a sense of repulsion and feelings of sexual abandonment; (iv) shame, disappointment, and frustration; (v) annoyance and suspicion; (vi) embarrassment and a sense of self-incrimination. Mangan claimed that his results suggested that sexsomnia can elicit negative emotions and cognitions that may become a source of personal and relational distress.

Research published in 2010 by Lisa Klein and Dr. Daniel Houlihan (both at the Minnesota State University, USA) in the International Journal of Sexual Health examined relationship and sexual satisfaction, sexual functioning, and sexual desire in 32 sexsomniacs who were recruited online. Compared to controls, sexsomniacs reported lower levels of sexual satisfaction, lower levels of relationship satisfaction, and similar levels of sexual desire. They also reported that more frequent incidence of sexsomnia resulted in lower sexual satisfaction. However, frequency was not found to impact on the level of sexual desire or relationship satisfaction Four-fifths of the sexsomniacs (81%) also reported at least one sexual problem.

A review paper led by Dr Monica Andersen (Universidade Federal de São Paulo, Brazil) published in a 2007 issue of Brain Research Reviews, attempted to assemble the characteristics of sexsomniacs based on the small empirical base. They noted the sexsomnia should receive more attention and concluded:

“Reports describing sexual activity of sleeping humans are still rather infrequent and the etiology of this peculiar sleep disorder is still obscure… Moreover, sexsomnia is often a longstanding disorder that carries major adverse physical, psychosocial, and legal consequences. We anticipate that this condition is currently underreported”.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Andersen, M.L., Poyares, D, Alves, R.S.C., Skomro, R. & Tufik, S. (2007). Sexsomnia: Abnormal sexual behavior during sleep. Brain Research Reviews, 56, 271-282

Anubhav, R. & Bhatia, M.S. (2011). Is Sexsomnia a New Parasomnia? Delhi Psychiatry Journal, 14, 378-380.

Klein, L.A. & Houlihan, D. (2010). Relationship satisfaction, sexual satisfaction, and sexual problems in sexsomnia. International Journal of Sexual Health, 22, 84-90.

Mangan, M. A. (2004). A phenomenology of problematic sexual behavior occurring in sleep. Archives of Sexual Behavior, 33, 287-293.

Mangan, M. A. & Reips, U. (2007). Sleep, sex, and the Web: Surveying the difficult-to-reach clinical population suffering from sexsomnia. Behavior Research Methods, 39, 233-236.

Rosenfeld, D.S. & Elhajjar, A.J. (1998). Sleepsex: A variant of sleepwalking. Archives of Sexual Behavior, 27, 269-278.

Schenck, C.H., Mahowald, M.W. (2005). Rapid eye movement and non-REM sleep parasomnias. Primary Psychiatry, 12(8), 67-74.

Schenck, C.H., Arnulf, I., Mahowald, M.W., 2007. Sleep and sex: what can go wrong? A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences. Sleep, 30, 683–702.

Shapiro, C.M., Fedoroff, J.P., & Trajanovic, N.N. (1996). Sexual behavior in sleep: A newly described parasomnia. Sleep Research, 25, 367.

Shapiro, C.M., Trajanovic, N.N., & Fedoroff, J.P. (2003) Sexsomnia: A new parasomnia? Canadian Journal of Psychiatry, 48, 311-317.

Trajanovic, N.N., Mangan, M. & Shapiro, C.M. (2007). Sexual behaviour in sleep: An internet survey. Social Psychiatry and Psychiatric Epidemiology, 42, 1024-1031.