What Is Sexsomnia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

You’ve likely heard of sleepwalking and sleeptalking, which belong to a family of sleep disorders known as parasomnia.

“Parasomnia is a undesirable physical event or experience with autonomic nervous system activity that occurs during any stage of sleep or its transitions from or into wakefulness,” says Thomas Kilkenny, DO, director of the Institute for Sleep Medicine at Northwell Staten Island University Hospital in New York.

There’s also sexsomnia, which involves engaging in middle-of-the-night movements that are sexual in nature.

Here, learn more about this rare sleep disorder, including what it is, what causes it, and how to make it stop.

According to the Cleveland Clinic, the sexual acts related to sexsomnia include:

• Fondling
• Masturbation
• Intercourse
• Pelvic thrusting
• Spontaneous orgasm

A key aspect of sexsomnia is being asleep and unconscious while engaging in these acts. “The condition must include unresponsiveness or minimal responsiveness to conversation, unusual sexual responses or aggression, and an inability or difficulty to be woken during the event,” Dr. Kilkenny says.

Even though you’re asleep the entire time, your eyes may be open and seemingly alert. “Although the person is asleep, it can appear to others that they are awake,” Kilkenny says.

Reasons for why sexsomnia episodes occur are murky at best. “No one can explain exactly why,” Kilkenny says.

One thing that seems to trigger parasomnias is an abrupt change from one stage of sleep to another, which appears to “open a door” to the unwanted sleep-related activity, he says.

“Sexsomnia occurs outside of dream sleep and likely occurs as the person transitions through the phases of sleep,” says Keisha Sullivan, DO, a doctor of osteopathic medicine and family medicine and a sleep medicine specialist at Kaiser Permanente in Largo, Maryland. The trigger could be something as simple as a noise or a light that turns on in the room, according to the Cleveland Clinic.

Or, a health condition that disrupts your sleep could be to blame. “This may include restless legs syndrome, teeth grinding, heartburn, sleep apnea, insomnia, and sleep-related seizures,” Dr. Sullivan says.

Kilkenny adds Kleine-Levin syndrome, narcolepsy, persistent sexual arousal syndrome, or nocturnal psychotic disorders to the list of health conditions that may increase the risk of sexsomnia.

You’re also more at risk if you experience another parasomnia such as sleepwalking, according to the Cleveland Clinic.

There are also some lifestyle factors that can trigger sexsomnia episodes if you have the disorder. According to the Cleveland Clinic, these include:

• Alcohol
• Recreational drugs
• Stress
• Anxiety
• Sleep deprivation
• Fatigue
• Some over-the-counter sleep aids

“In essence, any condition that can cause stress or sleep disruption can trigger the disorder,” Kilkenny says.

Oftentimes, people only find out they’re engaging in these sexual episodes if someone else witnesses it — a partner or roommate, for example, per the Cleveland Clinic. If this happens to you, have that person write down what they saw. It may be hard for you to hear, but it could help a doctor understand what’s going on and diagnose the condition.

Many people have trouble admitting to sexsomnia behaviors since they feel embarrassed and shameful and oftentimes are behaving in ways they never would if they were awake, according to the Cleveland Clinic.

This can get in the way of treatment. “Embarrassment may prevent many people from seeking help,” Kilkenny says. “Sexsomnia is likely an under-diagnosed condition as a person may only look for medical assistance when facing negative consequences either from the bed partner — or legally.”

Prognosis of Sexsomnia

The good news is that if you’re able to speak with a healthcare professional about the sexsomnia episodes you’ve experienced, sexsomnia is treatable in most cases.

If sexsomnia is treated or not, it does not appear to affect long-term health in terms of increasing risk for other disease or chronic illness. It, along with the behaviors it involves, can affect emotional health and well-being, which is covered in more detail below.

Since sexsomnia is often underreported and can be experienced differently from person to person, there’s no current data on how frequently these episodes typically occur or how long they last. But it is possible to overcome sexsomnia.

In most cases, it will continue until the underlying cause is treated. “If a patient’s triggers are treated properly, symptoms may resolve over time,” Sullivan says.

There are treatment options available, and they center on what your healthcare provider determines to be the underlying cause. “The first step is to make sure you are talking to your doctor about all the symptoms you are experiencing,” Sullivan says. “The doctor can help to develop a course of action to understand triggers.”

If your doctor suspects there’s an underlying sleep disorder, they will likely suggest a recorded sleep study, according to 2021 research. From there, they can determine if there’s a medical issue that’s disrupting your sleep and causing sexsomnia. They can then focus your treatment plan there. For instance, diagnosing and treating underlying sleep apnea with a continuous positive airway pressure (CPAP) device could help minimize or completely end sexsomnia episodes, according to the Cleveland Clinic.

Seeking a diagnosis and treatment is important as sexsomnia can be risky to those you live with since you’re not in control of your actions. “A doctor may encourage patients to take steps to ensure the safety of the patient and the patient’s partner while they work to find a resolution,” Sullivan says.

Lifestyle and Behavioral Changes That Can Help

Seeing as stress, substance abuse, and sleep deprivation can trigger sexsomnia, your provider may advise you to make lifestyle changes that make you feel calmer and better prepared to get a good night of sleep. “The doctor can help to create a treatment plan which can include simple lifestyle changes such as reducing stress, limiting alcohol consumption, and maintaining a consistent sleep schedule,” Sullivan says.

You can also embrace lifestyle changes aimed at protecting your and your partner’s safety. For instance, you may decide to sleep in a separate room, lock doors, avoid triggers, and prioritize good sleep hygiene while you figure out a treatment option, according to the Cleveland Clinic.

Medication Options

Your doctor may determine there’s a health issue interfering with your sleep and leading to sexsomnia episodes, and may prescribe a medication to treat it. For instance, if you have another parasomnia such as sleepwalking that’s increasing your risk of sexsomnia, your doctor may prescribe a benzodiazepine medication, according to previous research.

In addition to a CPAP device for sleep apnea, your doctor may recommend a selective serotonin reuptake inhibitor (SSRI) to treat depression or anxiety or medication to address heartburn or restless leg syndrome — if your doctor suspects those conditions are triggering your sexsomnia, per the Cleveland Clinic.

There aren’t large studies involving medication treatment for sexsomnia at this time, but there are smaller case studies documenting what has worked. One case study found the SSRI paroxetine worked to resolve sexsomnia for one patient. This patient experienced worsened sexsomnia symptoms when he drank alcohol, so he was treated with the SSRI rather than a benzodiazepine, which could have similar effects to alcohol.

Finally, sexsomnia that’s caused by seizures can be treated with the anticonvulsant medications carbamazepines, according to previous research.

Alternative and Complementary Therapies

Counseling or therapy can also be helpful in dealing with sexsomnia, a case study published in 2021. This is recommended for the person experiencing sexsomnia, as dealing with the episodes can bring up all sorts of difficult emotions and situations.

It also may be helpful for anyone affected by sexsomnia, such as the person’s partner. This person may have concerns about safety or question the integrity of their relationship with their partner, and a therapist or counselor may be able to help work through those feelings or encourage communication between the two partners, according to the Cleveland Clinic.

RELATED: How to Find a Therapist Who's Right for You

One of the most common negative effects of sexsomnia is the embarrassment it causes. “Sexsomnia patients feel ashamed of their acts and fear that their secret will be exposed within various relationships, whether familial or social,” Kilkenny says.

For instance, in the case study from 2021 mentioned earlier, a patient sought help from a healthcare professional after her sexsomnia episodes spurred relationship issues with her husband. He felt insecure that he was not satisfying her sexually and thought she could be cheating on him because she said the names of other men in her sleep.

“The bed partners can suffer in feeling afraid of not sexually satisfying their partners, or they fear betrayal by the patient,” Kilkenny says. “They also feel the shame of the situation being exposed in their other relationships.”

There’s also the possibility that the sexual activity is aggressive and can lead to physical injury or even sexual assault. There may be legal consequences associated with sexsomnia, such as when sexual acts involve another person without their consent.

There have been several cases where sexsomnia was used as a defense for the criminal prosecution of sex crimes, according to a review of case law. It’s controversial, however, and precedent shows it thus far has rarely cleared someone from guilt.

It’s hard to say how many people experience sexsomnia. Someone may not know they’re doing it unless a partner or someone else witnesses the act, and they may feel too ashamed to admit it. However, research found nearly 8 percent of people at a sleep center exhibited signs of sexsomnia.

Take that with a grain of salt, however. “This number is misleading as it only accounts for observations during sleep studies,” Sullivan says. The number is likely to be lower among the general population, and, to complicate things further, sexsomnia often goes undiagnosed. “A majority of patients don’t feel comfortable discussing their symptoms to obtain a proper diagnosis,” Sullivan says.

Overall, sexsomnia is extremely rare. “In almost 30 years of practice, I have had only two patients present with the disorder,” Kilkenny says.

In general, men experience sexsomnia more frequently than women (up to 3 times as much), according to the sleep center research. “Men are more likely to exhibit more aggressive symptoms, such as fondling, sexual aggression, and sexual assault,” Sullivan says.

As mentioned, sexsomnia could be connected to another sleep-related disorder or seemingly unrelated health condition. Here are the most common conditions related to sexsomnia:

• Sleep apnea
• Anxiety
• Fatigue
• Sleepwalking or sleep talking
• Restless leg syndrome
• Heartburn
• Epilepsy
• Head injuries
• Migraine
• Crohn’s disease
• Colitis
• Kleine-Levin syndrome
• Narcolepsy
• Persistent sexual arousal syndrome
• Nocturnal psychotic disorders

The Takeaway

Sexsomnia is when a person engages in acts of a sexual nature while sleeping. These can include masturbation, thrusting, intercourse, or spontaneous orgasm. To be classified as sexsomnia, the person engaging in these acts needs to be unable to wake up, very difficult to wake up, or unresponsive to conversation during the acts. The exact cause of sexsomnia is not known, however, like other parasomnias (such as sleepwalking), it usually occurs when one phase of sleep suddenly changes to another. Factors such as the use of recreational drugs or alcohol, sleep deprivation, anxiety and stress, or fatigue may trigger episodes of sexsomnia. Over-the-counter sleep aids may also be a factor. Treatment for sexsomnia centers around identifying the condition and addressing the cause, so talk to your doctor about getting the appropriate help.