As sleep medicine researchers continue to uncover the biological basis of many sleep disorders, one category of nocturnal behaviors (called parasomnias) remains mysterious and often misunderstood. A review in the Journal Sleep (Vol. 30, No.6, 2007, p. 683) discussed the classification of abnormal sexual behaviors and experiences during sleep – called Sexsomnias. The authors conducted a computerized literature search relating to sleep and sex and compiled data from 31 published cases of sexually-related parasomnias and 7 published cases of epilepsy with abnormal sleep related sexual behaviors. Sexsomnia is a form of Non-Rapid Eye Movement (NREM) parasomnia where individuals engage in sexual acts while they are sound asleep and without memory for the behavior.

The authors stated that there are many categories of parasomnias, such as confusional arousals or sleepwalking, with or without obstructive sleep apnea (OSA), as well as REM sleep behavior disorder (acting out dreams). Other parasomnias include sleep exacerbation of persistent sexual arousal syndrome (PSAS), sleep-related painful erections or nocturnal psychotic disorders (sexual delusions / hallucinations after awakenings).

A Range of Behaviors Described

Numerous sexual behaviors in sleep have been described, both in the scientific literature, as well as in the press and media. Often, those affected by Sexsomnias will exhibit vocalizations, such as talking or shouting, as well as more dramatic, and overt behaviors including agitated or assaultive sexual behaviors. It is important to keep in mind that with Sexsomnias, the person is unconscious to the behavior and may not remember anything about the episodes upon awakening.

Men and Women Exhibit Sexsomnias

This review of the literature shows that Sexsomnias occur in both men and women, but more frequently in men. The review also demonstrated that Sexsomnias primarily affect people in their twenties and thirties.

Because of the intimate nature of these conditions, a lot of discussion has taken place regarding the forensic and possible criminal aspects of abnormal sleep-related sexual behavior. Clear identification and treatment of these parasomnias is crucial as the implications of these unwanted behaviors can sometimes result in dire consequences if left untreated.

Causes of Sexsomnia can be Identified and Effectively Treated After a Sleep Study

The International Classification of Sleep Disorders, 2nd edition (ICSD-2) recognizes this phenomenon as a parasomnia and has classified Sexsomnia as a variant of confusional arousal and sleepwalking. There is increasing awareness and knowledge surrounding Sexsomnia, as this is often quite dramatic and difficult to explain. More importantly, many causes of Sexsomnia can be identified and effectively treated following clinical evaluation and polysomnographic (PSG) testing by a sleep specialist.