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    Sexsomnia: A Sleep Disorder With Sexual Behaviour
    By Richard Mankiewicz | March 5th 2010 01:56 AM | 22 comments | Print | E-mail | Track Comments
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    Making love in the middle of the night while both of you are half asleep is undoubtedly pleasurable. But what if you suddenly realize that your partner is still asleep; not just half asleep but fully asleep on the job? If so, then he or she may be suffering from sexsomnia, a rare sleep disorder involving sexual behaviour.

    Strangely, the first paper to discuss sexsomnia appeared as late as 1996 in Sleep Research where it was still called “sexual behaviour in sleep” (SBS). The first attempt to define this seemingly new sleep disorder was in the June 2003 issue of The Canadian Journal of Psychiatry. In this research, sexsomnia is classed as one of many parasomnias, which also include things such as sleep-walking and talking. A parasomnia in general is a dissociated sleep state with a partial arousal due to a transition between the sleeping and waking states. But whereas sexual dreams and sleep orgasms have been well documented, why has sexsomnia only recently emerged from under the covers?

    One thing that sets this disorder apart from all the other parasomnias is that it most often involves a second person. If that person is your partner then they may not even be aware that you're actually still asleep and be a willing participant in the act. One commenter on a New Scientist article admitted that this is exactly what happens, and it is only when he sometimes awakens from his sleep state that he is shocked to find what he is in the middle of doing. His concern is whether in the future he may do something harmful to his partner yet be completely oblivious to his actions.

    Indeed, although the neurophysiology of such behaviour remains unknown, it has not taken long for it to be accepted as a defence against some alleged rape cases. The first such case was in 2005, when a Toronto court acquitted a man of sexual assault because he claimed to suffer from sexsomnia. The court classed his state of mind as “non-insane automatism”; he could not be found guilty as he had no conscious awareness of his actions. The Ontario Court of Appeal later upheld the original decision but expect the man to undergo a mental health review to decide on appropriate treatment – this last aspect is still to be decided. In legal terms, sexsomnia is thus being treated as a form of sleep-walking.

    Although it is still not known why some people suffer from this condition, the above case also highlights some of the common triggers, which include previous sleep deprivation and an excessive consumption of alcohol and other drugs. These, plus stress, are also well-known triggers for other parasomnias such as sleep-walking. However, such sleep disorders are considered common in children (an estimated 15% of the child population) and to decrease in adulthood (to about 6% of the population), and yet are thought normal in children but a psychopathology in adults. But perhaps such parasomnias do not suddenly disappear in adulthood but go largely unreported, sometimes becoming sexual.

    One case study in the CJP article was of a man diagnosed initially with sleep-driving; his sexsomnia came out purely by accident. “This emerged at a “routine” follow-up at which the first author had commented to Mr W that his “sleep-driving” was being rivalled as the most unusual of parasomnias. A description of sexsomnia was given, and Mr W responded by saying “Oh, but I do that.” The disingenuous response by the interviewer “but you never told me” was followed by Mr W saying “but you never asked.” Mr W’s 2 current girlfriends independently confirmed that he frequently engages in sexual behaviour while asleep. One describes him as a “different person” during these activities—apparently, he is a more amorous and gentle lover and more oriented toward satisfying his partner when he is asleep.” Now, you can understand perfectly why this woman was not going to complain about a mere sleep disorder.

    But isn't a plea of sexsomnia just too easy to fake? Not under a polysomnograph (PSG), which measures different brainwave patterns during sleep. In all the researched cases slow-wave sleep (SWS) is interrupted by inexplicable flashes of arousal from alpha-waves. Some researchers think these may be mild epileptic discharges. Such intrusions into deep sleep seem necessary but not in themselves sufficient to trigger an episode of sexsomnia. The subjects also generally had experienced multiple types of parasomnia throughout their lives, so that the sexual angle was just one dimension of an overall problem in their sleep pattern.

    The New Scientist article mentioned above was about a woman who would have sex with strangers while sleep-walking, thereby combining somnambulism with sexsomnia. The woman was happily married so this was a shock both to her and her husband. Repressed sexual fantasies tend to come out in dreams rather than sexsomnia – there is no satisfaction in being unconscious of acting out such fantasies. Sexsomnia is classed as a non-REM (NREM) parasomnia and hence outside of the classic dream state. But how accurate is our current knowledge of what goes on during sleep anyway?

    Our common picture of sleep being divided into a dreaming REM phase and a deep-sleep NREM phase is starting to show serious cracks. The phase changes between conscious wakefulness and sleep can be experienced; they are now called hypnagogia and hypnopompia. Other parasomnias puncture the NREM phase and yet are not dreams. There seems to be a prevalence to define anything out of the ordinary as a disorder when in fact it could just be uncommon because unspoken of out of ignorance. A cursory look at Sleep Yoga and Dream Yoga from the Dzogchen school shows accurate descriptions of these phase changes, how to generate them and how to be aware of what the experiences are. People are often frightened by such experiences, such as sleep paralysis, because nobody has taught them that the experience is normal, in the sense that it happens every night, yet unusual, in that we usual slip through that phase change without noticing. The idea that we exist in one of two states - conscious or sleeping - may need to be replaced with a range of intermediate states.

    The CJP article ends with some interesting thoughts. Looking at the whole range of parasomnias, it seems that humans are perfectly able to walk, talk, eat, drive a car, have sex and even kill, all completely unconsciously! This is a life with our consciousness wide shut. Where has our awareness gone? How can we do so many things, and do them perfectly adequately, without a consciousness being conscious?

    “First, one must consider whether it is possible to perform complex acts while asleep. To answer this, we should view the brain as a network of different groups of neurons, which may be variably active. Many subcortical and cortical neurons are indeed inactive during sleep. However, the reticular formation and hippocampal structures, for example, will react even during sleep to any external stimuli, initiating movement to preserve the integrity of the body. On the other hand, cortical structures are normally very active during REM sleep as part of the dream mentation. Also, a good measure of primary and secondary (higher-order) functioning is preserved during sleep, which may give an impression that, during a parasomnic episode, something exists that could be viewed as purposeful act. However, a person experiencing a parasomnic event does not have a fully “awakened” brain—some of the cortical structures, such as those responsible for memorizing and learning or those that help us to distinguish events from objective reality and intrinsic experiences, remain inactive, making some of the higher-order functions, including the consciousness, impaired.”

    In the Sleep Yoga I mentioned, one is trained to remain aware during sleep. That may sound impossible to those trained to think of sleep as a dark oblivion but these glimpses into parasomnias show us that awareness may be possible in some of these states. Without memory there is no recall of past events. Is it still possible to be aware during an event and yet not have it stored in memory? Such questions have to be left for another time, and yet the researchers concede that there are important philosophical and neurophysiological questions. As in the case of the sleep-driving sexsomniac, sometimes the most important step is in asking the right question.


    Courtesy of David Shankbone.

    Coming back to sexsomnia, there are a few treatments available but, as the condition is very new, I would consult a real expert on this to get a complete picture of other possible parasomnias. You don't want to be taking Clonazepam for no good reason. But before any treatment must come a diagnosis and, much like sleep-walking and sleep-eating, the first indications of a problem may well come from another person, most probably your partner if you have one. The problem is that you may at some point end up sleeping with someone who is less understanding and the truth may come out in a public court rather than the privacy of a clinic. For those who think this sounds like fun, remember that it's done unconsciously and the person doesn't recall doing it – now where's the fun in that?

    Comments

    jtwitten
    This supposed case study is a great example of the need to be careful with evidence:
    One case study in the CJP article was of a man diagnosed initially with sleep-driving; his sexsomnia came out purely by accident. “This emerged at a “routine” follow-up at which the first author had commented to Mr W that his “sleep-driving” was being rivalled as the most unusual of parasomnias. A description of sexsomnia was given, and Mr W responded by saying “Oh, but I do that.” The disingenuous response by the interviewer “but you never told me” was followed by Mr W saying “but you never asked.” Mr W’s 2 current girlfriends independently confirmed that he frequently engages in sexual behaviour while asleep. One describes him as a “different person” during these activities—apparently, he is a more amorous and gentle lover and more oriented toward satisfying his partner when he is asleep.” Now, you can understand perfectly why this woman was not going to complain about a mere sleep disorder.
    The patient (and the "independent" verification) only claimed sexsomnia after a very strong suggestion by the interviewer, including a challenge to a characteristic that made Mr. W seem unique to himself.

    This type of suggestion also underlies the pseudoscience of "repressed memory" that put many innocent people behind bars.

    Thanks for providing a lovely example to use in understanding how to evaluate evidence as part of the scientific method.
    rychardemanne
    Perhaps you forgot to read this part:
    But isn't a plea of sexsomnia just too easy to fake? Not under a polysomnograph (PSG), which measures different brainwave patterns during sleep.
    This is psychology, not Lego, and an attempt to define a new condition so that it can be diagnosed in others in the future. What method would you suggest? Not asking research subjects? Questionnaires, corroborating evidence from partners plus EEG and polysomnograph studies were combined.

    One anecdote is not the whole research - and you attempt to attack one anecdote using a "pseudoscience" (your word) in your defence. Up to you!
    jtwitten
    I didn't question the existence of the disorder. I questioned the use of this suspect piece of evidence - a very dramatic anecdote -  in describing it. That paragraph is a great one for asking a student, "What is wrong with this evidence?" - except that asking the question that way is biased also. The suggestibility of the human mind is psychology.

    I'm sorry you do not Legos. Perhaps you prefer Construx or Tinker Toys?
    These are very interesting views. As a wife of a narcoleptic, I find the sexsomnia occurred but ended with
    a cataplexic response meaning I sometimes had trouble getting out from under his collapsed body.

    Well, I guess it isn't as bad as my condition of pavor nocturnus (pardon me if my Latin is a little off; it's been over 30 years since I studied it....it means 'night terror'). Imagine going through a closed bedroom door while completely asleep and turning the darn thing into a pile of splinters with your hands and feet and not recalling anything of what happened when you woke up!

    I think the 'terror' part is when you wake up and realize what you've done while completely asleep. At least, that's how it was for me. It took over two decades before 1) the right medications were put on the market and 2) the right combination of benzodiazpines, atypical neuroleptics, and an SSRI was finally administered to get this condition under control.

    By the way, being an expert on psycho-pharmacology, I played a very active role along with my doctor in figuring out which combination of medications and at what dosages would do the trick. It took us two years to get the balance right. But, I'm proud to say that we did it! I now sleep like a baby. ;-)
    rychardemanne
    I've got an article on the way re psychiatry v psychoanalysis. As always, thanks for sharing your personal insights. I went through a similar process of negotiating meds until I found a leading expert who said I was misdiagnosed so threw the lot away! But on the above clash, do you think there are conditions that can only be attenuated (I daren't say cured) with medications and that non-pharmacological therapies should be rejected?

    I'll be writing on some of the other parasomnias soon too.
    No, of course not, Richard. As I a matter of fact, I think medications are used far too frequently and non-pharmacological therapies used not enough. Certainly, there are certain conditions which are inherited and require medication. But even those are exacerbated by trauma and abuse during the formative years.

    On the contrary, I think these "medications" are used far too often because it's a quick fix. But these drugs are extremely crude and can do more harm in the long run than good. And most people don't realize this, but no one really knows how the drugs work in the human brain. Psycho-pharmacology is more art than science. 95% of the information we have on these drugs has been extrapolated from lower organisms.

    Besides, I think the empathetic ear of a good friend or the hug from a loved-one, can have far more of a therapeutic effect that any pill or combinations of pills. I think most people are suffering more from loneliness and fear because they feel that there's no one to turn to in their time of need or that no one can or does understand what they are experiencing internally. I think that's why there are so many suicides each year.

    But at the same time I recognize that there are certain psychiatric conditions that require medications. But that doesn't mean a good friend can't go along with the medication. I think we have substituted emotional intimacy with pills in our society, and I can't think of a more destructive trend than that. And any psychologist or psychiatrist worth their salt knows that any psychological process in time will override any biochemical one. And if a person's problems are emotionally based, throwing pills at them is only a temporary fix. We are more than just a sack of water and neurotransmitters!
    I "suffer" from this!

    I had no idea it was "rare"!

    Many times in the past I've been told the next morning that I'd been groping my partner during the night. On at least one occasion I've gone all the way, but usually it's hands only. And what you said about pleasing my partner seems to fit as well (not that I don't do that while awake…). I don't think I've ever had an orgasm while asleep.

    Unfortunately, on a couple occasions I've groped unwilling partners while sleeping in close quarters, for example while camping with friends. My girlfriend at the time stepped in to say that yes, this was a "normal" occurrence and yes, I was totally asleep and had no memory!

    Only once have I had an unambiguous memory of waking up during the act. If my partner makes me stop then usually I don't wake up, or if I appear to, then I have absolutely no memory afterwards. On this one occasion, I remember thinking "The Universe would be perfected if only my hand were down my wife's pajamas!" It was a very satisfying experience, knowing that I was bringing order to chaos, the Universe was complete. (Really.) Clearly there's a bit of a dream-like consciousness involved…

    Finally, perhaps the strangest thing of all.

    I've been aware (or rather made aware, since I have no memory myself) of this since college.

    My wife and I did not have sex before marriage (although I was not a virgin). While we were dating and engaged, she will confirm I groped almost every night we spent together. (She'd politely remove my hand, fall back to sleep, and tell me about it in the morning.)

    After marriage, I hardly grope anymore at all!

    And I don't think it's about frequency of actual sex, or satisfaction…I had sex with my girlfriend in college, yet the groping continued. Maybe this is God's way of showing me I'm finally where I should be, in a sanctified relationship…some part of my subconscious is finally satisfied!

    There's my story.

    P.S., I have no compulsive disorders that I'm aware of…no gambling, drugs, alcohol abuse. No night terrors. I don't sleep walk or perform any other tasks while sleeping that I'm aware of.

    And fortunately, though it was frequent in the past, my sexsomnia seems to be mild compared to some people who actually have sex, or aggressively or actively seek sex. Whether awake or asleep, I stop when asked :-)

    rychardemanne
    I remember thinking "The Universe would be perfected if only my hand
    were down my wife's pajamas!" It was a very satisfying experience,
    knowing that I was bringing order to chaos, the Universe was complete.
    It strikes me as that a lot of people may have that experience! (not your particular wife's pyjamas!) but the feeling that what we are doing has to be done because it fits. Perhaps an element of compulsion should be added in the official diagnosis - and perhaps for all the other parasomnias too. Difficult to establish or measure if it remains subconscious. [sorry, this comment has ended up under the wrong message, but looks like the same Anonymous. It fits!]

    Thanks a lot for sharing your story.

    And like you say, if you're in a loving relationship this may never come out as a disorder but just be careful if there are situations with other people.
    Haha, thanks Rycharde, my wife and I had a good laugh at that one! :-)

    (Yes this is all the same Anonymous)

    rychardemanne
    We are doing a documentary series on Sexsomnia for a major cable network. This is a serious medical show that will also be dealing with night eating, sleep walking, etc. Please contact us for more information:


    [email removed. Although I am happy to have a link to the production company making this program, I think a mere gmail address does not build confidence. I have therefore left the comment so that the poster can supply more transparent details. RM]
    Rycharde, I have this disorder as well. You apparently seem quite awake, and as it was put above, more amorous. I would be interested in being involved in studies or documentaries, to bring awareness and new knowledge to this disorder. Your contact info was removed but you can reach me at brianwjackson@gmail.com

    My husband suffers from this. We've been married 6 years and he's done it as long as we've been together. Only this year did we finally realize what was truly going on. I remember when we first were married and I had to be to work very early. The fondling and groping was done in intervals throughout the night, but then he would roll over and go back to sleep. Or so I thought...he never woke up. He also would act out his dreams. During waking hours if he was really into a good book or video game, or if we had watched a good movie right before bed...then those were his dreams. If someone was chasing him, if he was on a pirate ship. Then there was the fantasy books. Elves, dragons, leprechauns and sex. I can't tell you how many nights this would happen and I just got used to it. Then this last year, it not only became more frequent (like almost every night) but a bit more dangerous. Twice he had his fingers to my throat, not in an aggressive manner but definitely applying pressure. Also some of the sex started becoming more aggressive. At that point, we knew he needed to be seen by someone. He was prescribed Clonazepam, and things did slow down a bit. In fact, I have to admit that I actually miss some of those midnight awakenings. I feel guilty saying that but I got so used to being woken up in that manner. It's easy to understand why more people don't report this condition. It definitely has some good points, but do you really want to take a chance that one night could be a really bad one? Well, I could go on forever. Just wanted to give another viewpoint.

    My husband suffers from this. It is awful. But he isn't amorous or more generous, he is aggressive and frightening, refusing to stop, pinning me down, etc. We have children and not a night goes by that I don't wonder & worry what might happen to them. This sleep disorder is a horrible. Please don't compare it to sleepy love-making. When it's bad, it should be called "rapesomnia."

    There is a Polish website on this topic:
    seksomnia.blox.pl

    I'm not sure if this is what's happening to me or not.

    I've always been a night-groper. It doesn't seem to be a completely unconscious act, however. I never remember actually starting starting to grope the other person, but, generally speaking, if it progresses and we go all the way, I usually "wake up" somewhere before the actual act occurs. It doesn't always progress this far; quite often I suddenly stop and simply go to sleep. I sometimes vaguely remember the fondling. Like some of the users above, at the time, it seems important somehow, like it's a "task" that requires completion or something. However, I've never groped a male; in fact, it seems to occur exclusively when I'm sexually attracted to the person sleeping next to me. For this reason, I'm suspicious of myself--I sometimes wonder if I'm "faking" the whole thing or something, somehow, like if I'm just justifying my actions after the fact. However, it's happened in enough circumstances now that I don't actually believe that this is the case. In several incidents, my partner told me that she firmly rejected my advances, then that I slept for a while and tried again. I'm not like this when I'm conscious; my partner's enthusiasm is an important part of my sexual arousal when I'm conscious. I've always been terrified that I might do something when sleeping with a friend or something, like on a camping trip, as one of the previous comments mentioned, or something like that.

    With me, these events seem to be associated with sleep deprivation. It almost always happens when I haven't been getting much sleep, or if I've stayed up way, way too late. I'll sometimes be feeling a sense of delirium, in a weird way, like my head is foggy and empty all at once. It generally happens after I've been in bed for at least 20-30 minutes or so. I'll gently stroke my partner's body and eventually (usually fairly quickly) target her genitals. I almost never stroke her breasts, which, again, is unusual for me, because the breasts are generally a focus of my attention when I'm awake (one of my favorite parts of her body).

    I've occasionally had other strange things occur when I'm sleeping, but nothing like sleepwalking. Sleep-paralysis was a common (and terrifying) occurrence when I was younger, although it's not as common now. I'll occasionally have a lucid dream (sort of; I rarely have any control over the events, just a clear awareness that I'm dreaming and complete memory of the dream when I awaken). Once, I had an unusual incident that scared me; I woke up to find a clock radio I had next to my bed smashed to pieces. Nobody else had been in my room. My hand had scratches on it, and was a little sore. I had no memory of the event. It worried me.

    I've (luckily) never been in a position in which this sort of sexual behavior was a particularly undesirable occurrence until very recently, and even then, quite thankfully, the other person was very understanding (perhaps a bit amused) by the situation. I'm still very embarrassed by the incident, however, and I'm too ashamed to tell my partner--I'm worried that she wouldn't understand, even though she probably would. I don't know. I don't really want to seek any sort of professional help; the whole thing just seems stupid and embarrassing. It wouldn't really be possible anyway; I'm working in Japan at the moment, and they'd probably just thing I was either a complete pervert or completely insane.

    I think my husband may have this. He has constantly groped me while asleep for years (we've been together for six and married for two). I'm lucky because he has always been VERY attracted to me and wants sex all the time, which I know is not the case for all couples...but I fear that it's because of this combination of constant both day and night advances that make me not want to respond to him physically anymore.

    The "sleep groping" bothered me but never as much as recently. We spent the night at another house and had been drinking a good amount. We went to bed and he right away attempted to have sex. When I drink, I am almost never in the mood and I'm tired and just want to fall asleep, and so I kept refusing him. He stopped, but later persisted throughout the night, sometimes aggressively, and even swearing at me when I pushed him away. At one point, I awoke to find him standing next to the bed and masturbating less than a foot away from my face. It was dark and I only could see shadows, but it was obvious what he was doing. For whatever reason, I chose not to tell him that I was awake. Maybe cause I didn't want to embarrass him, or because I was embarrassed, I don't know. I was horrified. He eventually made it back to bed and I fell back asleep.

    He remembers nothing except the original advance he made when we first got to bed, and is just as horrified.

    I'm not sure where to go from here. I don't want him to take medication and I know he wouldn't want to either. He is a wonderful man and husband and I love him dearly. We've been to counseling before and I suppose I will explore that again. I know there are some people on the receiving end that are like, well this is a nice surprise! But as evident by reading some of these posts, there are those like me that just feel violated...and there's nothing nice about it. And I sympathize with the men who are ashamed of their own unconscious acts because my husband would never knowingly make me feel violated or scared in ANY way.

    I'm glad I came upon this site. Good to know there is info out there.

    My husband does this. He has for as long as I have known him. We are currently going through a rough time in our marriage and he hasn't wanted to be intimate with me while awake but he still is while sleeping. He only gropes me and it has never gone further than that but I wouldn't be surprised if it did one day. To be honest, it doesn't bother me in the least but that is because he isn't aggressive and he only does it about once a week (sometimes less).

    I was with a boyfriend for 10 years in the 90s who had this condition - if - heaven forbid - anything ever happened where he was implicated, I would still jump straight to his defence.

    interestingly, his sexual style when asleep was totally different. Obviously not much varation in position, but he was much more verbal when he was asleep - much more passionate, persistant and exploratory. I eventually learned to use the whole thing to my advantage.

    When he used to wake up the next morning and I'd tell him we'd had full on sex he'd often be quite disappointed that he'd missed the whole thing. Oddly, the only dreams he ever reported having were a recurring dream of a wolf chasing him or 'total darkness in which I knew I existed in a dream state'...

    vongehr
    it seems that humans are perfectly able to walk, talk, eat, drive a car, have sex and even kill, all completely unconsciously! This is a life with our consciousness wide shut. Where has our awareness gone? How can we do so many things, and do them perfectly adequately, without a consciousness being conscious?
    This is silly. Of course a person is conscious (e.g. is conscious of the visual field), stuff is just not put into memory and the person acting is different (different mix of neural circuits/ brain modules compared to the daytime mix, especially the pre-frontal cortex censuring being suppressed). It is multiple personality disorder plus amnesia (dreaming usually is) minus the paralysis.
    I have so much I could say on this topic. Nearly all bad. I believe I'm a good person but have spent two years in prison due to this condition that I am unable to control. Even if, for some people, it is turned in to a positive, as mentioned in several of the comments above, sexual contact should never happen unless both partners are consenting. Therefor if your partner is knowingly, by you, to be doing this in their sleep then surly if they are not consious of this then you are in the wrong for letting it continue to happen. This condition has ruined my family life and my relationship with my beautiful wife and children, three of which I have been disallowed to see for three years, I am now labelled a sex offender due to this condition.
    I'd better stop now as I'm finding this very upsetting.
    My full empathy goes to all parties concerned, suferers and victims.