As a sleep specialist, I am often reminded how our sleep affects those who sleep with us. One particular disorder, sleep sex or sex somnia, can have a particularly psychosocial effect.
I was reminded of this recently when a 30-year-old man and his wife came to my office seeking help. Apparently, the patient has been having sex with his wife every night for the past three years and not remembering the event at all.
Sleep sex, a form of parasomnia, has only recently been described in sleep journals. It was first named a sleep disorder by Canadian researchers in 2003.
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Patients with sex somnia engage in sexual activity, including masturbation and sexual intercourse, and awake with no recollection of the activity. Understandably, patients and their partners can be injured during these episodes, which can be violent and may involve rape.
Sleep sex may be under reported due to its sensitive subject, but prevalence is believed to be around 1% to 4% of the population. It affects more men than women and can happen at any age. Triggers include increased stress, alcohol or recreational drug use and sleep deprivation.
Sleep sex may also coexist with other sleep disorders including sleep walking, sleep talking and sleep eating.
Interestingly, for some patients, the mere presence of someone sleeping with them can cause sex somnia events to occur. My patient’s wife had tolerated the acts over the years but now found her own sleep neglected. Sometimes the patient would wake her up as many as three times a night.
Between her job, her 2-year-old child and her husband waking her, the wife had also become sleep deprived. She also reported feeling violated by the episodes, even though she knew her husband was unaware of what was occurring.
The wife said she wanted to be able to sleep with her husband but was becoming more convinced that sleeping separately may be the best solution. He had started sleeping on the couch to avoid “attacking” her during the night.
Sex somnia is embarrassing for couples to talk about, and they are less likely to talk to their friends or family about it than other sleep disorders. As a provider, you may be the first person they confide in.
Treatment options vary, but the recognized treatment is clonazepam. Some patients have also benefited from melatonin and antidepressants. Sleeping separately may also be helpful. Counseling may be beneficial in dealing with the associated shame, embarrassment and fear that patients and their partners feel.
My patient has done well on clonazepam and is now back in bed with his wife. She says there are still episodes of sleep sex, but they occur only occasionally and usually only when her husband is really tired or stressed. As for any couple that deals with this parasomnia, communication about the subject is important and necessary.
Sharon M. O’Brien, MPAS, PA-C, is a practicing clinician with an interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.
