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A 38-year-old man repeatedly tries to force his wife to have sex in the middle of the night but has no memory of his actions when he wakes up.

A married woman in her mid-20s often tears off her clothing and masturbates but remembers nothing when her partner rouses her.

For a dozen years, a 31-year-old man masturbates while asleep, at times injuring his groin. Embarrassed due to his unconscious behavior, he avoids relationships for eight years.

These are all clinically documented cases of sleep sex, or sexsomnia, part of a family of sleep disorders called parasomnias that include sleepwalking, sleep talking, sleep eating and sleep terrors.

While it may seem as if people are acting out dreams, many parasomnias occur when the brain is not in a dream state, said Dr. Carlos Schenck, a professor and senior staff psychiatrist at the Hennepin County Medical Center at the University of Minnesota.

“These are disorders of arousal,” said Schenck, who has studied parasomnias for decades. “They most often occur during the slowest, deepest stage of sleep, called delta sleep. It’s like an alarm or trigger goes off in the central nervous system, and you go from your basement to your roof in no time flat.

“Your cognition is deeply asleep, and you’re not with the program, but your body is activated,” Schenck said. “That’s dangerous because then you start walking and running and doing all sorts of things without your mind being awake.”

It’s difficult to study sexsomnia, because unless people injure themselves many have no idea of their unconscious sexual activity until a bed partner tells them about it.

A 2010 study quizzed 1,000 randomly selected adults in Norway and found about 7% had experienced sexsomnia at least once during their lives, while nearly 3% were currently living with the condition.

“There are some people who will engage in sexual activity with their partner, and it’s not bothersome to either one of them. So it is possible that this could be consensual for some,” said Jennifer Mundt, assistant professor of sleep medicine, psychiatry and behavioral sciences at Northwestern University’s Feinberg School of Medicine in Chicago.

“There are definitely instances where it’s alarming to the partner and to the person who’s doing it once they realize what they’ve done.”

Sexsomnia can ruin lives

The episodes first began in 2005, according to one woman’s husband. About twice a month his wife would moan sexually and engage in “dirty talk,” words she never used while awake, he told Schenck, who treated the woman and published her anonymous case in 2021.

At times the woman would fondle her husband during the night, and they would engage in sex until she became conscious and accused her husband of forcing sex upon her.

She also masturbated while calling out other men’s names, including that of a male coworker, leading her husband to believe she was cheating on him. However, partners should not assume people with sexsomnia are allowing a secret to escape from their subconscious, Schenck said.

“The sleeping brain is wired very differently from the waking brain,” he said. “You’re not conscious when you’re asleep, so you can’t reach any valid conclusion about so-called lying or truth-telling in your sleep.”

The woman refused to believe her husband’s descriptions of her behavior for years, finally seeking professional treatment in 2015 after her 9-year-old son heard her moaning sexually while asleep.

“That was terrible, terrible,” Schenck said. “And what is really disconcerting to these patients is they have total amnesia. It’s the bed partner or family member telling them, ‘You did this, why did you do that?’ and then the patient says, ‘I don’t remember anything.’ So they are really embarrassed, full of shame, very apologetic and totally miserable.”

At times, people have even been arrested over their behaviors. “There certainly can be legal consequences from the sexual behaviors, particularly with minors, and also with aggressive behaviors during sleep,” Schenck said.

“There’s a whole area of sleep forensics to deal with these issues,” he said. “They do very comprehensive evaluations, case histories, and interviews with relatives and others to sort out about whether it’s an excuse or the real thing.”

What triggers sexsomnia?

There’s no way to predict that you will develop a parasomnia. Some people who have sleep talking or walking as children do develop sexsomnia or another parasomnia as adults, but many others do not, Schenck said.

“We don’t know the ultimate cause, but there is a genetic component,” he said. “If you have at least one first-degree family relative with a parasomnia, you are more likely to develop one. Then the more first- or second-degree relatives that have a parasomnia, the more likely the condition may persist into adulthood or reoccur.”

Having obstructive sleep apnea may also be a trigger. Also called OSA, obstructive sleep apnea is a serious sleep malady in which breathing stops for 10 seconds to two minutes many times per hour each night. The condition mostly occurs in men, although more women are now developing it.

“It’s the breath holding or apnea from the obstructive sleep apnea that triggers the arousal, typically in men, which then triggers the sexual behaviors in sleep,” Schenck said. “After you diagnose sleep apnea and you treat the patient, treatment not only controls the sleep apnea, it also controls the secondary sexsomnia.”

There are medications such as clonazepam, a drug used for epilepsy, restless legs syndrome and panic disorder, that can successfully control unwanted sexsomnia for many but not all.

Medication did not help the 41-year-old woman whom Schenck treated after her son overheard her, but quitting her high-stress job did. She began sleeping solidly for six to seven hours without any recurrence of her sexsomnia.

“It’s so interesting, because a lot of people with stress become hyposexual, not interested in sex,” Schenck said. “And for others, it’s the other way. So there’s no 100% absolute rule.”

Behavioral treatments are also available

Medication for sexsomnia has side effects and can become habit-forming. People who don’t wish to use drugs can try various behavioral approaches to control the condition, said Northwestern’s Mundt, who published a review of such treatments in September 2023.

“From the literature and from my own experience, it’s definitely true we can reduce the symptoms dramatically or possibly eliminate the symptoms for some people,” she said. “Others may only have a partial improvement or no improvement, and that’s where medication might be necessary.”

Education comes first, Mundt said, because many people don’t understand sleep stages and how sexsomnia is different from nightmares or the acting out of vivid dreams.

During the first and second stages of sleep, your body starts to decrease its rhythms. Then comes the third stage — a deep, slow-wave sleep in which the body is literally restoring itself on a cellular level. Rapid eye movement sleep, called REM, is when dreaming occurs — in this final stage the body becomes paralyzed so that you cannot act out your dreams and hurt yourself.

Since each sleep cycle is roughly 90 minutes long, most adults need seven to eight hours of relatively uninterrupted slumber to achieve restorative sleep, according to the US Centers for Disease Control and Prevention.

“Education in itself is a treatment strategy because often that really helps to reduce the person’s anxiety, and if we can reduce stress and anxiety that helps,” Mundt said.

“Then I will target sleep hygiene such as reducing caffeine or alcohol, keeping a more consistent sleep schedule, keeping the bedroom cool and eliminating noise in their environment,” she said. “Relaxation techniques come next, and if we need further strategies, I might move to hypnosis.”

Clinical hypnosis is nothing like the magician working his act on audience members, Mundt said. Instead, it’s encouraging a person to move into a daydreaming or trancelike state voluntarily.

“It’s like you’re riding on a bus and you’re looking out the window, and you’re not even seeing what’s in front of you because you’re so lost in thought,” she said.

A trance state is clinically useful because people are more open to new ideas, suggestions and imagery such as seeing themselves sleeping calmly and peacefully through the night, she said.

“In some ways, it’s similar to having a parasomnia episode,” Mundt said. “People vary in how easy it is for them to get into that trance state, but it can be very, very effective.”

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