One of my clients, who recently moved in with his girlfriend, called me because she had threatened to break up with him after accusing him of trying to have sex with her in the middle of the night when she was fast asleep. He insisted that he had no recollections of it at all, but she did not believe him.

I was not surprised — he was suffering from a condition called ‘sexsomnia’, a disorder that involves engaging in sexual behavior while still asleep, which is very rare. Not many people, even doctors, know about it. It was added in 2013 to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Understanding Sexsomnia

Sexsomnia, or the more common name ‘sleep sex’, is a type of parasomnia where the brain is caught in a transition between sleeping and waking states. It is most likely to occur in the first few hours of the night, during the deep sleep state. At this time, the cortex — the thinking, planning, and awareness part of the brain — gets switched off. But the brain stem, the part responsible for basic urges like the drive to eat or have sex, is still working.

During this stage, the sexsomniac is acting completely without inhibition. As with other parasomnias like sleepwalking or sleep talking, someone who is sleep sexing can seem fully awake and aware whilst engaging in sexual acts like masturbating, fondling, oral sex, or initiating intercourse. Because the lower level of the brain is amnesic, he or she will have no memory of what they have done. Women suffering from sexsomnia usually only masturbate or make loud aroused noises during sleep.

The behavior is not indicative of people’s true feelings and is a form of sleep-walking. Some people sleepwalk, some talk, some eat and some initiate sex states Dr. David Cunnington.

The consensus among opinion leaders in sleep medicine is that sexsomnia may be quite common, but often goes unreported because of embarrassment and shame on the part of the person perpetrating these acts. When they are told of what has happened, they usually respond with disbelief.

Reasons for sleep sex

Sexsomnia can be precipitated by stress, alcohol, illicit drugs, sleep deprivation, primary sleep disorders such as sleep apnea, or simply the presence of a bed partner.

Seeking medical help is important as a person with sexsomnia may experience negative emotions such as shame, confusion, anger, denial, fear, guilt, and frustration and these negative emotions can lead to enormous stress.

It can damage relationships when couples have to deal with this problem and there is also the worry of allegations of sexual assault or rape. Several unscrupulous lawyers have tried to use it as a defence against rape and the Australasian Sleep Association is concerned that growing numbers of people charged with sex offences are claiming to be affected by sexsomnia. They want to ensure the doctors called to give expert testimony in court are well versed in its symptoms and sexsomnia, as a defence, is scrutinised.

Sleep physician Dr Dev Banerjee from the Woolcock Institute of Medical research in Sydney, said, “It’s important that sleep clinicians called to give expert testimony in sexsomnia cases can identify true manifestations of the condition. We are seeing a few clinicians out there who think they’re experts but who are not trained to give expert advice“.

In 2014 Dr Banerjee gave a presentation to colleagues in Perth at an Australasian Sleep Association conference called Sleep DownUnder, on how to conduct themselves in court if they were called to give evidence in such cases.

Seeking help for sexsomnia is very important and can increase awareness and understanding of the problem to help individuals and couples deal with the condition constructively.

According to Dr. David Cunnington, director of the Melbourne Sleep Disorders Centre:

We [sleep experts] assess people’s overall medical state to see if there are medical causes for the condition and monitor them in the sleep laboratory to exclude other things as triggers for sleep disorders such as sleep apnea, leg movements or epilepsy.

If there are no clear triggers and sexsomnia behaviour is frequent or distressing, we look at using medication or psychological strategies such as hypnosis or meditation to reduce the frequency of behaviours.

We explain to people with sexsomnia and their partners that the behaviour is not indicative of people’s true feelings and is a form of sleep-walking. Some people sleep walk, some talk, some eat and some initiate sex. It is not linked to deep-seated psychological issues or an indicator of mental illness, it is just a failure of switching on/off all parts of the brain in synchrony on the border of wake and sleep.

If you believe you have any of these symptoms, see your primary physician and ask for a Sleep Clinic referral.

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This post originally appeared in The Huffpost Australia Edition and was published on June 23, 2017. This article is republished here with permission and updated on January 22, 2021.