Sexsomnia: Exploring the Enigma of Sleep’s Intimate Intruder

A phenomenon that is as intriguing as it is confusing, sexsomnia is a term to denote the occurrence of sexual behaviours during sleep, without the person being aware, nor remembering upon waking up. These behaviours, sometimes perceived as unusual, can have significant repercussions on mental health, relationships and in medical and legal terms.

It is vital that both the general public and health professionals have a better understanding of this illness in order to identify those individuals impacted and help them to seek the right treatment. The aim is to limit the risks incurred by sexsomniacs and those around them.

Described for the first time in 1996 (Shapiro et al., 1996), sexsomnia remains largely misunderstood and underdiagnosed (Pirzada et al., 2019). The term ‘sexsomnia’ was proposed by Shapiro et al. in 2003 after observing eleven clinical cases. Nowadays, sexsomnia is recognised in the international classification of sleep disorders as a form of non-REM sleep parasomnia, with the likes of sleepwalking or night terrors (American Academy of Sleep Medicine, 2014).

Sexsomnia is defined as sexual behaviour that occurs during sleep, most often during deep sleep phases (non-REM sleep), manifesting itself through acts such as masturbation, groping, attempts at sexual intercourse, moans, dirty talk, or even spontaneous orgasms (Pyrgelis et al., 2021). Such episodes take place when the affected is asleep, and has no memory of the event upon waking up. Total amnesia has been reported in 90 to 96% of cases (Holoyda et al., 2021 ; Pirzada et al., 2019).

Sexsomnia is a rare disorder, however it may be under-reported. In scientific works, a little over one hundred clinical cases have been published (Pyrgelis et al., 2021). A recent Norwegian study (Pallesen et al., 2025), however, notes a lifetime prevalence of 10.5%, which is higher than the 7.4% reported by Bjorvatn et al. in 2010, but lower than the 15.3% reported by Cankardas et Schenck in 2021. These results suggest that a significant chunk of the population may experience an episode of sexsomnia in their lifetime. Regarding recurring sufferers of sexsomnia, the percentage is estimated to be around 6.5% of people (Pallesen et al., 2025).

This disorder affects a greater proportion of men (around 75% of cases recorded), but it’s probable that women don’t come forward about such an issue due to societal taboos surrounding feminine sexuality. It’s generally difficult to accurately estimate the prevalence of sexsomnia as shame, fear of judgement, or possible legal implications dissuade patients from talking to health professionals (Pirzada et al., 2019).

The symptoms of sexsomnia are extremely varied. They can range from auto-erotic behaviours all the way to acts directed at a partner. Studies note primarily:

• Masturbating during sleep;
• Attempted or achieved sexual relations;
• Caressing or groping a partner;
• Pelvic thrusts, making sexual sounds, or making erotic remarks;
• Having spontaneous orgasms
• Having erotic dreams (Pyrgelis et al., 2021 ; Pirzada et al., 2019).

Episodes most often take place in the first third of the night, when the person is sleeping deeply, and each episode tends to last around 30 minutes (Holoyda et al., 2021). They begin abruptly, sometimes after a bout of snoring, sleep apnoea, or micro-awakenings.

During the episode, the sleeper may seem awake: opening their eyes, talking, initiating contact, but their behaviour is automatic and they are not self-aware. The next morning, they have no recollection of the event. Some partners describe behaviour as more direct and uninhibited than usual, on rare occasions aggressive, sometimes accompanied by remarks not often made by the sleeper (Holoyda et al., 2021). These episodes can be the cause of guilt, shame, misunderstanding, marital tensions, even separation (Pirzada et al., 2019).

As with other types of parasomnia, sexsomnia is the result of the brain only partially awakening during deep sleep: some zones that are linked to movement or motivation are activated, whilst those that deal with consciousness remain asleep (Schenck et al., 2015).

The process for diagnosing sexsomnia is the following:

• A detailed interview with the patient and their partner that aims to gather information on their episodes, how often they occur, and in what circumstances they occur.
• Neurological and psychiatric examinations to rule out nocturnal epilepsy, dissociative disorders, or any underlying psychiatric conditions.
• A sleep assessment using polysomnography, combined with an EEG and video recording of the sleeper (Holoyda et al., 2021).

Although polysomnography is rarely able to capture a sexsomnia episode live, it can reveal abnormal micro-awakenings in non-REM sleep phases, which are characteristic of parasomnias. Sexsomnia occurs more rarely during REM sleep, when the sleeper imitates or “acts out” dreams with sexual content (Pirzada et al., 2019).

The diagnosis is backed by the patient showing total amnesia, unconsciousness during the act, and behaviours that are unplanned, stereotypical, and similar to other parasomnias (sleepwalking, for example).

Treating sexsomnia requires education, healthy sleeping, behavioural therapy, and medical care. The first steps are to:

• Optimise sleep (regular hours, avoid sleep deprivation),
• Avoid alcohol, sleeping pills, and drugs,
• Reduce stress, as well as physical and mental fatigue,
• Treat related sleep problems (apnoea, teeth grinding, restless legs, etc.),
• Inform the partner of said episodes,
• Secure the sleeping environment, for example sleep in separate beds or lock the bedroom to avoid any involuntary contact (Holoyda et al., 2021).

If this is not enough, first-line treatment is clonazepam, a benzodiazepine administered in small doses at night that has proven efficient in around 86% of cases (Pirzada et al., 2019 ; Schenck, 2015). Antidepressants can also be prescribed, depending on the patient’s profile, especially in cases of psychiatric comorbidity. In other cases, treating sleep apnoea is enough to stop occurrences of sexsomnia (Pirzada et al., 2019).

Psychological support is also extremely important. Living with sexsomnia often requires facing guilt, shame, and stigma. Those affected may fear being viewed as deviant or violent, even though they themselves are unconscious during the act. What’s more, they may also be afraid of experiencing new, unexpected episodes. Their partners may struggle to understand the situation, and feel distrusting or anxious around their partner.

Post-traumatic stress can also occur, as the sexsomniac may be shocked to find themselves engaged in sexual activity upon waking, as may their partner, who has been solicited without their prior consent. If necessary, couples counselling is recommended to restore trust and discuss the emotional and sexual repercussions. One study has shown a correlation between sexsomnia and lower sexual and relationship satisfaction (Klein & Houlihan, 2010). Some partners therefore choose to sleep in a separate, locked bedroom to avoid these episodes (Holoyda et al., 2021).

One of the most sensitive areas pertaining to sexsomnia is linked to its legal implications. Some people have been prosecuted for sexual assault or even rape after an episode of sexsomnia. International case law has recognised in certain cases the criminal non liability of the accused, once presented with solid proof (polysomnography, known triggers, statements from friends and family, the emotional reaction of the accused) that confirmed the involuntary nature of the act (Ingravallo et al., 2014).

The following table is taken from the article by Holodya et al. (2021). It suggests some points to consider in order to differentiate between the behaviour of a perpetrator of sexual violence and that of a person with sexsomnia :

Still a little-known disorder, sexsomnia illustrates the complexity of the sleep state, where consciousness and behaviour can become dissociated. A better understanding of sexsomnia enables early diagnosis, avoids criminal implications, and offers patients appropriate, guilt-free medical and psychological care. Dialogue between patients, partners and healthcare professionals remains key to breaking the taboo and placing this disorder in its true context: that of a parasomnia, rather than a harmful or deliberate act.