At times, individuals have even faced arrest due to their actions. "There can certainly be legal repercussions from the sexual behaviors, especially involving minors, and also from aggressive behaviors during sleep," Schenck noted.
"There exists an entire field of sleep forensics to address these matters," he explained. "They conduct thorough assessments, delve into case backgrounds, and conduct interviews with family members and others to ascertain whether it's a genuine condition or just an excuse."
What triggers sexsomnia?
There's no surefire way to anticipate the onset of a parasomnia. Some individuals who experience sleep talking or walking during childhood may develop sexsomnia or another parasomnia in adulthood, while others may not, according to Schenck.
"The ultimate cause remains unknown, but there's a genetic aspect," he stated. "If you have a first-degree family member with a parasomnia, your likelihood of developing one increases. Furthermore, the presence of parasomnia in more distant relatives increases the likelihood of the condition persisting into adulthood or recurring."
Obstructive sleep apnea (OSA) could also act as a catalyst. This serious sleep disorder, predominantly affecting men but increasingly observed in women, involves repeated pauses in breathing lasting 10 seconds to two minutes throughout the night.
"The apnea episodes from OSA trigger arousals, primarily in men, which subsequently lead to sexual behaviors during sleep," Schenck explained. "Once OSA is diagnosed and treated, not only does it manage the sleep apnea, but it also alleviates secondary sexsomnia."
Certain medications, like clonazepam, used for epilepsy, restless legs syndrome, and panic disorder, can effectively manage sexsomnia for many individuals, though not all.
However, medication proved ineffective for a 41-year-old woman treated by Schenck, whose sexsomnia came to light when her son caught her in the act. Instead, quitting her high-stress job resolved her condition. She began enjoying uninterrupted sleep for six to seven hours without any recurrence of sexsomnia.
"It's intriguing because many individuals experiencing stress become hyposexual, losing interest in sex," Schenck observed. "Yet for others, it's the opposite. So, there's no absolute rule that applies universally."
Behavioral treatments are also available
Medication for sexsomnia carries potential side effects and the risk of dependency. For those averse to pharmaceuticals, Northwestern's Mundt suggests exploring various behavioral interventions to manage the condition, as outlined in her September 2023 review.
"Based on the literature and my own practice, significant reduction or even complete elimination of symptoms is achievable for some," she affirmed. "However, others may experience only partial or no improvement, necessitating medication."
Mundt emphasizes the importance of education, as many lack understanding of sleep stages and how sexsomnia differs from nightmares or vivid dream enactment.
Sleep consists of distinct stages, beginning with a decrease in bodily activity during the first and second stages. The third stage entails deep, slow-wave sleep, vital for cellular restoration. Rapid eye movement (REM) sleep, where dreaming occurs, involves bodily paralysis to prevent acting out dreams and potential injury.
The US Centers for Disease Control and Prevention recommend seven to eight hours of uninterrupted sleep per night for adults to achieve restorative sleep within the 90-minute sleep cycles.
"Educating patients is therapeutic in itself as it often alleviates anxiety," Mundt noted. "Reducing stress and anxiety levels is crucial."
Addressing sleep hygiene follows, including minimizing caffeine and alcohol intake, maintaining consistent sleep schedules, and optimizing bedroom conditions for comfort and quietness.
Relaxation techniques precede potential hypnosis interventions if further strategies are needed.
Contrary to popular belief, clinical hypnosis involves inducing a voluntary, daydream-like or trance state rather than stage magic antics.
"It's akin to gazing out a bus window, lost in thought and oblivious to the surroundings," Mundt explained.
This trance state fosters receptivity to new ideas and suggestions, such as envisioning oneself sleeping peacefully throughout the night.
"In some respects, it mirrors experiencing a parasomnia episode," Mundt remarked. "Individuals vary in their susceptibility to trance states, but it can be highly effective."
