Ask an Expert: Unusual behavior during sleep

Sleep Disorders

Unusual behavior during sleep
04/04/2008

Question:

My husband dreams that he is having sex, sometimes with other women and other times, masturbating. When I have awakened him, he says he does not know what I am talking about. I have stayed awake most of the night listening and watching him and he does these things and denied them. I have suggested that he attend a sleep study, but he will not, I think for fear that someone other than me will see him. I have sought therapy for myself on this, and before you ask, we do have intercourse at least twice a week. I have also tried having sex every day for a few months. Nothing helps. What can I do?

Answer:

Undesirable events that occur during sleep or during transition between wakefulness and sleep are called "Parasomnias". Some of the well known parasomnias are sleep walking and sleep talking. A less common one is sleep-sex, otherwise known as sexsomnia.
Several researchers have reported patients with inappropriate sexual activities occurring during a mixture of wakefulness and sleep state without conscious awareness. Individuals with parasomnias may appear awake during their odd episodes but almost never remember the events that take place during their parasomnia episodes. Such activities may result in feelings of guilt or shame or in depression, and they may have medical and legal implications. Sleep-sex can be a disturbing condition, and may affect trust in any relationship.
The description you give of your husband's condition is typical of sleep-sex as a parasomnia. Sleep-sex occurs during non-REM (or nondream) sleep where we retain our ability to move and to talk. This explains why you observe him doing these actions. This is not the same as nocturnal emission, also known as "sex dreams" or "wet dreams." I would like to emphasize that your husband, most probably, is not dreaming about sex, because sex dreams occur during REM (or dream) sleep where we are unable to move or talk. Individuals who act out their dreams have another sleep disorder called "REM behavior disorder."
You attempted to increase the frequency of intercourse with your husband. This increase in wake-time sexual activity may decrease sex dreams, but it does not change sleep-sex parasomnia frequency.
I understand how stressful this is to you, to your husband, and to your relationship. An evaluation by a Sleep Specialist is necessary to make the diagnosis and rule out other conditions that may mimic parasomnias and sleep-sex. Such conditions include obstructive sleep apnea, REM sleep behavior disorder, nocturnal seizures, and psychogenic dissociative disorders. Also, certain drugs, substances, and medical conditions may precipitate or may exacerbate many sleep disorders and a history is needed to determine if these may be contributing factors. Further testing (by a sleep study) will probably be required.
Until you can convince your husband to be evaluated in a Sleep Clinic, here are some general methods that may help your husband control his parasomnia symptoms:

Assure a comfortable, quiet, cool, and dark sleep environment

Have him avoid sleep deprivation, and keep a regular sleep/wake schedule

Have him minimize alcohol, caffeine, and tobacco use close to sleep time

Avoid benzodiazepines and other hypnotic medications

If you would like additional information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website . This website also contains a list of Sleep Centers across the country so you can locate one near you if need it.

I wish you and your husband the best of luck.

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Response by:

Ziad Shaman, MD
Assistant Professor of Medicine
Department of Medicine
School of Medicine
Case Western Reserve University