• Posted September 27, 2023

What Is 'Sexsomnia'? And 'Sleep Eating'? Can They Be Treated?

Everyone's seen a movie or TV show featuring someone sleepwalking -- eyes half-lidded, bumbling around, tripping over furniture.

But sleepwalkers are actually capable of much more complex behaviors during their restless slumber, a new paper says.

During sleep some people can engage in sex ('sexsomnia'), pig out on junk food, try to cook, have a lively conversation or even hop in their car for a quick spin.

"There's really a full spectrum here where sometimes it is just harmless and doesn't need treatment and then sometimes it can be on the other end of that and can be quite dangerous,"said lead researcher Jennifer Mundt, an assistant professor of sleep medicine, psychiatry and behavioral sciences at Northwestern University's Feinberg School of Medicine in Chicago.

Unfortunately, unlike other sleep disorders like sleep apnea or insomnia, there are no consensus guidelines for treating what are called "arousal disorders"or "parasomnias,"a new evidence review in the journal Sleep Medicine concludes.

Mundt and her colleagues did the review to discover how these disorders are being treated.

"There haven't been any systematic reviews and there aren't treatment guidelines for these, so we really wanted to sort of collect everything that's been done and help provide a foundation for creating better treatment and guidelines for these disorders,"Mundt said.

Her team found 72 papers published between 1909 and 2023, but most were either case reports or uncontrolled clinical trials.

Parasomnias typically take place in deep sleep, Mundt said.

"Parts of the brain are awake, but parts are asleep,"she said. "So that's why people can do things that look like they're awake. They can walk or talk or cook or drive. Sometimes they can do pretty complex things and appear to be awake, but they actually are not fully awake, and they often don't remember it at all."

These disorders aren't rare, researchers said.

Nearly 1 in 5 people (19%) at some point will have simple confusional arousal, where they stir or sit up in bed in a state of confusion, the report said.

"It might be something as minor as maybe the person just kind of sits up and looks around and seems to be confused and maybe mumbles and then they go back to sleep,"Mundt said. "And if that's not happening that often and it's not to the point where it's disrupting their sleep quality, then it may not be a problem. It's not disturbing them or anyone else, so they may not even need treatment."

However, other forms of parasomnia are more risky.

About 7% of people sleepwalk at some point, 10% have sleep terrors, 7% engage in sex during sleep (sexsomnia), and 4.5% have sleep-related eating.

"If someone is sleepwalking and maybe they're attempting to cook in their sleep, that could be very dangerous if they're turning on burners or using knives or equipment,"Mundt said. "Or they may be eating things that aren't safe to eat."

Sometimes, sleepwalkers don't just eat food.

"They may ingest medications or they may eat things that aren't food or they eat uncooked food, things that could actually be dangerous and could harm them,"Mundt said.

Sleepwalking, sleep terrors and confusional arousals are more common in childhood, and often fade as kids grow into teens, researchers said.

But sexsomnia and sleep-related eating typically begin in adulthood, and some people never shake their childhood sleepwalking behaviors, Mundt said.

Researchers think a combination of genetic factors and lifestyle factors increase a person's risk for developing a parasomnia.

"We know that there are genes that have been associated with sleepwalking in particular,"Mundt said.

That genetic predisposition can then be triggered by stress, sleep deprivation, alcohol, medications or other events, she said.

"A noise can trigger it,"Mundt said. "There's a noise that happens and that might sort of partly wake up your brain. Your brain kind of hears that and it doesn't fully wake up, but it partly wakes up and then starts having one of these episodes where the brain is basically reverting to these basic primitive behavior patterns. That's why we tend to see certain behaviors happen, like walking, eating or sexual behavior."

Dr. Virginia Skiba, a sleep medicine specialist at Henry Ford Health in Detroit, agreed.

"Parasomnias are often triggered by stress, insufficient sleep [most adults need seven to nine hours of sleep a night], illness or fever, and use of substances such as alcohol, caffeine, marijuana and medications including sleep medications like Ambien,"said Skiba, who did not participate in the evidence review.

Treatments for parasomnia are available, including some medications, Mundt said.

"Clonazepam is a really common medication that's used for sleepwalking and sleep terrors,"Mundt said. "There are some other medications that can be used, and those are definitely important if this is a really dangerous situation."

Most cases don't require drugs, though.

The treatments with the most evidence backing their effectiveness include cognitive behavioral therapy, hypnosis, sleep hygiene and scheduled awakenings, researchers said. Sleep hygiene refers to establishing a regular routine for going to bed and getting up, while scheduled awakenings involves waking a sleeper shortly before the time they typically have a parasomnia episode.

"Multi-component cognitive behavioral therapy showed benefits," Skiba said. "This treatment approach focuses on several components we can all implement, including having better sleep hygiene, relaxation and stress management."

Doctors also should look at other health problems that might prompt a patient's sleepwalking, she added.

"Although the review focuses on behavioral approaches, as a sleep medicine doctor I often find that treating medical conditions that disrupt sleep can be quite helpful, including obstructive sleep apnea, restless leg syndrome and even acid reflux,"Skiba said.

Skiba also noted that it is most important to discuss actions people with parasomnias can take to keep themselves and their children safe.

"These include not sleeping on a top bunk bed, installing alarms on doors and windows so if they are opened, the alarm would wake up others in the household, as well as storing car keys, knives and other weapons out of reach,"Skiba said.

Mundt recommends going to a sleep clinic for anyone who finds themselves engaging in potentially dangerous behavior while sleepwalking.

"Sometimes these sort of behaviors might actually be caused by epilepsy,"Mundt said. "So it's important to go to a doctor and get this evaluated. If you're moving in your sleep or it's disrupting you or someone else, get it checked out and really get an assessment to determine if it is something that's benign that may or may not need treatment, or if it's something like epilepsy that would need a different treatment."

More information

Duke University has more about parasomnias.

SOURCES: Jennifer Mundt, PhD, assistant professor, sleep medicine, psychiatry and behavioral sciences, Northwestern University Feinberg School of Medicine, Chicago; Virginia Skiba, MD, sleep medicine specialist, Henry Ford Health, Detroit, Mich.; Sleep Medicine, Sept. 6, 2023, online