Sexsomnia: Sleep Sex Research and Its Legal Implications

“Sleep sex,” also known as sexsomnia, is a sleep disorder characterized by sexual behaviors committed while asleep. There has recently been increased interest in sexsomnia due to controversies arising in legal trials that have been widely publicized in the social and public media. This article attempts to marshal the current information about sexsomnia from the forensic literature and provides an overview of sexsomnia including common features, precipitating factors, prevalence rates, diagnostic procedures, and treatment. As sexsomnia represents a condition in which sexual acts are committed without awareness or intention, this paper also reviews the development of sexsomnia as a legal defense and summarizes Canadian case law on the topic. It provides an overview of the hurdles presented to defense attorneys attempting to utilize the defense and examines popular public notions surrounding the legitimacy of sexsomnia and the possibility of malingering. We conclude that sexsomnia is a legitimate sleep disorder for which case law now exists to support its use in legal defenses based on automatism. The question of whether it is an example of “sane” or “insane” automatism remains to be determined by the courts. Regardless of whether or not sexsomnia is determined to be a mental disorder by the courts, it is now a recognized and well-described sleep disorder that can be safely treated and managed by knowledgeable clinicians.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. R. v. Luedecke. O.J. No. 5088. 2005. First Canadian case using sexsomnia as a subcategory of automatism and the defendant was found not guilty.
  2. Fedoroff JP, Brunet A, Woods V, Granger C, Chow E, Collins P, et al. A case-controlled study of men who sexually assault sleeping victims. In: Shapiro C, McCall Smith, editors. Forensic Aspects of Sleep. Toronto: John Wiley and Sons; 2007. p. 127–40. First description of sexsomnia. Includes polysomnogram of man engaging in sex act while asleep.
  3. Anderson ML, Poyares D, Alves RS, Skomro R, Tufik S. Sexsomnia: abnormal sexual behavior during sleep. Brain Res Rev. 2007;56:271–82. Compilation of known clinical cases of sexsomnia from literature review.
  4. Schenck H, Arnulf I, Mahowald M. Sleep and sex: what can go wrong? A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences. Sleep. 2007;30:683–702. PubMed CentralPubMedGoogle Scholar
  5. Badawy R. Sexsomnia: overcoming the sleep disorder defense. Natl Center Prosecution Child Abuse. 2010;22(4–5):1–8. Google Scholar
  6. Pressman M. Finally—sleep science for the courtroom. Sleep Med Rev. 2006;11:1–3. Google Scholar
  7. Shapiro C, Trajanovic N, Fedoroff P. Sexsomnia—a new parasomnia. Can J Psychiatry. 2003;48(5):311–7. First authors to coin the term ‘sexsomnia’. PubMedGoogle Scholar
  8. Guilleminault C, Moscovitch A, Yuen K, Poyares D. Atypical sexual behavior during sleep. Psychosom Med. 2002;64(2):328–36. ArticlePubMedGoogle Scholar
  9. Shapiro C, Trajanovic N. Sexsomnias. The parasomnias and other sleep-related movement disorders. Cambridge: Cambridge University Press; 2011. p. 70–81. Google Scholar
  10. Karacan I. Erection cycle during sleep in relation to dream anxiety. Arch Gen Psychiatry. 1966;15:183–9. ArticleGoogle Scholar
  11. Bornemann MA, Mahowald MW, Schenck CH. Sleep forensics: trailblazing a new discipline. Med Sommeil. 2008;5(15):1–46. ArticleGoogle Scholar
  12. Bejot Y, Juenet N, Garrouty R, Maltaverne D, Nicolleau L, Giroud M, et al. Sexsomnia: an uncommon variety of parasomnia. Clin Neurol Neurosurg. 2010;112:72–5.
  13. Laberge L, Tremblay RE, Vitaro F, Montplaisir J. Development of parasomnias from childhood to early adolescence. Pediatrics. 2000;106(1 Pt 1):67–74. ArticleCASPubMedGoogle Scholar
  14. Ohayon M, Caulet M, Priest R. Violent behavior during sleep. J Clin Psychiatry. 1997;58:369–76. ArticleCASPubMedGoogle Scholar
  15. Ohayon M, Guilleminault C, Priest R. Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders. J Clin Psychiatry. 1999;60(4):268–76. ArticleCASPubMedGoogle Scholar
  16. Partinen M, Hublin C. Epidemiology of sleep disorders. In: Kryger MH, Roth T, Dement WC, editors. Principals and practice of sleep medicine. 3rd ed. New York: WB Saunders Co; 2000. p. 558–79. Google Scholar
  17. Chung SA, Yegneswaran B, Natarajan A, Trajanovic N, Shapiro CM. Frequency of sexsomnia in sleep clinic patients. Sleep. 2010;33:A226.
  18. Mangan M. A phenomenology of problematic sexual behaviour occurring in sleep. Arch Sex Behav. 2004;33:287–93. ArticlePubMedGoogle Scholar
  19. Trajanovic N, Mangan M, Shapiro C. Sexual behaviour in sleep: an internet survey. Poster presentation at the annual meeting of the Associated Professional Sleep Societies, Salt Lake City, UT; 2006.
  20. Mangan M, Reips U. Sleep, sex, and the web: surveying the difficult-to-reach clinical population suffering from sexsomnia. Behav Res Methods. 2007;39(2):233–6. Largest Internet survey of sexsomniacs. ArticlePubMedGoogle Scholar
  21. Klein L, Houlihan D. Relationship satisfaction, sexual satisfaction, and sexual problems in sexsomnia. Int J Sex Health. 2010;22:84–90. ArticleGoogle Scholar
  22. Zaharna M, Budur K, Noffsinger S. Sexual behaviour during sleep: convenient alibi or parasomnia. Curr Psychiatry. 2008;7(7):21–30. Google Scholar
  23. Ebrahim I. Somnambulistic sexual behaviour (sexsomnia). J Clin Forensic Med. 2006;13:219–24. ArticlePubMedGoogle Scholar
  24. Pressman M. Hypersynchronous delta sleep EEG activity and sudden arousals from slow-wave sleep in adults without a history of parasomnias: clinical and forensic implications. Sleep. 2004;27(4):706–10. In this study authors find that individuals without parasomnias still suffer from arousal from slow-wave sleep. PubMedGoogle Scholar
  25. Ebrahim I, Wilson W, Marks R, Peacock KW, Fenwick P. Violence, sleepwalking and the criminal law. Crim Law Rev. 2005; 601–13.
  26. Consens F, Chervin D, Koeppe A. Validation of a polysomnographic score for REM sleep behavior disorder. Sleep. 2005;28(8):993–7. PubMedGoogle Scholar
  27. Pressman M. Factors that predispose, prime and precipitate NREM parasomnias in adults: clinical and forensic implications. Sleep Med Rev. 2007;11(1):5–30. ArticlePubMedGoogle Scholar
  28. Pressman MR, Mahowald MW, Schenck CH, Bornemann MC. Alcohol-induced sleepwalking or confusional arousal as a defense to criminal behavior: a review of scientific evidence, methods, and forensic considerations. J Sleep Res. 2007;16:198–212. Controversial findings concerning the impacts of alcohol on confusional arousal, and the use of alcohol in provocation studies.
  29. Hublin C, Kaprio J. Genetic aspects and genetic epidemiology of parasomnias. Sleep Med Rev. 2003;7:413–21. ArticlePubMedGoogle Scholar
  30. Cartwright R. Sleepwalking violence: a sleep disorder, a legal dilemma, and a psychological challenge. Am J Psychiatry. 2004;161:1149–58. ArticlePubMedGoogle Scholar
  31. Wills L, Garcia J. Parasomnias, epidemiology and management. CNS Drugs. 2002;16(12):803–10. ArticlePubMedGoogle Scholar
  32. R. v. Kemp. 1 QB 399. 1957.
  33. Roach K. Criminal law. 5th ed. Toronto: Irwin Law; 2012. Google Scholar
  34. R. v. Parks. 2 S.C.R. 871. 1992. Development of medical model for parasomnias, the defendant was found not guilty.
  35. R. v. Stone. 2 S.C.R. 290. 1999.
  36. R. v. Ferritto. O.J. No. 4906. 1995.
  37. R. v. Granger. B.C.J. No. 486. 1996.
  38. R. c. D.N. J.Q. no 7640. 2009.
  39. R. v. McKendrick. ONCJ 590 (CanLII). 2013.
  40. R. v. McManamy. N.J. No. 99. 1995.
  41. R. v. Pond. O.J. No. 4907. 2007.
  42. R. v. Teepell. O.J. No. 3988. 2009.
  43. R. v. Luedecke. O.J. No. 804. 2010. Development of the public safety model for the ruling on parasomnias, the defendant was found NCR-MD.
  44. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition. Non-rapid eye movement sleep arousal diroders. Arlington: American Psychiatric Association; 2013. p. 399–404. Google Scholar
  45. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition. Rapid eye movement sleep arousal disorders. Arlington: American Psychiatric Association; 2013. p. 407–10. Google Scholar
  46. R. v. Spence. O.J. No. 987. 2008.

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Conflict of Interest

Alexandria Organ and J. Paul Fedoroff declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Algonquin College, Ottawa, Canada Alexandria Organ
  2. Sexual Behaviours Clinic, The Royal, Ottawa, Canada J. Paul Fedoroff
  3. Division of Forensic Psychiatry, University of Ottawa, Ottawa, Canada J. Paul Fedoroff
  4. Institute of Mental Health Research, University of Ottawa, 1145 Carling Avenue, Ottawa, K1Z 7K4, Canada J. Paul Fedoroff
  1. Alexandria Organ