When a Good Night’s Sleep Turns Into a Nightmare
For most people, the bed is a sanctuary, but for some people, the bed can be a very scary place.
Sleep researchers at Stanford University recently reported in the journal Psychosomatic Medicine (April/May issue) on 11 cases of people afflicted by a rare but treatable medical condition. Described as “violent sleep sex,” the disorder causes the afflicted to moan in sexually evocative ways, masturbate violently and engage in rape-like behavior toward their bedmates, some of whom developed what might be called bed dread.
Researchers, who examined the patients over four years, assert that the nocturnal behavior stems from hiccups that occur in brain-wave patterns during the sleep cycle. Although the condition is rare, roughly 2% of the population is thought to experience “violent sleep sex.” Researchers say the estimate may be low because people who have the condition rarely report it.
“What was surprising to us was why it took so long for people to ask for help,” said Dr. Christian Guilleminault, a professor of psychiatry and behavioral sciences at Stanford University School of Medicine and lead researcher of the study. “One man waited 15 years. These people may have talked to their doctor about it, but they felt rejected by the medical establishment because their physician didn’t believe them or hadn’t heard of the sleep disorder. Some of them were too ashamed of the behavior to seek help. In some cases, the bed partner was having a difficult time because the patient denied the behavior because they could not remember it.”
The seven men and four women research subjects were evaluated by a psychiatrist, neurologist and a sleep specialist, and divided into three groups, according to the severity of their symptoms. The first group’s anomalous behavior was characterized as “annoying to bed partner, but not harmful” and included two women in their late 20s whose loud, sexually evocative moaning and inarticulate sounds occurred within 20 minutes of sleep onset. One woman felt guilty because the moaning was so loud it disturbed her spouse and children, according to the study.
The second group--whose behavior was described as annoying to bedmate and at times harmful to the patient--included a woman, 26, and a man, 31, both of whom masturbated violently while asleep. The woman’s behavior also included loud moaning and attempts at tearing off her pajamas. When her husband tried to initiate intercourse, he was rejected, the researchers wrote. The woman, who repeated the behavior if interrupted, had no memory of the nocturnal activity. In the man’s case, the violent masturbation left him deeply bruised in his groin area and anxious about “losing control” in sleep. This led to rejection by girlfriends and caused him to avoid intimate relationships for years, according to the researchers.
The third group included six men and one woman who made unwanted and sometimes violent sexual advances toward their bed partners while asleep. In one case, a 38-year-old man had sexually assaulted his wife for 12 years, which involved tearing off his wife’s clothes, fondling her and attempting sexual intercourse, the researchers noted. During one episode, the man tried to strangle his wife, which prompted a teenage child in the home to call the police, eventually leading to a referral to Stanford’s Sleep Clinic. In another case, a man was so full of despair and shame over his sexual behavior in sleep that he tried restraining himself to the bed, which resulted in his breaking two fingers.
The woman in this group, 26 years old, would initiate foreplay by adjusting her bed partner’s clothing, fondling him and uttering sexually provocative things in her sleep. When her bed partner responded in kind, the woman would awaken confused and accuse him of trying to coerce her into having sex while she was asleep, according to the study. The couple began seeing a counselor because the husband did not believe she was unconscious, said Guilleminault.
Although the cases sound psychological in origin, Dr. David Saul Rosenfeld, director of the Sleep Medicine Clinic and Laboratory at Kaiser Permanente Medical Center in Los Angeles, said that most cases of parasomnia--automatic behaviors that occur in sleep such as sleepwalking--do not appear to have psychological causes.
“There is no evidence to confirm that people are acting out unconscious feelings, or sexual fantasies,” said Rosenfeld, who authored a 1998 study of two men who were engaged in sexual activity while asleep--including biting behavior and talking dirty. “Both of the cases we reported on demonstrated sleep behaviors that were not characteristic of their daytime personality.... No one knows why there is this fundamental split.”
Guilleminault and his co-researchers believe the underlying problem of violent sleep sex relates to sleep disorders and, in some cases, to neurological diseases (such as epilepsy). Each of the patients in their study had additional emotional problems, which Guilleminault said influenced the form the sleep disturbance took. Had the patients not had emotional problems--which included obsessive-compulsive personality disorder, generalized anxiety disorder, and major depressive disorders--the sleep disorder, he said, would still have existed but might have emerged as sleepwalking, sleep eating or sleep talking. (Indeed, seven of the patients had a history of sleepwalking too.) Sleep disturbances occur when a person fails to seamlessly pass through the five phases of sleep. Each phase is marked by a classic brain-wave pattern, but the researchers noticed the brain imaging of the patients revealed that they had unusual patterns during one of the sleep phases or had short interruptions in their sleep.
Audio and video recordings of the patients revealed that the sleep-sex behavior occurred during these glitches in the sleep cycle. The scientists determined that sleep sex, like other parasomnias, occurs when there is a disturbance during the brain’s transition from deep sleep (non-REM sleep) to wakefulness (REM sleep).
“When we dream, we are in REM sleep and usually our body is paralyzed,” said Guilleminault. “But there are a certain number of people, for a lot of different reasons--some of which we don’t understand--who don’t have paralysis of the body during REM sleep. So they are able to act out their dreams. So if they are having a sexual dream, they do the same physically.”
In every case analyzed in the Stanford study but one, the sleep disturbances were successfully resolved with sleep-disorder treatments, and those patients and their partners have been able to sleep without fear even up to five years later. Therapy included treatments for breathing disturbances such as apnea and certain drugs.
“The reason why we did the study was because these people felt there was no hope and no diagnosis and no treatment,” said Guilleminault.
“People may not hesitate to tell you that they had a fishing dream and they were casting and doing all these physical movements in bed. But when it comes to sexual behavior, that is taboo.”
