After five years together, Grace*, 37, and her then-partner were struggling to make their relationship work. There was almost no physical intimacy between them—until they started having sex in their sleep. When she felt his touch, Grace would begin to dream that she was sleeping with someone else. Of course, once she woke up she realized it must have been her boyfriend, but it was as if the need for closeness that went unaddressed in real life was being realized in their sleep. They’d discuss it in the morning, and while they both vaguely remembered having sex, neither had intentionally initiated it.

Elizabeth*, 36, and her then-partner also began having sex in their sleep when they’d stopped doing it during waking hours. “While we knew the relationship was ending, we were still living together,” she explains. “We still wanted it, just not necessarily with each other,” she says. “Since we were still living together and, at that point, still sleeping in the same bed, it manifested subconsciously.” She’s only aware it even happened because she would sometimes wake up in the middle of it. Elizabeth also experienced this with another, shorter-term partner the first time she slept at his place.

The experience they’re describing is called sexsomnia, a sleep disorder similar to sleepwalking except, instead of getting up and moving around, sufferers have sex or masturbate while asleep. One Toronto Western Hospital study found that 11 percent of male sleep center patients and four percent of female patients experienced the condition, but W. Christopher Winter, MD, president of Charlottesville Neurology and Sleep Medicine and medical director of Martha Jefferson Hospital Sleep Medicine Center, believes many more people have had sex in their sleep at some point. The most common cause of sexsomnia, he says, is Ambien or other sleeping pills. Many times, sexsomnia stops occurring once his patients stop taking these drugs. Alcohol, sleep deprivation, restless leg syndrome, sleep apnea, nocturnal seizures, and sleeping in new environments can make it manifest as well.

As Grace and Elizabeth’s stories show, the cause can also be psychological: Sexomniacs enacting desires in their sleep that they’re unable or reluctant to fulfill in real life. Winter had one patient who yelled, “If you don’t fuck me, I’ll find someone who will!” at her husband while asleep. While awake, he says, she “wouldn’t even say the word ‘sex’ without whispering it.”

Despite the aggression with which many sexsomniacs initiate sex, some are unclear as to whether they’ve even consented. Dr. Winter’s patient was upset that her husband had sex with her as she slept. Meanwhile, her husband said he felt pressured into sex by her.

“A sleepwalking person or an unconscious person or a person with dementia or Alzheimer’s or a person with sexsomnia cannot give consent, even if the partner were to ask,” says couples and sex therapist Stephen Duclos, LMFT. “If the partner were to ask, and no conversation was possible, this might be an indication that something was wrong.” Usually, once the sexsomnia sufferer’s partner realizes their partner has been sleeping during sex, they stop doing it to avoid any violation of boundaries.

Though not all sexsomnia sufferers consider it a violation. “They like the initiation of sexual activity in the middle of the night,” explains sexual wellness coach Lauren Brim. “One man told me that he says really loving and tender things to his partner during his episodes of sexsomnia.”

Grace didn’t feel violated by the sex she had in her sleep since her partner was sleeping, too. “It was very much an automatic sleep action rather than any—not even a subconscious—sense of entitlement to my body,” she says.

It was similar with Elizabeth. “Both were partners I’d happily and safely been with already, and in both cases, each of us was asleep when the act happened,” she explains. “If this had happened with a totally new person, or a random person whom I’d met on a night out, say, I would have likely felt violated.”

Though sometimes it’s the sexsomniac’s partner who feels violated, says Winter. People are often more forward in their sleep than they are when they can consciously choose whether they’ll act on their urges. “That’s the worst part of it,” he says. “This violation of trust and consent.”

Brim has worked with three men with sexsomnia, and they all have to warn new partners and avoid sharing beds with people they’re not in relationships with. Many sexsomniacs end up embarrassed over their late-night activity, she adds.

But for those who don’t want to be woken up, have sex with someone who won’t remember it, or have sex while they’re not fully conscious, there are work-arounds beyond just avoiding sleeping next to one another. “Partners with healthy communication know how to navigate the sexsomnia so it doesn’t become something nonconsensual or something that deprives them of sleep,” says Brim. “Those in a relationship with a sexsomniac can help their partner discover what triggers might bring on sexsomnia in the night, and how to lessen or stop the behavior.” For example, one of her clients realized he was only having sex in his sleep if he fell asleep while touching his partner.

There are also medical treatments, like CPAP machines for sleep apnea and medications like clonazepam, says Duclos.

In the worst cases, some couples may have to sleep in separate beds until the sexsomnia is sorted out, says Winter, but he’s never had a patient feels the need to do so permanently. “There are definitely treatments for it,” he says. “You don’t have to sit there and take it.”

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