Covid-19: Sex is a potential non-pharmacological sleep aid


At the best of times, half of all Canadians report that they have trouble falling asleep and staying asleep. The stress of living through a pandemic is only making matters worse. Yet advice on insomnia seldom mentions a potential non-pharmacological sleep aid that’s free and easily accessible to most people: sex, whether with a partner or alone.

After orgasm, levels of oxytocin and prolactin rise while levels of cortisol drop. Common sense suggests that raising the level of feel-good hormones in the body and reducing stress hormone levels is likely to help us sleep better.

Yet data on sex and sleep is scarce, due partly to taboos and squeamishness.

Dr. Judith Davidson, a Queen’s University clinical psychologist and sleep researcher, was surprised by the dearth of good quality research on sex and sleep when she wrote the second edition of her insomnia self-help book, Sink into Sleep.

“I really don’t know why evidence is lacking,” she says. “Perhaps the researchers in the sleep field and those in the sex field have not looked much beyond their respective academic borders. It has puzzled me.”

So far, only one small study of 10 people has examined sleep after sexual activity using polysomnography– the gold standard test for diagnosing sleep disorders, which measures brain waves, heart rate and other indicators.

Published in 1985, the study concluded that masturbation had no significant impact on sleep.

But the study had major limitations beyond its small size. The researchers may have interrupted participants’ sleepiness after masturbation by removing an anal temperature probe.

What’s more, the study compared sleep after masturbation and sleep after reading – a known sleep inducer – which may have blunted differences between intervention and control.

More recent research suggests that sex can reduce stress and help people with insomnia fall asleep and stay asleep. Although the evidence base is small and some studies lack objective measures, a 2016 review by University of Ottawa researchers concluded that sex is a “possible alternative or addition to other intervention strategies for insomnia.”

It’s a conclusion that many people appear to reach by themselves. A 2019 study of 778 people led by Dr. Michele Lastella of the Central Queensland University in Australia found that both men and women perceive that they fall asleep quicker and sleep better after orgasm with a partner or alone.

According to Lastella, the link is worth exploring given that many people have trouble sticking to the usual sleep hygiene advice. Setting a bedtime, exercising regularly, and avoiding screens all require discipline and long-term commitment to pay off. He says switching “screen time for playtime” may be an easier sell with more immediate results.

Overcoming barriers

Getting such advice into clinical guidelines is another matter. According to Dr. Charles Samuels, past president of the Canadian Sleep Society, “with so many taboos related to sex, opening that door is overwhelming.”

Asked why sleep advice seldom mentions sex, Samuels cites clinical inertia given the other treatment options available and a lack of rigorous research.

“Sleep researchers pride themselves on high-quality, objective markers and sex research is difficult,” Samuels says. However, he acknowledges that the next generation of clinicians and researchers may be more interested in tackling the topic.

According to Lastella, ethical issues often hamper studies that involve sex, video, and researchers entering a room where sex takes place.

There are also logistical challenges, such as drawing blood samples to measure hormonal activity during and after orgasm without interrupting sleepiness.

Expensive portable polysomnography units could help address some of these issues by bringing the lab to the bedroom rather than the bedroom to the lab. But Lastella says that reducing the stigma surrounding sex and sleep remains a far bigger obstacle to overcome.

Dr. Caroline Pukall, director of the Sexual Research Lab at Queen’s University, says that many of her patients already use masturbation as a sleep aid. “Patients often cite that it is part of their bedtime routine… and that it’s something that helps them to relax and fall asleep.”

But while there are multiple sources of funding for sex research in Canada, Pukall says sex researchers still face an uphill battle to legitimize their field and secure ethics approval for studies. She has started giving educational talks to ethics review boards, which have often regarded sex research as a “frivolity… nice to know but not need to know.”

Dr. Stephanie Hart, a family physician with a focus in sexual medicine in Okotoks, Alberta, says such talks should start in medical school and residency.

She says that discussions about the importance of healthy sexuality notably lack in medical training. Instead, “the focus is on sexually transmitted infections and dysfunction.”

Within that framing, “sex is bad, dirty, even gross, so we don’t talk about that. We don’t bring it up because we are embarrassed, and then patients are embarrassed.”

But a more sex-positive perspective is gaining traction. Hart has received multiple invitations to talk about sexuality at the University of Calgary, student groups and medical conferences.

“I tell them if they can practice saying words like anal sex, masturbation and clitoris over and over until they stop blushing, then maybe we can have some hope that patients will be able to discuss this important part of their health.”

Sleep problems are common and costly worldwide (1, 2). In particular, population estimates predominantly from Western countries have shown downward trends in average sleep duration and higher prevalence of insomnia and other sleep difficulties (3–5).

While numerous studies have considered behavioral and lifestyle strategies to improve sleep onset, little is known about the relationship between a common bedtime activity: sexual behavior and sleep. Given that both sex and sleep are essential for the maintenance of physiological and psychological well-being, surprisingly few studies have explored the possibility that sexual activities may be associated with better quality sleep (6–9).

The combined release of oxytocin, prolactin, and the inhibition of cortisol following orgasm may prompt a sleep facilitatory effect (10). Oxytocin is elevated as a result of sexual intercourse (11) and has been associated with a better quality of life, a reduction in stress (cortisol) and improved sleep quality in both males and females (12, 13).

Prolactin, which is associated with both quality of orgasm and sexual satisfaction, has also been shown to increase following orgasm, and even more so, when orgasm occurs during sexual intercourse (10, 14). Together, these findings suggest that sexual activity may be part of the underlying neuro-hormonal mechanism facilitating sleep after sexual intercourse.

Brissette et al. (7) is the only investigation to examine sleep in humans following sexual activities with and without orgasm using the gold standard in sleep monitoring, polysomnography. This particular investigation examined the effects of solo masturbation on sleep latency and sleep architecture in five men and five women following masturbation with and without orgasm.

While their findings revealed no differences for sleep latency or duration between genders across three conditions; no masturbation (involved light reading in bed), masturbation without orgasm, and masturbation with orgasm, some limitations within the experimental design may have affected their results.

First, the presence of a researcher having to remove the anal probe following orgasm may have delayed participants’ sleep latency. Second, the control condition required participants to read for 15 min before attempting sleep; this may have sleep inducing effects obscuring the results of this study.

Finally, the findings of this study are limited to solo masturbation meaning less is known about the potential sleep benefits of sexual activity with a partner. Consequently, the relationship between sexual activities, sleep quality, and sleep latency is largely unknown in human subjects.

This warrants greater attention, as sexual activities followed by orgasm may have a facilitatory effect on human sleep (15–17) and thereby offer non-pharmacological alternative toward improving sleep. While, Kinsey et al. (9), frequently reported relaxation, sleepiness, and sleep onset as an aftereffect of orgasm in both male and females, Halpern and Sherman (16) only reported this facilitatory effect in males.

Despite the early findings of Kinsey, little is known today about public perceptions of the relationship between sex, sleep quality, and sleep latency. Therefore, the main aim of this study was to explore the perceived relationship between sexual activities, sleep quality, and sleep latency in the general adult population and identify whether any gender differences exist.

This study is the first to explore the perceived relationship between sexual activities, sleep quality and sleep latency in the general adult population to specifically identify whether any gender differences exist. A difference between males’ and females’ perceptions of sleep quality, particularly following sex with a partner, was apparent.

Significant gender differences existed in perception of sex with a partner and impact on subsequent sleep quality and sleep latency. Specifically, a higher proportion of males reported perceived improvement in sleep quality and sleep following sex with a partner.

The reason for the difference between males and females was not explored in this study, but it may be explained by the gender gap in orgasm frequency; that is, men, when compared with women, are more likely to orgasm during sex with a partner (22). The wording of the survey question regarding sex with a partner, however, may not have adequately captured the nuances of this situation, and should be considered in future studies.

Most notably, there were no differences in perceived sleep quality or latency between males and females when sex with a partner involved an orgasm, with the majority of both men and women indicating they felt sleep quality and latency improved with orgasm.

These findings seem to be consistent with the hypothesis put forward by Brody and Krüger (10) that higher levels of oxytocin and prolactin following orgasm may prompt a sleep facilitatory effect. Furthermore, our findings appear to corroborate the ideas of Leeners et al. (14) linking higher levels of sexual satisfaction and quality of orgasm with increased levels of prolactin in women.

Only 3–6% of all participants indicated that they felt they slept worse following sex that involved a partner and an orgasm. These findings suggest that sex with a partner involving an orgasm may serve as a means to promote and improve sleep for both genders.

Interestingly, no gender differences were found in perceptions of the impact of masturbation on sleep quality or sleep onset with or without orgasm. This finding broadly supports the work of Brissette et al. (7) who also found no gender differences in sleep outcomes resulting from solo masturbation.

Our findings did, however, indicate that over 50% of participants had improved sleep quality through masturbation resulting in an orgasm. This further supports the idea of orgasm, as opposed to sexual activity, facilitating sleep in both men and women.

reference link:

More information: Janice Hiller. Speculations on the links between feelings, emotions and sexual behavior: Are vasopressin and oxytocin involved?, Sexual and Relationship Therapy (2004). DOI: 10.1080/14681990412331297974



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