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Dr. Mark, Psychotherapist
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My husband cant sleep without sex

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My husband has great difficulty with sleep. He generally doesn't sleep well, and it is worse the more tired he is. He usually needs to have sex at bedtime to fall asleep. If he does fall asleep without sex (usually after a few drinks), he wakes up 1.5 hours later, wide awake. He says he feels like his whole body is vibrating, and he can't quit worrying about his job, our finances, etc... What kind of doctor should I send him to? I don't know how much longer I can live with his intense needs, but for our two kids I don't want to leave him!!!

Oh, I forgot to mention that he was diagnosed with chronic fatigue syndrome at age 25 and takes 20mg of elavil every night as well as 1 mg melatonin.  I'm not sure these help much.  Other suggestions are very welcome!

Hi! I believe I can be of help with this issue.

Let me say that I can imagine how frustrating and distressing this situation must be for you. We need to establish some foundation for understanding what's going on in order to answre your question of what kind of doctor to send him to. I'm also going to include a technique that he can use to help him calm himself at night when he does wake up so he goes back to sleep or to help soothe himself without sex to go to sleep. It is a good start for the kind of therapy I'll be recommending he start. And by the way, you might find the technique useful. It's not a cure, but it is relaxing and soothing and can be used throughout the day and night.

First, I'm assuming that with the Chronic Fatigue Syndrome (CFS), he's having regular medical checkups. If not, there are some tests that need to be done. He's going to have to tell his doctor that he's having sleep problems, that most likely it's an anxiety disorder, and that he needs to have testing for thyroid function, vitamin deficiencies, etc. to rule out physiological problems.

Then, assuming that there is no biomedical problem going on we proceed. The symptoms are more consistent, as I said above, with an anxiety disorder than with a medical problem. So the treatment needs to be for that. Given he has CFS, anxiety medicaitons might be overwhelming and tire him out too much or send him into depression. That will have to be monitored, but if his regular doctor quickly wants to just prescribe an anxiety med, please slow the doctor down and discuss this possible problem first and that therefore meds might need a psychiatrist. But even so, meds are not the best form of treatment for him. Why not?

Partly because of the FS, but mostly because your husband is exhibiting a phobic behavior: sleep for him has become a scary event that causes anxiety and he soothes and comforts himself with sex to be able to cope with the anxiety. Thus psychotherapy is the best form of treatment. This would be with a psychologist or psychotherapist who is experienced with anxiety disorders.

There are two approaches here you can take. One would be to seek someone who is also a sex therapist as the phobic fear of sleep is being dealt with sexually. You would want to seek an experienced sex therapist. By that I mean a psychologist or psychotherapist who is certified by either the AASECT ( or the American Board of Sexology ( They each have a listing of their certified therapists. The American Board of Sexology is a bit more prestigious but that's not a big deal here. You want to find someone who seems to you very experienced with anxiety disorders and not just sexual dysfunction. So, interview the therapists before deciding on the one he will go to therapy with.

The other approach would be to find someone who is focused on the anxiety issues and is not necessarily a sex therapist. That combination might not be easy to find and a regular therapist might be easier to find. Fortunately, anxiety and phobias are among the most researched disorders in terms of effective treatments. And the therapies today are very effective. The preferred form of treatment today is Cognitive Behavioral Therapy to learn skills.

If your doctor isn't able to refer to anyone, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (they show you a photo of the therapist!) look at the listing and see if they list CBT therapy in their orientations and anxiety disorders as one of the areas they work with.

If you want someone who isn't as structured as a pure CBT therapist, consider seeing if the therapist also lists psychodynamic therapy in their orientation. The idea here isn't that these types of therapy are magic. It's that you may want to find a therapist who will form a strong therapeutic alliance with you and will help him look at the sources of his anxiety and phobic reactions. I think given his history that this might be very useful

Okay, that should help him get working on these symptoms and get some relief. I wish you the very best!

Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from depression or anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.

I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety states is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?


  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.


Customer: replied 4 years ago.
Thanks for the info. I agree that he likely has an anxiety disorder. Our 9 year old son actually has been on medication for anxiety for several months, and has shown great improvement. I have hoped his results will encourage my husband to seek similar treatment, but he is a very private person, and I don't feel optimistic about getting him to a therapist or psychiatrist. He is searching for a new doctor, as he feels his CFS care has not been effective. He cannot lose weight, no matter how much he exercises (he's about 30 pounds over where he should be), and we both feel his inability to sleep is strongly related to this problem. We are both hoping he can find an MD who will check his hormone profile and offer some medical help.
CFS is still controversial in the US and some doctors are not very used to working with it. So your challenge is to interview doctors that are experienced and open. I'd recommend trying Google to see if there are any CFS groups in your area or any chats online in your area where you could find out which doctors are the go to ones.

I don't know if you are interested in alternative medicine but acupuncture is one that I respect highly and in anxiety disorders it can be very helpful without the medications, especially as you try to get the CFS more under stable medical supervision. It may help him with the weight if it helps him with the anxiety. You might also join Weight Watchers together and go to the meetings as well as their website to get a better handle on the "invisible" eating that might be going on to compensate for anxiety that he's not really counting into his calorie intake. If he's exercising and still not losing weight, this is most often the cause if there's no underlying organic medical issue.

It is tough sometimes to get guys to go to therapy and often if you go first with him as a couple, it is a way to introduce the concept. But this will be very helpful to him.

So, you've got quite a few options to look into and some goals to get to and I wish you the very best! Be optimistic.

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