My partner and I have been together for four years and used to have a good sex life. He has a diagnosed sleep disorder and falls asleep very quickly. While I am still awake and reading in bed, he will sometimes half wake up shortly after falling asleep and try initiating sex. I always fully wake him, ask if he actually wants to have sex and then we either do or don’t, which is fine. But for the past 10 months these encounters are the only time my partner seems interested in sex. When I try to initiate, he says he is not interested. A few nights ago he tried initiating while half-asleep and I told him I wasn’t interested as he only seems to want to have sex while half-asleep. His reply was: “We won’t have sex then.” I asked if he understood why I was upset by this and he didn’t answer. We haven’t discussed it since. I have gained two stone (28lb/13kg) during the course of our relationship and I know he now finds me less attractive. I’m worried that I have killed off our sex life completely with my comment.

Your partner’s sleep disorder has led to enormous challenges for both of you. You need specialised help and sometimes it is necessary to have more than one expert involved. I believe you need to have the physician who diagnosed (and is presumably treating) the sleep disorder work with a sex therapist or sexual medicine specialist to try to help you both navigate this. Your concern about consent is laudable, but the communication issues between you are significant and need some real work.

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Different sleep disorders require different approaches, so you need support and education – and so does he. Most importantly, do not blame yourself or your weight gain for this. It was perfectly reasonable of you to try to engage him in a conversation about your feelings, but the overall problem is insurmountable without professional guidance. Sexual problems that go hand in hand with other psychological or physiological issues should never be approached in isolation. Our sexual expression encompasses everything about who we are and is affected by fundamental problems such as stress, anxiety, bereavement, depression, attentional disorders, diabetes, high blood pressure, addiction and so on. Take a deep breath and partner him in finding the solutions you both need.

• Pamela Stephenson Connolly is a US-based psychotherapist who specialises in treating sexual disorders.

• If you would like advice from Pamela on sexual matters, send us a brief description of your concerns to [email protected] (please don’t send attachments). Each week, Pamela chooses one problem to answer, which will be published online. She regrets that she cannot enter into personal correspondence. Submissions are subject to our terms and conditions.