Could Obstructive Sleep Apnea Be to Blame for Erectile Dysfunction and Low Testosterone?

by Martin Reed Patient Advocate
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Sleep apnea comes with a number of health risks including high blood pressure and heart disease. Research also suggests that there may be a link between obstructive sleep apnea, erectile dysfunction and reduced sexual libido in men.

What is obstructive sleep apnea?

Obstructive sleep apnea (OSA) is a type of sleep apnea that occurs when the muscles in the back of the throat relax, leading to a narrowing or even a temporary closure of the airway.

The body senses this blockage and awakens you so your airway can reopen. This can happen a number of times during the night. It's important to note that obstructive sleep apnea is a potentially serious sleep disorder. Symptoms may include:

  • Loud snoring

  • Daytime sleepiness

  • Nighttime sweating

  • Abrupt nighttime awakenings

  • Waking with a dry mouth or sore throat

  • Mood changes such as irritability or depression

The link between OSA and erectile dysfunction

Research published in the Archives of Sexual Behavior studied 207 men with an average age of 44. The men were divided into four groups based on the severity of the sleep apnea:

  • 32 men were placed in the "simple snoring" group

  • 29 men were placed in the "mild OSA" group

  • 38 men were placed in the "moderate OSA" group

  • 108 men were place in the "severe OSA" group

Researchers found that almost 61 percent of all the men suffered erectile dysfunction and that this prevalence was highest (72 percent) in those with severe OSA.

When compared to men in the "simple snoring" group, men with severe OSA also had significantly lower testosterone levels.

Another study found that approximately half of men with OSA who were not being treated for their sleep disorder reported diminished sexual desire. Interestingly, this study also found that total sleep time and sleep efficiency also affected libido in untreated men.

Even more supporting data comes from a population-based cohort study published in Sleep Medicine. The study found that, compared to those without a sleep disorder:

  • Men with an apnea sleep disorder were over nine times more likely to suffer from erectile dysfunction.

  • Men with a non-apnea sleep disorder were nearly four times more likely to suffer from erectile dysfunction.

Why is there a link between erectile dysfunction and OSA?Studies suggest that the sleep fragmentation associated with OSA can lead to a decrease in rapid eye movement (REM) sleep. The erections typically associated with REM sleep may protect against erectile dysfunction, therefore those who get less REM sleep due to OSA may be more likely to suffer from erectile dysfunction.

Repeated disruption in sleep over the course of a night can also interfere with the body's production of testosterone. (Testosterone levels typically peak just as non-REM sleep transitions into REM sleep.)

The cycle of repeated oxygen starvation and reduced nitric oxide levels may also lead to issues with the inner lining of blood vessels and peripheral nerve dysfunction, making erections more difficult. Furthermore, benzodiazepines are known to reduce REM sleep and therefore may increase the risk for erectile dysfunction.

How to fix erectile dysfunction when suffering from OSA

The study published in the Archives of Sexual Behavior found that after three months of continuous positive airway pressure (CPAP treatment), erectile dysfunction scores improved significantly in those with obstructive sleep apnea.

CPAP is the leading therapy for sleep apnea but it can only be prescribed by your doctor. Therefore, if you are displaying symptims and think you may be suffering from OSA, or any other sleep disorder, it's important to seek medical advice.

Martin Reed
Meet Our Writer
Martin Reed

Martin is the creator of Insomnia Coach, an eight-week course that combines online sleep education with individual sleep coaching. His course helps clients improve their sleep so they can enjoy a better life with more energy and start each day feeling happy, healthy, rested, and refreshed. Martin also runs a free sleep training course that has helped over 5,000 insomniacs. He holds a master’s degree in health and wellness education and studied clinical sleep health at the University of Delaware.