How sleep apnea can wreck your sex life
By Lisa Shives, M.D
It was a normal follow-up to see how Kurt was adjusting to his CPAP, the continuous positive airway pressure machine prescribed for people with sleep apnea. Not only did he report having a pretty easy time of getting used to sticking some plastic up his nose every night, he said he also felt more rested when he awoke and was more alert throughout the day.
When he began to tell me how happy his wife was, I thought that he was going to say, as many men do, that she was glad that he was no longer snoring or that she was relieved that he no longer stopped breathing during the night. Instead, he grinned as he related how, in the past month, he and his wife had more sex than they had had in the past two years. “Hey doc, if you want men to use this thing, just get the word out that it helps with ED (erectile dysfunction). They’ll be in here begging you for a CPAP.”
ED affects an estimated 30 million American men; 15% of men age 70 and older report complete impotence. Women have sexual issues as well; in one study, 43% of women reported sexual dysfunction that impaired their quality of life. And a study in last month’s Journal of Sexual Medicine found that women with sleep apnea were more likely to have significant sexual dysfunction.
Sexual dysfunction can be embarrassing and demoralizing to many people. Therefore, physicians often see a hesitation in bringing this topic up so we think
Kurt’s experience is not unique; there is a growing body of research that shows a strong correlation between sleep apnea and erectile dysfunction in men. There is even evidence that sleep apnea is linked to a higher prevalence of sexual dysfunction in women. One study found that men with RLS (restless legs syndrome) were 78% more likely to have ED. The common mechanism here might be that both disorders involve a malfunction of the neurotransmitter, dopamine.
Experimental research that used a sleep deprivation protocol to study the effects of sleep on the hormones and metabolism. Healthy young men found a decrease in testosterone when there were several nights of short sleep times (five hours or less) for a week or less.
If sleep deprivation is chronic, as it often is in real life, then it may be that milder levels of sleep deprivation have a cumulative effect and could lead to adverse hormonal consequences such as decreased testosterone.
Testosterone is produced during the night; the levels climb steadily throughout the night and peak in the morning. There are studies showing not only that a decrease in the total amount of sleep can lower a man’s testosterone, but also that REM sleep is important to the production and release of testosterone.
We know that REM sleep is often decreased or absent in patients with sleep apnea. Therefore, it seems that both the quantity and quality of sleep are important for testosterone production.
However, with sleep apnea, there is another reason that there could be erectile dysfunction: the low oxygen levels that are often associated with apnea, especially when it is severe. In some studies, the severity of the sleep apnea was the greatest predictor of ED while in others it was how low the oxygen went. We have known for years that chronically low oxygen levels at night adversely affects the vasculature of the heart, lungs, brain, and now we can add the penis.
The good news is that often with treatment of the sleep disorder, the sexual dysfunction improves dramatically, thereby enhancing energy, mood and overall quality of life.
The information contained on this page does not and is not intended to convey medical advice.
