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The Link Between Sleep Apnoea And Erectile Dysfunction

Regardless of the reason, lack of quality sleep can not only make us unpleasant people to be around, but has also been linked to more serious problems like diabetes, depression, obesity, cardiovascular problems and  cognitive dysfunction.

There is also evidence that sleep disorders are linked to erectile dysfunction (ED).

ED is very common among patients with Obstructive Sleep Apnoea (OSA) and may be under recognised because patients do not spontaneously report the problem.

Not only is there a high incidence of ED among patients with OSA, but the two conditions together also tend to cause further detriments in both mood and quality of life than either condition alone.

ED is significantly related to age; chronic disease such as heart, cerebrovascular, metabolic and neurological; and urological problems, as well as cigarette smoking, excess alcohol, obesity and stress.

A study examined the relationship between OSA and erectile dysfunction. The researchers found that men with erectile dysfunction were more likely to have OSA, than those without erectile dysfunction.

Several studies have supported the association of OSA and ED, reporting that one in three patients with OSA has ED, and conversely up to 40% of patients with ED have at least five episodes of apnoea/hypopnoea per hour of sleep.


Mechanisms And Physiological Factors Involved In ED

People with OSA have an interrupted testosterone cycle. It is possible that such disrupted hormonal cycles may be the link between OSA and the ability to maintain an erection.

The major contributing factor for decreased serum testosterone levels appears to be hypoxia resulting from apneoa and hypopnoea episodes. Sleep fragmentation alone may also play a role in the pituitary–gonadal dysfunction in OSA patients.

REM sleep is usually accompanied by an erection, a decrease or absence of REM sleep in OSA patients is associated with a reduction in erections both during the night and on awakening.

Absence of erections on awakening from sleep is the best predictor that differentiates the organic from the psychogenic causes of ED.

A high sympathetic activity has been reported in OSA patients during wakefulness and to an even greater extent during sleep, especially REM sleep. The increased level of circulating norepinephrine does not only alter the erectile function by opposing the physiologic mechanism of erection but is also a causative factor of hypertension, a common risk factor associated with penile arterial insufficiency.

Repeated apnoea-related hypoxic events in OSA may be similar to hypoxia/reperfusion injury, which initiates oxidative stress, release of oxygen radicals, and breakdown of endothelial derived nitric oxide (NO). NO is an important mediator in the physiology of erection

Researchers at Mount Sinai Medical Center in New York evaluated 870 consecutively enrolled men through a cardiac screening program. Patients were screened for obstructive sleep apnoea and erectile dysfunction through clinical questionnaires and were asked about their history of cardiovascular disease, blood pressure, diabetes and smoking.

63% of patients in the study screened positive for obstructive sleep apnoea, 5.6 percent had a history of diabetes, and 29 percent had a smoking history. The likelihood for having OSA increased as the severity of ED increased.


How To Achieve Better Sexual Health

The good news for patients with both OSA and ED is that treatment for sleep apnoea through continuous positive airway pressure therapy (CPAP), has been shown to improve symptoms of ED.

Getting a good night’s sleep can do a world of good for your whole body.

Impaired Nitric oxide activity appears to play an important role in the pathogenesis of erectile dysfunction.

Nitric oxide helps relax your blood vessels, including those supplying blood to your penis. As blood vessels in your penis dilate, it increases blood flow, which helps maintain an erection.

Presence of a mutation in the eNOS gene results in decreased synthesis of nitric oxide and reduced availability. Test for mutations of the eNos gene through the Emed genetic profile tests.

L-arginine can also help with erectile dysfunction as it is a precursor for nitric oxide.

Use Denton Anti-Snore pillow to help correct sleeping posture and help unblock the airways.

  • Cut caffeine
  • Quit smoking
  • Avoid alcohol as a sleep aid
  • Maintain healthy weight
  • Relax before bedtime – create a pre-sleep ritual, such as light stretching or a hot bath, to help you unwind from the day.
  • Exercise – regular exercise, usually in the mornings or afternoons, can help you sleep like a baby. The increased blood flow that occurs during exercise encourages the endothelium to make more NO.


Further Reading:



Budweiser S et al., Sleep apnea is an independent correlate of erectile and sexual dysfunction., J Sex Med. 2009; 6(11):3147-57 (ISSN: 1743-6109)

Shin HW, Rha YC, Han DH, et al. Erectile dysfunction and disease-specific quality of life in patients with obstructive sleep apnea. Int J Impot Res. 2008;20:549-553.

Santos T, Drummond M, Botelho F. Erectile dysfunction in obstructive sleep apnea syndrome–prevalence and determinants. Rev Port Pneumol. 2012;18:64-71


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