Can sleep apnea cause erectile dysfunction and other sexual problems? Read our guide to sleep apnea and ED to find out.
Last Updated: 04/13/2023
Sleep apnea and erectile dysfunction (ED) are two conditions that at first glance may seem unrelated. But there’s a definite connection between these two problems, and men who have sleep apnea are more likely to also have ED. More and more research suggests that getting a good night’s sleep is good for your sexual health.
In this guide to sleep apnea and ED, you’ll discover why these two disorders are linked and how men with sleep apnea can reduce their risk of erectile dysfunction.
Sleep apnea is a sleep disorder that causes a person to intermittently stop breathing during sleep, leading to low oxygen levels, what scientists call chronic intermittent hypoxia.
People with this sleep disorder have poor sleep quality, often suffer from fragmented sleep, and wake up frequently during the night. In addition, they don’t feel as if they’ve gotten a good night’s sleep even after sleeping for seven to nine hours.
Often, people with sleep apnea suffer from loud snoring that keeps their partner awake. Sleep apnea is also called sleep disordered breathing.
Sleep apnea occurs when the upper airway muscles temporarily collapse during sleep and block the airway and the ability to breathe. These episodes of breathlessness may last for 10 seconds or more.
Obstructive sleep apnea syndrome (OSA) is classified as either mild, moderate, or severe based upon the apnea-hypopnea index (AHI). To come up with an AHI value, scientists measure the number of apnea plus hypopnea episodes per hour of sleep. Apnea refers to breathing pauses while hypopnea relates to shallow breathing.1
A normal AHI is less than five events per hour, five to 14.9 events are considered mild OSA, 15 to 29.9 are considered moderate OSA, and at least 30 are considered severe OSA.
However, not everyone agrees on the exact definition of hypopnea, which leads to differences in the AHI value.2
There are two kinds of sleep apnea:
Obstructive sleep apnea (OSA) – This is the most common type of sleep apnea. In obstructive sleep apnea, you’re unable to breathe because your airway is blocked, leading to poor sleep quality.
Globally, an estimated 936 million people aged 30 to 69 years have OSA.3 It’s more common in men than women. The prevalence of OSA in men goes up with age, from 10% of men aged 30 to 49 to 17% of men aged 50 to 70.3 In the United States, an estimated 24 million people with sleep apnea are undiagnosed.3
Central sleep apnea – In this condition, the brain doesn’t communicate with the muscles involved in breathing. Central sleep apnea can occur because of heart failure, stroke, end-stage kidney disease, sleeping at a high altitude, taking medications like opioids, or because of an unknown cause.4
You also can develop a combination of OSA and central sleep apnea if you use a continuous positive airway pressure (CPAP) machine to treat sleep apnea. Central sleep apnea is more common in older people, especially those over the age of 60.4
Most of the research on sleep apnea and erectile dysfunction is on obstructive sleep apnea.
Sleep apnea is a serious condition that can cause other consequences besides erectile dysfunction. Untreated sleep apnea is linked to high blood pressure, stroke, depression, and increased mortality.5 High blood pressure and depression are contributing factors for erectile dysfunction.
Although a lot of men with erectile dysfunction don’t realize they have obstructive sleep apnea, sleep disordered breathing can cause symptoms that can clue you in that you should seek professional medical advice about getting tested for sleep apnea.
Symptoms of sleep apnea include:
Excessive daytime sleepiness
Not feeling refreshed even after getting enough sleep
Sore throat or dry mouth when you wake up
Waking up during the night
Gasping for breath when you awaken
Having a hard time concentrating
Sexual problems including erectile dysfunction
Irritability or depression
High blood pressure
Researchers first reported a link between obstructive sleep apnea and sexual dysfunction in 1977. Since then, a lot more research has taken place on the prevalence of erectile dysfunction in men with obstructive sleep apnea syndrome. Depending on the study, an estimated 40% to 80% of OSA patients have ED.3
Five studies found that obstructive sleep apnea was present in 28% to 79% of ED patients.3 Another study found that 51% of OSA patients had erectile dysfunction while research involving 94 men with severe obstructive sleep apnea found that 64 of them suffered from ED.6,7
Most studies have found that erectile dysfunction occurs more often in men who have the most severe obstructive sleep apnea compared to those with a more mild form of OSA.8
According to one study, ED occurs together with OSA in 64.5% of men and together with severe OSA in 73% off men.8 In many studies, but not all of them, the severity of erectile dysfunction corresponded to the severity of OSA.8
Sleep deprivation causes fatigue that interferes with sexual function and can lead to irritability, mental health problems that aren’t good for relationships, and sexual dysfunction.
However, beyond the tiredness caused by sleep apnea, sleep disordered breathing can lead to physical responses in the body that cause erectile dysfunction.
Sleep apnea causes inflammation and problems with blood vessels that can reduce blood flow throughout the body and to penile tissues. Blood flow is crucial for healthy erections and constricted blood vessels can lead to erectile dysfunction.
One of the changes during sleep apnea that can affect erectile function is that the body makes less nitric oxide (NO).3 This important molecule keeps your blood vessels healthy, promotes blood flow, and triggers erections.3
Obstructive sleep apnea can also impact the nerves around the penis, leading to erectile dysfunction.9 Decreased REM sleep that occurs during sleep apnea can cause nerve damage in and around the sexual organs, causing erectile dysfunction.8 Rapid eye movement (REM) sleep is the stage of sleep associated with dreaming, memory, and processing emotions, but REM sleep disturbances can also affect sexual health.
Sleep apnea affects erections by boosting sympathetic nervous system activity during sleep, especially rapid eye movement (REM) sleep, which activates the fight-or-flight response to stress and increases heart rate.3
The increase in sympathetic nervous system activity during sleep apnea raises levels of a brain chemical called norepinephrine.10
Higher levels of this brain chemical reduce erectile function and can also lead to high blood pressure, which is another risk factor for erectile dysfunction and can explain in some men how sleep apnea and erectile dysfunction are connected.3
Another way in which sleep apnea and ED are connected is through mental health issues like depression that can occur due to sleep disorders like obstructive sleep apnea.3
Depression often occurs in men with sleep apnea.11 Depression can cause sexual dysfunction by reducing sexual desire and/or blocking parasympathetic nerve activities, which control sexual function.12
Another reason why sleep apnea may cause erectile dysfunction is because obstructive sleep apnea is linked to low testosterone levels,13 which in turn are tied to reduced erectile function.14
Studies found low testosterone production in male patients with OSA, and the worse the sleep apnea the lower the testosterone levels.13,15
In one study, researchers found lower total and free testosterone levels in men with high abdominal fat who also had OSA and an Epworth Sleepiness Scale score greater than 10 compared to abdominally obese patients without OSA.16
However, many doctors and scientists have found that testosterone replacement therapy can make sleep apnea worse, and advise against treating testosterone deficiency in men with obstructive sleep apnea.17
Your best bet may be losing weight, which is shown to reduce sleep apnea and increase testosterone levels.
The best strategy for preventing sleep apnea and supporting sexual health is maintaining a healthy weight. Sleep apnea has become more common with the large uptick in obesity worldwide.8 Obesity is also related to erectile dysfunction.
Although some people who have OSA are a healthy weight, weight gain puts a man at increased risk for sleep apnea, especially men with moderate to severe OSA.18
A 10% increase in weight leads to a six-fold increase in the progression of OSA, and increases in body mass index are linked to worse severity of sleep apnea.8
The risk of sleep apnea patients developing erectile dysfunction goes up as body mass index increases.8 The body mass index of men with sleep apnea and erectile dysfunction was significantly higher than that of men who had sleep apnea without ED.8
Smoking and alcohol intake also can make matters worse, so quitting smoking and limiting alcohol use may reduce sleep apnea.
If you suspect you have sleep apnea, seek professional medical advice to get a proper diagnosis.
Your doctor may provide you with a home sleep test If you have any of the symptoms or risk factors for sleep apnea. In this type of test, you wear a monitoring device on your finger while you sleep. The monitor measures your heart rate, blood oxygen level, breathing pattern, and airflow throughout the night.
If the device reports abnormal results, your doctor may treat sleep apnea with a continuous positive airway pressure (CPAP) machine.
Your health care provider may also give you a referral to an ear, nose, and throat specialist to find out if there’s a blockage in your nose or throat.
Because home sleep tests aren’t always accurate, if your results are normal and you have a lot of common risk factors or signs of sleep apnea like high blood pressure, loud snoring, sleep deprivation, and obesity, your doctor may order nocturnal polysomnography from a sleep lab.
This type of testing involves sleeping at a sleep clinic while you’re connected to equipment that monitors:
Lung and brain activity
Blood oxygen levels
Arm and leg movements
Your doctor will likely choose to treat sleep apnea in one of the following ways.
For mild sleep apnea, the only treatment doctors may recommend are lifestyle changes such as losing weight or quitting smoking. Changing sleep positions may also help. Treating allergies that congest the sinuses may be another solution.
Doctors treat moderate to severe sleep apnea or sleep apnea that doesn’t respond to lifestyle changes with a continuous positive airway pressure machine, which you use at home while you sleep.
With continuous positive airway pressure devices, you wear a mask to provide air pressure while you sleep, which keeps your upper airway passages open. Continuous positive airway pressure machines prevent sleep apnea and snoring.
If you find CPAP machines uncomfortable, talk to your health care provider to see if they can be adjusted to increase their comfort. Also talk to your doctor if you’re still snoring while using the machine. If you’ve gained weight the pressure settings on the machine might need to be adjusted.
Your dentist can customize an appliance designed to keep your throat from becoming blocked during sleep. These often work by bringing your jaw forward, which can stop mild obstructive sleep apnea and snoring.
If your sleep apnea is moderate or severe, CPAP may be the way to go, since it’s usually more effective. However, oral appliances are easier to use.
Another sleep apnea treatment is surgery. Unless you have problems with your jaw structure, this approach is only used if you’ve tried treating sleep apnea in other ways, but they did not work. Surgical approaches include:
Removing tissue from the top of the throat and rear of the mouth, but this is not effective for obstructive sleep apnea
Tissue shrinkage for mild to moderate sleep apnea
Creating a new air passageway. Used for severe sleep apnea.
Studies show that CPAP treatment and oral appliances used for sleep apnea can result in at least some improvement in erectile dysfunction.8
In one study published in the journal Sleep Medicine, researchers investigated the effects of CPAP on 64 men who had both OSA and erectile dysfunction.19 CPAP treatment significantly improved erectile function in men suffering from moderate and severe ED.
The OSA patients who were more likely to see improvement in erectile dysfunction were the ones who were good about using the CPAP machine.
In a randomized study comparing the use of CPAP with an ED medication, men who regularly used CPAP experienced improved sexual function, sexual desire, overall sexual self-esteem, and relationship satisfaction, as well as less daytime sleepiness and better quality of life.20
OSA patients using CPAP also had more sleep-related erections compared to men not using CPAP.
The beneficial effects of CPAP on erectile dysfunction may have nothing to do with raising testosterone levels, since many studies suggest that CPAP does not increase testosterone production. In one of these studies, long-term CPAP use did not significantly affect testosterone levels in obstructive sleep apnea patients.21
Low oxygen levels due to a condition called sleep apnea are linked to erectile dysfunction. Sleep apnea causes fragmented sleep, waking up in the morning feeling unrested, and problems with sexual health. Sleep apnea is also associated with heart disease and high blood pressure, health problems tied to erectile dysfunction.
ED patients are more likely to have sleep apnea and people with sleep apnea are more likely to have erectile dysfunction. Depending on the study, an estimated 40% to 80% of obstructive sleep apnea (OSA) patients have ED.3
Sleep apnea can cause sexual dysfunction in several ways:
Sleep deprivation causes fatigue that interferes with sexual function
Poor sleep quality and low oxygen reduce blood flow to penile tissues
Sleep apnea can damage the nerves around the penis, leading to erectile dysfunction
Reduced REM sleep during sleep apnea increases sympathetic nervous system activity, which in turn boosts levels of a brain chemical called norepinephrine.10 Higher levels of this brain chemical reduce erectile function and can also lead to high blood pressure.
Sleep apnea may lead to depression and irritability, mood changes that aren’t great for your sex life.
Men with sleep apnea often have low testosterone levels.
CPAP treatment and oral appliances used for sleep apnea can result in at least some improvement in erectile dysfunction.8
In one study published in the journal Sleep Medicine, scientists studied the use of CPAP in 64 men who suffered from both OSA and erectile dysfunction.19 CPAP treatment significantly improved erectile function in men suffering from moderate and severe ED.
The OSA patients most likely to see improvement in erectile dysfunction were the ones who faithfully used their CPAP machine.
Sleep disorders like sleep apnea can lead to testosterone deficiency. Low Testosterone levels are associated with decreased libido and other sexual problems that play a role in a less-than-satisfying sex life.
Studies found low testosterone levels in male patients with OSA, and the worse the sleep apnea the lower the testosterone levels.13,15
However, many doctors and scientists have found that testosterone replacement therapy can make sleep apnea worse, and advise against treating testosterone deficiency in men with OSA.17
The opposite may be true. According to recent research, Viagra may make sleep apnea worse.
In a double-blind, placebo-controlled study published in the Archives of Internal Medicine, researchers compared the effects of a single 50 mg dose of Viagra compared to placebo in 14 middle-aged men with severe OSA.22 The men were monitored throughout the night with sleep tests.
Compared to the placebo, when men were taking the Viagra they spent more time with a lower blood oxygen saturation level during sleep. While taking the ED medication, the men also stopped breathing more times during sleep.
These results were only preliminary and based on a small number of men, so the researchers followed up four years later with a similar study.23 The newer study, conducted in 13 men, reached a similar conclusion in that a single dose of Viagra worsened severe OSA and promoted cardiac problems in these patients.