Does Sleep Apnea Cause Erectile Dysfunction?

Do you struggle to get or maintain erections and have trouble with snoring in your sleep? Sleep apnea and erectile dysfunction (ED) are more connected than you might think.

Your overall health plays a major role in your ability to get and maintain strong erections. A healthy heart, balanced hormones, and good mental health all contribute to erectile function. 

Sleep apnea — a condition where you stop breathing for short bursts while you sleep — can mess with more than just sleep. It’s linked to a higher risk of health problems. 

And a growing body of research suggests a connection between sleep apnea and ED. 

Let’s dive into the evidence and break it all down. 

Sleep apnea is a sleep disorder where your breathing stops and starts repeatedly during sleep. It’s part of a group of conditions called sleep-disordered breathing. 

These interruptions can last seconds or even minutes, and can happen multiple times throughout the night. Even if you’re in bed for hours, sleep apnea can lead to poor sleep quality and leave you feeling unrested.

In one extreme case from 2018, researchers documented a woman whose breathing stopped for nearly 4 minutes. 

There are three main types of sleep apnea:

1. Obstructive sleep apnea (OSA): OSA is the most common type of sleep apnea. It happens when your throat muscles relax and cause a blockage in your airways. Estimates suggest it affects about 10 percent of middle-aged men.

2. Central sleep apnea (CSA): Central sleep apnea occurs when the brain fails to send proper signals to the muscles controlling your breathing.

3. Complex sleep apnea syndrome: Complex sleep apnea is a combination of OSA and CSA.

ED is a type of sexual dysfunction involving the inability to achieve an erection firm enough for sexual intercourse. 

It’s not uncommon to experience erection issues from time to time. But if it happens often, ED could be a sign of an underlying health issue. 

Read more about ED in our condition guide. 

Experts have been looking into the link between sleep apnea and ED since the 1970s. 

Recent studies suggest a link between sleep apnea and erectile dysfunction, suggesting they may share similar physical and psychological causes.

Pauses in your breathing during sleep can limit oxygen levels in your blood. This can leave you feeling tired even after getting a full night’s sleep. 

Both conditions are often tied to underlying health issues like:

• Diabetes

• High blood pressure

• Heart disease

• Depression

• Other psychological factors

Researchers of a 2022 review concluded that OSA might be a risk factor for ED, though the research was mixed. 

Here’s what the studies showed:

• 3 studies found no significant connection between sleep apnea and ED.

• One study reported a higher prevalence of ED in people with a history of heart attack.

• One study found ED was more common in Chinese men with OSA.

• In 5 studies, 28–78.92 percent (AKA a pretty big range) of people with ED also had OSA.

• In 12 studies, 40.9–80% of people with OSA also had ED.

• 3 studies noted that more severe sleep apnea was tied to higher ED severity.

An older systematic review also found a link between OSA and ED.

Theories on Why ED and Sleep Apnea May be Connected

Any condition that impairs your vascular or neurological health can potentially lead to ED. The connection between obstructive sleep apnea and ED likely involves several factors.

One key theory is that low oxygen levels during sleep trigger vascular and inflammatory issues, including reduced nitric oxide levels. Nitric oxide is crucial for relaxing blood vessels and supporting healthy erections. 

Nerve damage to peripheral nerves and their protective myelin sheath could also play a role. 

Additionally, men with OSA often experience higher sympathetic activity during sleep, especially during REM sleep, which could impact sexual function.

Psychological factors, like depression, common in men with both OSA and ED, may reduce sexual desire. 

Hormonal changes might contribute, too, since studies show that men with OSA often have low testosterone levels. 

If you have sleep apnea, you might experience sleep deprivation despite getting enough sleep. 

Sleep apnea symptoms might include:

• Loud snoring

• Gasping or choking during sleep

• Waking up frequently through the night

• Daytime sleepiness

• Difficulty concentrating

• Morning headaches

• Mood changes like irritability or depression

Risk Factors for Sleep Apnea

Factors that increase your likelihood of developing sleep apnea include:

• Obesity. Excess weight can contribute to the narrowing of your airways. Obesity is one of the top risk factors for sleep apnea.

• Large tonsils and a thick neck. Having large tonsils or a thick neck can make you more likely to develop an obstruction in your throat when you’re lying down.

• Age. Sleep apnea is more common in older adults. As you get older, fatty tissue can build up in your neck.

• Biological sex. Men are more likely than women to develop sleep apnea.

• Heart or kidney failure. These conditions can cause fluid to build up in your neck.

• Family history. A genetic predisposition can increase your risk of breathing issues during sleep.

• Lifestyle choices. There’s a link between sleep apnea and smoking, alcohol use, and sedative medications.

• Opioid use. Opioid use disorder or long-term prescription of opioid painkillers increases your risk of central sleep apnea.

• Premature birth. Babies born before 37 weeks have a higher risk of breathing problems when sleeping, but the risk usually decreases with age.

• Health conditions. Some health conditions increase your risk of central sleep apnea such as stroke, amyotrophic lateral sclerosis, and myasthenia gravis.

Risk Factors for ED

ED can develop in anybody with a penis, but some people are at a higher risk than others.

Risk factors for ED include:

• increasing age

• diabetes

• being overweight

• low physical activity

• cardiovascular disease

• chronic kidney disease

• high blood pressure (hypertension)

• multiple sclerosis

• Peyronie’s disease

• prostate cancer treatment

• injury to your penis, spinal cord, bladder, prostate

• bladder cancer surgery

• certain medications such as some antidepressants

• anxiety and depression

• fear of sexual failure

• high stress in general

• high stress about sexual performance

• feelings of guilt related to sexual activity

• smoking

• drinking too much alcohol

• using illicit drugs

Snoring or gasping for breath during sleep are signs that you might be living with sleep apnea. 

If your doctor suspects you might have sleep apnea, they may send you to a sleep medicine specialist for further evaluation.

To diagnose sleep apnea, healthcare providers may recommend:

• Polysomnography (AKA a sleep study). This diagnostic test takes place in a sleep lab and involves monitoring your breathing, oxygen levels, heart rate, and brain activity while you sleep.

• Home sleep apnea testing (HSAT). An HSAT is a more convenient way to detect OSA. It involves measuring your heart rate, blood oxygen levels, airflow, and breathing patterns while you sleep in the comfort of your own home. 

Treating sleep apnea and ED often requires a multifaceted approach, focusing on the root causes while supporting overall health. 

Treating Sleep Apnea

Treatment for sleep apnea aims to improve your sleep quality and reduce complications. 

Treatment options include:

• Continuous positive airway pressure therapy (CPAP therapy).
  CPAP is the gold standard for treating OSA. A CPAP machine delivers a steady stream of air through a mask, keeping your airways open during sleep. Some studies suggest CPAP therapy may improve erectile function in men with sleep apnea.

• Oral appliances. Your healthcare provider may recommend devices that reposition the jaw or tongue to prevent airway obstruction for mild to moderate OSA.

• Surgery. If nothing else works, surgical interventions like uvulopalatopharyngoplasty (UPPP) or maxillomandibular advancement may be an option. 

• Lifestyle changes. Lifestyle changes like weight loss, avoiding alcohol or sedatives, and improving sleep hygiene might also help with sleep apnea symptoms. 

Treating Erectile Dysfunction

The treatment for ED depends on the underlying cause. Treatment options include:

• Phosphodiesterase type 5 (PDE5) inhibitors. Erectile dysfunction medications like sildenafil (Viagra) and tadalafil (Cialis) can help increase blood flow to the penis. Shop for PDE5 inhibitors from Hims.

• Testosterone replacement therapy (TRT). For men with low testosterone levels, TRT can improve libido and erectile function.

• Vacuum erection devices (VEDs). VEDs create a vacuum around your penis, drawing blood into the tissue to facilitate an erection.

• Penile implants. If other treatments are ineffective, implants may help restore erectile function.

• Psychotherapy. Counseling can help address psychological factors contributing to ED.

Implementing healthy lifestyle changes may help improve symptoms of sleep apnea and ED.

Here’s how to tweak your lifestyle for better sexual health and overall health:

• Exercise regularly. Exercise can improve your heart health and reduce stress.

• Adopt a healthy diet. Focusing on nutrient-rich foods filled with healthy, unprocessed foods can support your vascular health and hormonal balance.

• Quit smoking. Smoking damages blood vessels and can potentially exacerbate ED and sleep apnea.

• Limit alcohol consumption. Alcohol can interfere with sleep and sexual function.

• Prioritize sleep hygiene. Keeping a consistent sleep schedule, creating a comfortable sleep environment, and avoiding stimulants like caffeine before bed may help you improve your sleep and overall health.

Sleep apnea and ED can have a profound impact on your physical and emotional well-being and your overall quality of life. 

Let’s recap what we know about sleep apnea and ED:

• Sleep apnea might increase your risk for ED. Research suggests that people with sleep apnea might be more likely to develop ED than people without it.

• Snoring and gasping during sleep are telltale signs of sleep apnea. Unless you have a partner who notices these symptoms, you might not know you have the condition. 

• Both sleep apnea and ED are treatable. Whether you’re dealing with sleep issues like sleep apnea or sexual function problems, help is available. 

Think you might be living with sleep apnea? And worried about how it’s impacting your sexual health? Talk to your healthcare provider. They may recommend a sleep study. 

Want to learn more about how to spot the signs of erectile dysfunction? Read our guide: How to Know If You Have ED.