Obstructive sleep apnea (OSA) and erectile dysfunction (ED) may seem like very different health conditions. However, research shows that about 41 percent to 80 percent of people with OSA also have erectile dysfunction. Some studies also suggest that severity of OSA may affect the severity of ED.

Obstructive sleep apnea is a sleep-related breathing disorder. Common symptoms include loud snoring and gasping for air while sleeping. In people with OSA, the throat muscles relax too much during sleep, which can block the upper airway and limit airflow. Without effective treatment, OSA can disrupt sleep throughout the night and lower blood oxygen levels. Over time, this may lead to life-threatening health problems.

Erectile dysfunction — sometimes called impotence — happens when the penis can’t get or stay firm enough for sex. It’s normal to occasionally have trouble with an erection, but frequent ED may need treatment and can sometimes be a sign of another health condition.

This article discusses several possible links between OSA and ED. If you have sleep apnea and are concerned about erectile dysfunction, talk with your doctor about your personal risk factors.

Sleep Apnea May Affect Sex Hormones

Research shows that the sex hormone testosterone is released at its highest levels during rapid eye movement (REM) sleep. Because people with sleep apnea wake up many times during the night, REM sleep is often disturbed. This may reduce testosterone production and lead to low testosterone levels. Less REM sleep may also affect the nerves involved in sexual function and contribute to erectile dysfunction.

Interrupted sleep from sleep apnea puts stress on the body. Poor sleep quality and low oxygen levels can reduce testosterone levels and increase levels of cortisol, the body’s main stress hormone. High cortisol levels can affect many parts of the body, including further lowering testosterone.

Low testosterone can raise the risk of ED, interfere with natural sleep rhythms, and contribute to ongoing sleep problems. Over time, this can create a cycle of poor sleep lowering testosterone and low testosterone continuing to worsen sleep.

Poor Sleep Can Cause Fatigue and Stress

Disrupted sleep can lead to daytime symptoms that may also contribute to erectile dysfunction. Common effects of sleep apnea include daytime drowsiness, fatigue, and mental health problems (such as depression and anxiety) — issues that can also affect sexual health and performance.

Psychological stress can lower libido (sex drive) and may sometimes lead to erectile dysfunction. Fatigue is also a common cause of ED. When sleep apnea and ED occur together, they can have a serious impact on quality of life.

Sleep Apnea and Erectile Dysfunction Share Risk Factors

Research suggests that people with obstructive sleep apnea may be more likely to develop erectile dysfunction. These two conditions share several risk factors. Both are linked to a higher risk of cardiovascular disease and nervous system problems.

People with OSA or ED are also more likely to develop comorbidities (coinciding health conditions), including:

• Diabetes
• Metabolic syndrome (a group of conditions including high blood pressure, excess belly fat, and high blood sugar)
• Endothelial dysfunction (when blood vessels don’t widen properly)
• Peripheral neuropathy (nerve damage that can cause pain, tingling, or numbness)

OSA can raise the risk of serious health problems because repeated pauses in breathing lower oxygen levels. The body’s tissues and organs, including the heart and brain, need oxygen to function properly.

Erectile dysfunction can sometimes be an early warning of heart disease. Trouble getting or keeping an erection may be caused by reduced blood flow to the penis due to narrowed or damaged blood vessels.

Other risk factors common to both OSA and ED include:

• Older age
• Heavy alcohol use
• Smoking
• High body weight or obesity

Treating Sleep Apnea May Improve Erectile Dysfunction

Sleep apnea is typically treated with a continuous positive airway pressure (CPAP) machine, which delivers a steady flow of air through a mask worn during sleep. The air pressure helps keep the airways open. One study found that CPAP therapy significantly improved erectile function in people with both OSA and ED.

The same study also looked at medications classified as phosphodiesterase 5 (PDE5) inhibitors. These drugs improved some aspects of erectile function, such as satisfaction during sexual intercourse, whereas CPAP was more effective at increasing total erectile events. The researchers suggested that CPAP — possibly combined with a PDE5 inhibitor — may be an effective treatment for some people with sleep apnea and ED.

Another small study followed 92 men with sleep apnea, about half of whom also had erectile dysfunction. CPAP therapy improved both sexual function and sexual satisfaction in participants who had ED and in those without ED.

Research on CPAP and erectile dysfunction is still ongoing. Some findings show that CPAP doesn’t worsen ED, but the full extent of its possible benefits isn’t clear. Future research may help clarify how much CPAP can improve erectile dysfunction in people with OSA and ED.

Talk With Your Doctor About Sleep Apnea and Erectile Dysfunction

Sleep apnea and erectile dysfunction can affect each other. The good news is that both conditions can be treated. It’s important to get a sleep evaluation done if you have symptoms of sleep apnea, including:

• Loud snoring
• Episodes of gasping for air during sleep
• Pauses in breathing during sleep
• Poor sleep or ongoing sleep deprivation
• Daytime sleepiness or fatigue
• Morning headaches
• Trouble concentrating or memory problems

People with sleep apnea aren’t always aware of their nighttime symptoms. A bed partner may notice breathing pauses or loud snoring first. Getting an accurate diagnosis and starting sleep apnea treatment can help reduce the risk of ED and other health complications.

If you think you may have erectile dysfunction, discuss your concerns with your doctor. ED can affect your quality of life and sense of well-being, and it may indicate another health problem.

It’s common for people with ED symptoms to feel embarrassed or anxious about sexual health and avoid bringing up ED. As a result, erectile dysfunction often goes untreated. You and your healthcare provider can discuss treatment options that might fit your needs. In some cases, lifestyle changes — such as reduced alcohol consumption, weight loss, smoking cessation, and increased physical activity — may improve ED.

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