Sleep and Erectile Dysfunction [Relation]

12 minutes

Sleep is one of the most important factors that greatly affect a man’s sexual health. Sleep is important for sex drive because testosterone is mostly produced when you are in sleep. Testosterone is the hormone responsible for having a strong libido, as well as for general sexual health and erectile function in men.

Testosterone levels normally peak in the morning and are at their lowest point before we fall asleep. In other words, sleep is like filling up your testosterone gas tank to be used throughout the day. With diminished levels of testosterone, a man will experience reduced sexual desire and sexual performance.

The autonomic nervous system (ANS) is closely related to sexual function and desire. The ANS stimulates your body to react to stressors (good or bad). It is well known that in sexual arousal, the part of the ANS that responds to good stimulators plays a significant part.

For a whole cascade of events related to the proper operation of the ANS and hormone releases, sleep is necessary. Plus, when people don’t get enough sleep, the portion of the ANS that responds to negative stimuli, such as stress, becomes more sensitive. To optimize sex drive, it is important to get all the sleep needed and to be fully rested, mentally and physically.

Sleep and Erectile dysfunction

Sleep deprivation is caused when you get less than the optimum sleep period, which is  7-9 hours a day for adults. A few nights of sleep loss is not likely to trigger ED, but in that time frame, you may feel less libido.

However, ED in men may be caused by chronic sleep loss, such as sleep deprivation caused by sleep disorders.

Sleep deprivation can cause Erectile dysfunction by reducing your testosterone levels, making you unable to get an erection, and by making you unable to maintain an erection for sexual intercourse.

Lack of sleep can cause Erectile dysfunction in many ways that include

  • Reduced testosterone production
  • Weakened D2 dopamine receptors
  • Decreased nitric oxide production
  •  Hormonal imbalances
  • Increased fatigue 
  • Increased mood swings and depression


Sleep is an important biological function that is now accepted as central for both physical and mental health. Given the fact that adults spend about a third of their lives asleep, doctors and scientists alike have overlooked sleep for a long time. Beginning in the 1980s, sleep disorders are systematically studied, understood, widely diagnosed, and sleep medicine became a medical specialty. 

Good sleep is important for proper health . Sleep health is widely recognized by both the medical community and the general public as critical for physical and mental health, and there is considerable interest in how sleep disturbances and concerns can be prevented and treated.

Sleep-related Erections

A sleep-related erection (SRE) is a normal and spontaneous condition in healthy males that usually happens during sleep. There is no definite explanation on why and how SREs exist, but it is proposed that SREs are controlled by the hypothalamus as a result of a study in rats.

SREs occur from infants to old age, and with aging, the magnitude and period begins to decrease. SREs are known to be a distinct process from erections that occur through visual stimulation or imagination. SRE studies are helpful to distinguish psychogenic from organic erectile dysfunction (ED), but psychological causes that may influence SREs, such as stress, anxiety, have been seen by other urologists and fatigue.

Currently, it is believed that the overall quality of sleep is more important for SREs than whether they are caused by psychogenic or organic factors.

Sleep, Sleep Disorders, and Erectile Dysfunction

As men often undergo changes in their sexual wellbeing as men mature into midlife and beyond, and those changes can lead to dysfunction. Much of the modifications were due to reduced levels of sex hormones, such as testosterone. Diminished testosterone can lead to erectile dysfunction (ED), reduced libido, loss of body and pubic hair, decreased orgasmic and ejaculatory activity, etc… Erectile Dysfunction(ED), The most known and distressing of these conditions is due to the failure to obtain and sustain a proper penile erection to have adequate sexual intercourse and frequently causes patients to seek care. Erectile dysfunction(ED) is very widespread, affecting more than half (52 percent) of men aged 40 to 70 years, especially in the middle-aged and older population. Erectile Dysfunction(ED) is commonly believed to be due to the normal aging process, although due to medical care, it can often occur secondary to other conditions or arise from altered emotional states, including anxiety, depression, or low self-esteem. Erectile Dysfunction(ED) often has a strong negative impact on the quality of life, regardless of origin.

For good health and well-being, good sleep is expected. Recently, by doctors and the general public, sleep medicine and sleep disorders have gained further coverage. Any of this focus is attributed to new studies that strongly shows that certain facets of human wellbeing are impaired by inadequate sleep and sleep disturbances and can cause severe illness if unchecked. Sleep problems have not been considered risk factors for Erectile Dysfunction in the past (ED). In Erectile Dysfunction(ED) populations, however, sleep is disturbed and the link between sleep disturbance, sleep disturbances, and Erectile Dysfunction(ED) has been increasingly studied.

1. Obstructive sleep apnea(OSA)

A widespread sleep condition characterized by loud snoring and diminished or missing airflow due to partial or total collapse of the upper airway is obstructive sleep apnea(OSA).

An apneic occurrence is described as a more than 90 percent decrease in airflow for at least 10 seconds while respiratory effort continues.

 A hypopnea is defined by a 30% to 90% decreased airflow accompanied by a 3% or greater oxygen desaturation.

Oxygen concentration decreases as the partial or total obstruction progresses, and this eventually causes brief arousal at which the patient gasps to reopen the airway. Usually, the arousals do not awaken the patient, who is frequently unaware the next morning of the frequency of these events. OSA intensity is measured by the number of incidents per hour of sleep.

OSA induces fragmentation of sleep, hypoxemia, loud snoring, disturbance of breathing, waking due to choking, which is frequently followed by sleepiness during the day. Epidemiologic tests have shown that in middle-aged men, the prevalence of OSA is 4% to 32.8%.

Studies indicate a high prevalence of erectile dysfunction (ED) in patients with male OSA, ranging from 47.1% to 80.0%. In the development of Erectile Dysfunction(ED), the severity of OSA is known to be a significant factor, but this result is not consistent.

2. Insomnia, chronic sleep insufficiency

One of the most common sleep conditions is insomnia. While a typical symptom of insomnia is trouble inducing sleep, other sleep disorders that are considered signs of insomnia include difficulty sustaining sleep, early than desired waking, aversion to going to bed on a satisfactory schedule, and difficulty sleeping without parents. According to prior epidemiological research, about 30 to 35 percent of the population sometimes has at least one of the signs of insomnia, and 9 to 10 percent of the population meets the medical requirements for insomnia disorder.

Sexual dysfunction in older men is more common, and insomnia, along with cardiovascular disease, diabetes, and depression, is an independent risk factor linked to sexual dysfunction. A drop in the level of testosterone is the most plausible reason for the cause behind the link between insomnia and sexual dysfunction. Testosterone has a regular development cycle, beginning to increase at the dawn of sleep and hitting a plateau during the first REM sleep bout. Circulating testosterone levels are also higher during sleep than during waking, and insomnia or inadequate sleep can adversely affect testosterone levels by shortening the length of sleep or modifying the sleep structure. It has been demonstrated that sleep loss during the second half of the night significantly reduces morning testosterone levels.

3. Circadian rhythm sleep disorders

Sleep conditions characterized by a failure to sleep at the appropriate time, rather than a deficiency of the underlying sleep generating pathways, are circadian rhythm sleep disorders. These sleep timing disorders result in a discrepancy between the clock hour at which sleep is attempted and the biological underlying time at which the circadian timing mechanism encourages sleep.

Across the nation, shift work is widespread, comprising more than 15 percent of the population. In certain occupations, the proportion of shift employees will hit as high as 50 percent, including police, firefighters, industrial personnel, transport, and medical workers. Given our 24/7 society, many businesses that historically had little to no shift staff do so today, including banking, customer service, and food-service. Serving at night or on a revolving schedule results in the pacing of sleep-wakefulness, feeding-fasting, and rest-activity being regularly changed with respect to the solar day and the inherent timing of the biological clock. This represents a significant risk to the physical, emotional, and psychosocial health of the shift worker.

Given the research findings showing that testosterone secretion begins to increase at the beginning of sleep and hits the maximum point at the first REM sleep period, it can be concluded that sleep disturbance by shift work should affect the secretion of testosterone. Compared to the control sample, a small sample of 4 stable shift employees reported a substantial rise in melatonin and a reduction in testosterone. Another laboratory experimental research found that fragmented sleep resulted in a decline in REM sleep and a subsequent lack of testosterone surge that could contribute to erectile dysfunction.

4. Restless legs syndrome

Restless legs syndrome (RLS) is a movement condition that is characterized by the legs’ unique sensory signs, including unpleasant pain and an overwhelming desire to move the legs to ease the sensations. When sleeping or sitting, these signs are normally worse at rest and occur at night or in the evening. The prevalence of RLS in men is smaller, affecting about 4.1% to 7.6% of men. Surprisingly, in one study, the prevalence of men was directly related to growing age, while another study found an opposite effect.

Although there are only a few studies on RLS and erectile dysfunction (ED), RLS is suspected to be associated with erectile dysfunction (ED). The association mechanism has not yet been explained, but it may be that RLS and Erectile Dysfunction(ED) have common biological mechanisms, including autonomic dysfunction and dopamine deficiency. A 6-year prospective analysis showed that RLS was a risk factor with a relative risk of 1.33 for the occurrence of Erectile Dysfunction(ED) and that the incidence of symptoms of RLS had a linear relationship with the severity of that risk. Kurt recorded that not only erectile dysfunction (ED) but also premature ejaculation was more frequent in men with RLS than in controls in a recent case-control study with 50 subjects each.

5. Periodic limb movements during sleep

Periodic limb movements during sleep (PLMS) is a form of movement condition consisting of repeated movement of the limb that most commonly involves the lower limbs during sleep, mainly as an extension of the toes, bending of the ankles and knees, and often also the hips.

Among erectile dysfunction (ED) patients, the prevalence of PLMS was found to be higher, affecting 54 percent to 60 percent, particularly males older than 70 years.

6. Narcolepsy

With a frequency of 0.02 percent to 0.06 percent, narcolepsy is a rare chronic sleep condition, affecting both sexes equally. Excessive sleepiness through the day or sudden sleep attacks are the major symptoms. Cataplexy (a rapid lack of muscle tone caused by emotion), sleep paralysis, or sleep hallucinations can be occurring in certain narcolepsy patients at sleep onset or upon waking. Narcolepsy is caused by loss of hypocretin (also known as orexin), a neuropeptide involved in regulating vigilance.

Only a few studies have been done to date on narcolepsy and sexual dysfunction. In his study evaluating the SRE of 28 patients with narcolepsy, Karacan observed that all medicated patients had a 20 percent shorter SRE period, and none of them had complete SREs. This finding suggested a connection between Erectile Dysfunction(ED) and medications such as stimulants and antidepressants used to treat narcolepsy.

7. Nocturia

The idea of nocturia is the need to wake up one or more times during sleep to empty urine. Nocturia in middle-aged and older patients is a frequent complaint. Although young adults rarely experience nocturia symptoms, urological studies show that nocturia is identified by nearly half of adults 60 years of age or older, and the incidence increases with advancing age. A high prevalence of nocturia in middle-aged and older individuals is also observed in sleep studies, and it is a significant cause of sleep disturbance.

Frequent nocturia may create disrupted sleep and reduce the level of testosterone as a result. Recent findings have indicated, despite a lack of data, that low testosterone could be linked to nocturia. Nocturia was also associated with Erectile Dysfunction(ED) in a sample of type 2 diabetes patients, and the incidence of nocturia was greater in patients with lower testosterone levels. There is a negative feedback association between nocturia and testosterone, in which nocturia causes a reduction in testosterone, and a decrease in testosterone leads to the production of nocturia in hypogonadal males with nocturia, which can lead to erectile dysfunction.


Owing to sleep disturbances, there are also oral drugs that may assist with Erectile Dysfunction. Talking to the psychiatrist helps you determine the causes of erectile dysfunction. Only taking this step will get you, not just your sex life, but your friendship, on your way to recovery! No need to think about your privacy, and remember, Clinics like “The ED Clinic”  take full care to make sure all privacy details are just that- Private.