Sleep and Erectile Dysfunction

Erectile Dysfunction(ED) is becoming a bigger topic in the medical sense. But what is it? Strictly defined, Erectile Dysfunction(ED) or erectile dysfunction, is the inability to attain and/or maintain a penile erection sufficient for satisfactory sexual performance.


Sleep is an essential biological process that is now appreciated as vital to both physical and mental health. Despite the fact that adults spend approximately one-third of their life sleeping, for a long time sleep was ignored by physicians and scientists alike. Beginning in the 1980s, sleep disorders began to be systematically studied, understood, and more widely diagnosed, and sleep medicine became a medical specialty. 

Good sleep is necessary for good health. Sleep health is increasingly recognized as important for physical and mental health by both the medical profession and the general public, and there is great interest in how to avoid and treat sleep disorders and problems.

Sleep-related Erections

Sleep-related erection (SRE) is a natural and involuntary phenomenon occurring typically during sleep in healthy males. There is no clear theory about why and how SREs occur, but results from a study in rats in which lesions of the lateral preoptic area of the brain were made suggested that SREs are regulated by the hypothalamus.

SREs appear from infants to old age, and the magnitude and duration tend to decline with aging. SREs are considered to have a different mechanism from the erections that occur by sensory stimuli or fantasy.SRE testing is useful to differentiate psychogenic from organic Erectile Dysfunction(ED), but other urologists demonstrated psychological factors that can affect SREs, such as depression, anxiety, 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 age into midlife and beyond, they frequently experience changes in their sexual health, and those changes can lead to dysfunction. Most of the changes are due to diminished sex hormone levels, such as testosterone. Decreased testosterone can lead to erectile dysfunction (Erectile Dysfunction(ED)), decreased libido, loss of pubic and body hair, impaired orgasmic and ejaculatory function, etc.. Erectile Dysfunction(ED), due to the inability to achieve and maintain a sufficient penile erection in order to have satisfactory sexual intercourse, is the most recognized and distressing of these disorders, and often leads patients to seek treatment. Erectile Dysfunction(ED) is quite prevalent, especially among the middle-aged and older population, affecting more than half (52%) of men aged 40 to 70 years. Erectile Dysfunction(ED) is typically assumed to be due to the natural aging process, but it may also occur secondary to other disorders, due to medical treatment, or to result from altered emotional states including fear, depression, or low self-esteem. Regardless of origin, Erectile Dysfunction(ED) frequently has a strong negative effect on the quality of life.

Good sleep is necessary for good health and well-being. Recently, sleep medicine and sleep disorders have received more attention among physicians and the general public. Some of this attention is due to recent research that indicates clearly that insufficient sleep and sleep disorders affect many aspects of human health, and when untreated can cause serious illness. In the past, sleep disorders were not considered as risk factors for Erectile Dysfunction(ED). However, sleep has been found to be disrupted in Erectile Dysfunction(ED) populations and the association between sleep disruption, sleep disorders, and Erectile Dysfunction(ED) has been increasingly studied.

1. Obstructive sleep apnea(OSA)

Obstructive sleep apnea(OSA) is a common sleep disorder characterized by loud snoring and reduced or absent airflow due to partial or complete collapse of the upper airway.

An apneic event is defined as a decrease of airflow of more than 90% 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.

 As the partial or complete obstruction continues, oxygen saturation falls, and this ultimately triggers brief arousal during which the patient gasps to reopen the airway. The arousals typically do not awaken the patient, who often is unaware of the occurrence of these events the next morning. The severity of OSA is measured by the number of events per hour of sleep.

OSA causes sleep fragmentation (from the frequent arousals), hypoxemia, loud snoring, breathing interruptions, awakenings due to choking, and often (but not always) is accompanied by daytime sleepiness. Epidemiologic studies have found that the prevalence of OSA is 4.0% to 32.8% in middle-aged men.

Studies show a high incidence of Erectile Dysfunction(ED) among male OSA patients, ranging from 47.1% to 80.0%. The severity of OSA is considered to be an important factor in the development of Erectile Dysfunction(ED), however, this finding is not consistent.

2. Insomnia, chronic sleep insufficiency

Insomnia is one of the most highly prevalent sleep disorders. While difficulty initiating sleep is a common insomnia symptom, other sleep problems that are considered symptoms of insomnia include difficulty maintaining sleep, awakening earlier than desired, resistance to going to bed on an appropriate schedule, and difficulty sleeping without parents. According to previous epidemiologic studies, approximately 30% to 35% of the population has at least one of the insomnia symptoms occasionally, and 9% to 10% of the population meet the diagnostic criteria for insomnia disorder.

Sexual dysfunction is more common among older men, and insomnia has been found to be an independent risk factor related to sexual dysfunction, along with cardiovascular disease, diabetes, and depression. The most likely explanation for the mechanism underlying the association between insomnia and sexual dysfunction is a decrease in the level of testosterone. Testosterone has a diurnal rhythm of production, starting to rise at sleep onset and reaching a peak during the first REM sleep bout. Therefore, circulating testosterone levels are higher during sleep than during waking, and insomnia or insufficient sleep could adversely affect the level of testosterone via shortening sleep duration or altering the structure of sleep. In fact, it has been demonstrated that sleep loss during the second half of the night significantly reduces morning testosterone levels.

3. Circadian rhythm sleep disorders

Circadian rhythm sleep disorders are problems with sleep characterized by an inability to sleep at the desired time, rather than a dysfunction with the underlying mechanisms generating sleep. These sleep timing disorders result in a mismatch between the clock hour at which sleep is attempted and the underlying biological time at which sleep is promoted by the circadian timing system.

Shift work is prevalent all over the world, comprising more than 15% of the workforce. The proportion of shift workers in some professions can reach as high as 50%, including police, firefighters, manufacturing employees, transportation, and hospital workers. Many industries that formerly had few or no shift workers now do so given our 24/7 culture, including retail, customer support, and food-service. Working at night or on a rotating schedule results in frequent shifting of the timing of sleep-wakefulness, feeding-fasting, and rest-activity with respect to the solar day and with respect to the underlying biological clock timing. This poses a serious threat to the shift worker’s physical, mental, and psychosocial health.

Given the research results showing that testosterone secretion starts to rise at sleep onset and reach the highest point at the first REM sleep cycle, it can be inferred that sleep disruption by shift work should influence testosterone secretion. A small study with 4 healthy shift workers demonstrated a significant increase of melatonin and a decrease of testosterone compared to a control group. Another experimental study in the lab showed that fragmented sleep resulted in a decrease of REM sleep and a corresponding loss of the testosterone surge which can result in Erectile Dysfunction.

4. Restless legs syndrome

Restless legs syndrome (RLS) is a movement disorder characterized by peculiar sensory symptoms of the legs, including unpleasant discomfort and an irresistible urge to move the legs to relieve the sensations. These symptoms are typically worse at rest when lying or sitting and appear at night or in the evening. The prevalence of RLS is lower in men, affecting approximately 4.1% to 7.6% of men Interestingly, the prevalence in men was directly proportional to increasing age in one study, whereas another study showed an inverse trend.

Although there are only a few studies about RLS and Erectile Dysfunction(ED), it is thought that RLS is associated with Erectile Dysfunction(ED). The mechanism of interaction has not been clarified yet, but it may be because RLS and Erectile Dysfunction(ED) have similar biological processes, including autonomic dysfunction and dopamine deficiency. A 6-year prospective study found that RLS was a risk factor for developing Erectile Dysfunction(ED) with a relative risk of 1.33, and the frequency of RLS symptoms had a linear relationship with the magnitude of that risk. In a recent case-control study with 50 subjects each, Kurt reported that not only Erectile Dysfunction(ED) but also premature ejaculation is more common in men with RLS than in controls.

5. Periodic limb movements during sleep

Periodic limb movements during sleep (PLMS) are a type of movement disorder consisting of repetitive limb movements most often impacting the lower limbs, especially as an extension of the toes, flexion of the ankles and knees, and sometimes even the hips, during sleep. 

The prevalence of PLMS has been known to be higher among Erectile Dysfunction(ED) patients, affecting 54% to 60%, especially men aged greater than 70 years.

6. Narcolepsy

Narcolepsy is a rare chronic sleep disorder with a prevalence of 0.02% to 0.06%, affecting both sexes equally. The main symptom is excessive daytime sleepiness or unexpected sleep attacks. Some narcolepsy patients may have cataplexy (a sudden loss of muscle tone provoked by emotion), sleep paralysis, or sleep hallucinations at sleep onset or upon awakening. Narcolepsy is caused by loss of hypocretin (also known as orexin), a neuropeptide involved in regulating vigilance.

To date, just a few studies about narcolepsy and sexual dysfunction have been carried out. In his study measuring SRE of 28 narcolepsy patients, Karacan found that all the medicated patients had a shorter duration of SREs by 20%, and none of them had full SREs. This finding suggested a connection between Erectile Dysfunction(ED) and medications such as stimulants and antidepressants used to treat narcolepsy.

 7. Nocturia

The definition of nocturia is the need to wake up one or more times to void urine during sleep. Nocturia is a common complaint in middle-aged and older patients. While young adults rarely report symptoms of nocturia, urological surveys find that approximately half of adults age 60 or older report nocturia, and the prevalence increases with advancing age. Sleep surveys also find a high prevalence of nocturia among middle-aged and older individuals, and it is a major cause of sleep disruption.

frequent nocturia could produce fragmented sleep and consequently decrease the level of testosterone. In spite of a lack of evidence, recent studies suggested that low testosterone might be related to nocturia. A study of type 2 diabetes patients also found nocturia was associated with Erectile Dysfunction(ED), and patients with lower levels of testosterone had a higher prevalence of nocturia. It is currently considered that nocturia and testosterone have a negative feedback relationship, in which nocturia produces a decrease of testosterone, and a testosterone decline contributes to the development of nocturia in hypogonadal men with nocturia which can result in Erectile Dysfunction.


There are many oral medications that can help with Erectile Dysfunction due to sleep disorders. Talking with your physician helps you find the causes for Erectile Dysfunction. Just taking this step will get you on your way to recovery, not only your sex life but your relationship! And remember, no need to worry about your privacy. Clinics like “The ED Clinic”  take full care to make sure all privacy details are just that- Private.

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