The impact of sleep apnea upon sexual dysfunction


Sleep-disordered breathing is a prominent sleep disorder and the most common type being obstructive sleep apnea syndrome

For decades, doctors and researchers alike have studied the impact of sleep or the lack thereof upon physical and mental health. Often overlooked, individuals will sleep about a third of their entire life. In fact, if a person lives for 75 years, 25 of those years would have been spent sleeping.

Individuals who experience healthy sleep will cycle through several sleep stages throughout the night. This progression through the stages of sleep has been associated with the repair and regeneration of various body tissues and the strengthening of the immune system.

There have been various sleep disorders identified and shown to disrupt the stages of sleep and to negatively impact health in many ways. In particular, the impact of sleep upon male sexual dysfunction, mainly erectile dysfunction and sexual desire will be discussed.

Obstructive Sleep Apnea Syndrome

Sleep-disordered breathing is a prominent sleep disorder and the most common type being obstructive sleep apnea syndrome (OSAS). OSAS is defined as a significant decrease (hypopnea) or the temporary stopping (apnea) of air flow due to the collapse of tissue near the throat during sleep. The collapse of the airway may interrupt normal breathing for seconds to even minutes.

The reduction the incoming air as one breathes during sleep creates a condition called hypoxia. This is when the body becomes deprived of the adequate oxygen it needs. These hypoxic episodes may occur hundreds of times each night resulting in detrimental changes to the body.

OSAS is a relatively common disorder that affects males more than females and approximately 5% of the general population overall. Unfortunately, it is estimated that just 1% of individuals with OSAS receive the appropriate treatment.

Most people are unaware that they have OSAS because it occurs when they are sleeping. Typically, the bed partner is usually the first to notice the signs and symptoms. The most noticeable sign is loud snoring, which is the sound created by air being forced past the collapsed airway. Extended pauses in breathing along with choking may also be witnessed by the bed partner. Fatigue and daytime sleepiness, caused by the disruption of cycling between the stages of sleep, are common symptoms as well.

The diagnosis of OSAS involves a medical examination, review of the patient’s medical history, assessment of risk factors and diagnostic testing like a sleep study called a polysomnogram. A sleep study measures your sleep cycles and stages by recording air flow in and out of the lungs during breathing, blood oxygen levels, body position, brain waves, breathing effort and rate, electrical activity of muscles, eye movement and heart rate. The data obtained from the sleep study is interpreted by a sleep specialist to determine if the criteria is met for the OSAS diagnosis.

The impact of OSAS upon erectile dysfunction

The erection of the penis involves several steps. Chemicals released by the brain trigger the release of other chemicals that causes blood to fill chambers within the penis and thus creating the firmness of an erection. Associated muscles in and around the penis keeps the blood from escaping and this is how an erection is maintained.

There are common risk factors that OSAS and erectile dysfunction (ED) share. Risk factors like obesity, advanced age, hypertension and diabetes are associated with both conditions. This commonality has led to a debate if whether OSAS is a direct cause of ED or if the two conditions coexist due to similar causative factors.

Symptoms of OSAS

Researchers found a direct link between hypoxia, which is the hallmark of OSAS, to the development of ED

However, researchers at the University of Louisville found a direct link between hypoxia, which is the hallmark of OSAS, to the development of ED in mice. The study found that the main chemical involved in penile erections was negatively affected in hypoxic mice.

Additionally, German researchers found that OSAS related hypoxia directly contributed to the development of ED. The study measured the oxygen concentration in blood from various individuals. It was found that lower concentrations of oxygen in blood was an independent cause of ED, regardless of their common risk factors.

The impact of OSAS upon sexual desire

Sexual desire is defined as a motivational state that can be expressed as a general interest in sexual objects. Such objects would include other people and activities. Also, it may include a wish, need or drive to seek out sexual objects or to engage in sexual activities.

The risk factors that affect sexual desire are similar to those that affect OSAS and ED mentioned earlier. Research has been conducted to establish if OSAS directly decreases sexual desire despite these common risk factors. It has been found that men who lack sleep have reduced levels of testosterone and such low levels of testosterone has been associated with a reduction of sexual desire. Israeli researchers found that OSAS has a direct effect on the specific glands that release chemicals that stimulate testosterone production.

The treatment of OSAS

Since OSAS, ED and reduced sexual desire share common risks factors, targeting the prevention or treatment of obesity, hypertension and diabetes is highly recommended. Moderate intensity aerobic exercise, anaerobic strength training or the combination to the two, called cross-training in addition to adopting the Mediterranean diet, has been shown to help individuals lose weight, lower blood pressure, lower blood sugar and improve sexual dysfunction.

Caution should be used with testosterone supplementation since low testosterone in men has been linked to decreased sexual desire. Testosterone supplementation has been found to possibly worsen untreated OSAS. If testosterone supplementation is indicated then it would be recommendation to rule out OSAS prior to use.

apnea treatment

The most common treatment for OSASis the use of continuous positive airway pressure (CPAP)

The most common treatment for OSAS specifically is the use of continuous positive airway pressure (CPAP). CPAP is a medical device that is worn by a person with OSAS during sleep. The device uses forced air to prevent the collapsing of the airway. CPAP use has been found as an effective way to improve the symptoms related to OSAS, including sexual dysfunction. Unfortunately, compliance of use due to wearing the device during sleep is an obstacle many have difficulty overcoming.

Researchers at the Baylor College of Medicine found that CPAP use in men with OSAS relieved ED in a third of the study’s participants. Drexel University researchers found that OSAS has an negative impact on sexual desire and is improved with CPAP treatment .

Finally, men who are experiencing erectile dysfunction (ED) or reduced sexual desire should follow up with a medical professional to rule out obstructive sleep apnea syndrome (OSAS), especially if they are overweight or obese and suffer from hypertension and diabetes. Consider the use of continuous positive airway pressure (CPAP) as part of the treatment for OSAS with sexual dysfunction, which has been found to relieve ED and improve sexual desire.

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