“I don’t have any sleep problem. My wife forced me to come here,” a young man in his forties vented out his irritation. I explain that the treatment of sleep apnea does reduce the risk of stroke, heart attack, and early death. Now, he got even more irritated, “I am not going to wear that CPAP.” I continued to make my case, “Studies have shown that the CPAP also improves intimacy and sexual function.” All of a sudden his eyes became big, he straightened up in the chair and asked hurriedly, “How soon Can I get that CPAP machine, Doc?”
Indeed, the studies have shown that up to 68% of men with Obstructive Sleep Apnea report sexual dysfunction and loss of interest in sex.
In a study published in Journal of Clinical Sleep Medicine, Judith L. Reishtein, Ph.D. and colleagues evaluated the sexual function of 176 patients with sleep apnea before and after the treatment with CPAP for 3 months.
Intimate and sexual relationships were assessed using the Intimate and Sexual Relationships subscale of the Functional Outcomes of Sleep Questionnaire (FOSQ). This disease-specific, self-administered instrument contains 30 questions and 5 stand-alone subscales.
As shown in the following table, difficulty with sexual desire, arousal, and orgasm decreased remarkably after 3 months of treatment with CPAP.
How does CPAP improve sexual function?
Those who are sleepier, as the researcher found, may be less interested and more impaired in sexual activity. Indeed, Barnes and colleagues also found among a group of 98 men with OSA, those with Erectile Dysfunction were significantly sleepier in the daytime than those without ED.
Margel and colleagues reported that morning tiredness was predictive of sexual satisfaction and the ability to have a morning erection.
In addition to excessive sleepiness, other potential mechanisms have been considered, including hormone levels as well as hypoxic-induced neural dysfunction affecting the erectile process. Comparing 10 men who had OSA with 5 healthy controls, Luboshitzky and others found that the OSA patients had lower mean luteinizing hormone (LH) and testosterone levels, secreting less LH and testosterone during sleep.
In a study of 1312 men, Barrett-Connor and colleagues found that men with the lowest testosterone levels had more severe apnea than those with normal levels. They also spent more of their sleep time with oxygen saturation less than 90%.
Soukhova-O’Hare found that chronically low oxygen level in rodents decreased levels of the endothelial nitric oxide, which mediates penile erection. This team also documented that chronic intermittent hypoxemia produced a 55% decrease in the number of daily spontaneous erections that were reversed after 6 weeks of recovery in normoxia. They also found reduced sexual drive and mating activity.
Thus, the findings from these studies suggest that the effect of OSA on intimate and sexual behaviors may be multifactorial.
How Quickly Sexual Function can Improve?
Bradshaw and associates demonstrated a significant increase in the Intimate and Sexual Relationships score in participants who received just 2 weeks of CPAP treatment.
Goncalves and colleagues reported Erectile Dysfunction resolved in 13 of 17 OSA patients treated for one month with CPAP.
Akashiba and colleagues reported that in patients with severe OSA, following 6 weeks CPAP treatment, Intimacy and Sexual Relationships scores improved 2.59 points.
In conclusion, treatment of sleep apnea with CPAP improves intimacy and sexual function besides reducing your risk of stroke, heart attack, high blood pressure, high blood sugar, and drowsy driving. So, listen to your spouse and talk to us.
God Bless You.
Sleep Well, Live Well.