How sleep apnea can wreck your sex life
October 12th, 2011
01:06 PM ET

How sleep apnea can wreck your sex life

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs regularly on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

It was a normal follow-up to see how Kurt was adjusting to his CPAP, the continuous positive airway pressure machine prescribed for people with sleep apnea. Not only did he report having a pretty easy time of getting used to sticking some plastic up his nose every night, he said he also felt more rested when he awoke and was more alert throughout the day.

When he began to tell me how happy his wife was, I thought that he was going to say, as many men do, that she was glad that he was no longer snoring or that she was relieved that he no longer stopped breathing during the night. Instead, he grinned as he related how, in the past month, he and his wife had more sex than they had had in the past two years. “Hey doc, if you want men to use this thing, just get the word out that it helps with ED (erectile dysfunction). They’ll be in here begging you for a CPAP.”

ED affects an estimated 30 million American men; 15% of men age 70 and older report complete impotence. Women have sexual issues as well; in one study, 43% of women reported sexual dysfunction that impaired their quality of life. And a study in last month’s Journal of Sexual Medicine found that women with sleep apnea were more likely to have significant sexual dysfunction.

Sexual dysfunction can be embarrassing and demoralizing to many people. Therefore, physicians often see a hesitation in bringing this topic up so we think

Kurt’s experience is not unique; there is a growing body of research that shows a strong correlation between sleep apnea and erectile dysfunction in men. There is even evidence that sleep apnea is linked to a higher prevalence of sexual dysfunction in women. One study found that men with RLS (restless legs syndrome) were 78% more likely to have ED. The common mechanism here might be that both disorders involve a malfunction of the neurotransmitter, dopamine.

Experimental research that used a sleep deprivation protocol to study the effects of sleep on the hormones and metabolism. Healthy young men found a decrease in testosterone when there were several nights of short sleep times (five hours or less) for a week or less.

If sleep deprivation is chronic, as it often is in real life, then it may be that milder levels of sleep deprivation have a cumulative effect and could lead to adverse hormonal consequences such as decreased testosterone.

Testosterone is produced during the night; the levels climb steadily throughout the night and peak in the morning. There are studies showing not only that a decrease in the total amount of sleep can lower a man’s testosterone, but also that REM sleep is important to the production and release of testosterone. We know that REM sleep is often decreased or absent in patients with sleep apnea. Therefore, it seems that both the quantity and quality of sleep are important for testosterone production.

However, with sleep apnea, there is another reason that there could be erectile dysfunction: the low oxygen levels that are often associated with apnea, especially when it is severe. In some studies, the severity of the sleep apnea was the greatest predictor of ED while in others it was how low the oxygen went. We have known for years that chronically low oxygen levels at night adversely affects the vasculature of the heart, lungs, brain, and now we can add the penis.

The good news is that often with treatment of the sleep disorder, the sexual dysfunction improves dramatically, thereby enhancing energy, mood and overall quality of life.

The information contained on this page does not and is not intended to convey medical advice. CNN is not responsible for any actions or inaction on your part based on the information that is presented here. Please consult a physician or medical professional for personal medical advice or treatment.

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soundoff (91 Responses)
  1. Woody in the morning

    So THAT's it... and all the time, I thought I just had to whiz.

    October 12, 2011 at 14:42 | Report abuse | Reply
    • teresa


      October 17, 2011 at 22:49 | Report abuse |
    • Don

      I had all the systems, fat neck, over weight, large over bite. Thankfully the VA has a sleep clinic and I got in for testing after a few months and recieved a CPAP machine. I am disappointed I haven't been retested after several years use to see if the machine is helping with low oxegen in blood from stopping breathing during sleep. Getting use to the machine has been a love – hate relationship. I still fight with to little or to much air pressure during the night. Over-all I am thankful for the machine. I worried lack of oxegen rich blood during sleep might be hurting my bodies' organs. I also worry about the long term effects of using this machine.

      October 23, 2011 at 15:44 | Report abuse |

    They fail to mention how MORE THAN 50% of people cannot even tolerate the CPAP machine for various reasons. These simplistic articles that mention a serious health issue that millions contend with, spending thousands of dollars for, and see hosts of doctors to no avail, and then say 'oh, its a simple fix!' Screw you! Be in the person's shoes to see how detrimental it is and how MOST cannot fix it no matter how hard they try.

    October 12, 2011 at 15:05 | Report abuse | Reply
    • Steph

      I am not sure we read the same article. I didn't take it that the CPAP is a simple fix, I read it as "here is some information and research that is showing how sleep apnea is releated to ED". For this person getting a CPAP helped. It was probably mentioned because it is the most known treatment for sleep apnea. I didn't see where it said everyone with sleep apnea should get a CPAP. If you suffer from this, I am sorry, I can see where you are understandably frustrated, but you come across as a very bitter person.

      October 12, 2011 at 17:56 | Report abuse |
    • elle

      How is anybody supposed to sleep with all the noise that machine makes? Sometimes the cure is worse than the ailment and most of the time the medical community just doesn't get it. I hope that those who are extolling the benefits of this machine for profit use it themselves.

      October 13, 2011 at 13:28 | Report abuse |
    • marweewees

      What is keeping you from tolerating a CPAP? I was diagnosed with sleep apnea a few years ago and resisted the notion of having to sleep with a CPAP for about six months. I did not want to use it. But the headaches, and extreme fatigue got to be too much, so I caved and got the machine. It tok a good six months to get used to it, but now a few minutes after putting on the mask, I'm out like a light! I feel better than I have in years. I wake up rested, with energy. I even started to lose weight! There are many types of CPAP machines out there that can be chosen from. I'm sure that with a little effort you can find the perfet one for your needs. Sweet dreams!

      October 13, 2011 at 13:49 | Report abuse |
    • Not a Crock

      My DH and I are both diagnosed with OSA and both use CPAP machines. We have different preferences in masks, but the machines have done wonders for us both. Machines that are now being used are so quiet, that I am sometimes unsure that it is even on.

      October 13, 2011 at 16:42 | Report abuse |
  3. Dana

    Sleep apnea is not an easy fix. Stop pretending like it is CNN.

    October 12, 2011 at 15:06 | Report abuse | Reply
  4. Shari

    I have sleep apnea. I went through multiple sleep studies, and was repeatedly told that, although I had apnea, it was so mild that insurance wouldn't authorize CPAP treatment. I was prescribed Provigil, which worked, but is prohibitively expensive, and I didn't want to be on medication for the rest of my life in order to function during the day. I finally found a doctor who was willing to work with me and my insurance company to get approval for a CPAP machine. This has been a LIFE CHANGING event. Since I have had my CPAP machine, I no longer have to set 5 alarm clocks to wake me up in the morning, I am no longer falling asleep at the wheel of my car, and no more 4 hour afternoon naps!!! I feel like a new person, with an entirely new outlook on life!!! I know that the machines are awkward and uncomfortable, but the difference it makes is more than worth the effort. I travel weekly, and carry my machine with me wherever I go. The difference it has made has been nothing short of miraculous. The change in my sleep has even allowed me to go off my depression medication that I thought I was going to have to take for the rest of my life. Before the CPAP, I would have been a soggy bundle of tears without my antidepressants, but now, I'm even more emotionally balanced that when I was on the medication. Along with all these other changes, my restless legs, which have plagued me since I was a child, are all gone – no more twitching, jumping and jerking all night. I can't recommend this treatment highly enough. Make the effort to make the machine work for you – it's well worth it.

    October 12, 2011 at 15:26 | Report abuse | Reply
    • Dr. Michael J. Krahe

      Shari: CPAP is not the only treatment for OSA. It is the gold standard for treatment of OSA according to the American Academy of Sleep Medicine. Unfortunately, compliance is less than 50%. The AASM also has stated that oral appliances are an effective treatment for mild to moderate OSA and have much high compliance rates than CPAP. Untreated OSA is a silent killer. Talk to your physician about an oral appliance or speak to a dentist who is trained in dental sleep medicine.

      October 12, 2011 at 18:50 | Report abuse |
    • xeno

      Shari–that's great! I'm not sure why the shameless commerce not medical but PhD dude is exploiting your good success, but hey, everyone's gotta make a living, right?

      October 12, 2011 at 19:05 | Report abuse |
    • Vijendra

      I am a fellow Snorkle Klown. I use the CPAP ceabuse the inside of my nek is flabby. I used to hallucinate hearing things during my waking hours before the sleep study revealed my sleep apnea. I am OK now due to the use of CPAP.If you want a much more comfortable than the mask, look into CPAP Pro. It is excellent compared to the mask that comes with your machine. I've been using CPAP Pro for going on 8 years and I have to say even if I didn't need it I wouldn't want to sleep without it.

      March 3, 2012 at 21:28 | Report abuse |
  5. spindrift

    Tied to an obnoxious,loud machine and hope to sleep or do w/o and toss and turn all night, Add rx's and it gets even worse. Sleep apnea is joke.

    October 12, 2011 at 15:28 | Report abuse | Reply
    • Auth

      It would be awesome if you could sleep as sonduly with the comfort of CPAP. Cpapman.com is my usual source and it has never failed me. I never knew I had OSA until a year ago, and snoring was like crazy with the sleepless nights. I wanted surgery but my doctors prescribed CPAP instead and I turned to cpapman.com and I have been very thankful since. I should probably try this pillow too.

      April 14, 2012 at 12:35 | Report abuse |
  6. spindrift

    Shari, I am so glad for you and hope your success continues. Mine did not. Wonderful for first 18 mo or so. Then a steady decline in sleep and an uptick in RLS, even w/ provigil. Back and forth w/ co. and cp tech produced limited results. Four years in and found out this is common as the body adapts. Good luck.

    October 12, 2011 at 15:36 | Report abuse | Reply
    • Carolina

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      March 5, 2012 at 22:40 | Report abuse |
  7. Barb

    Wonder if you're all hypothyroid. Low thyroid levels make your breathing slower, leading to less oxygen, and eventually, gasping for air. Light, restless sleep can also be a sign of other hormones being low like estrogen, progesterone, testosterone. You need more than a TSH test to test your thyroid levels. More at tiredthyroid.c o m

    October 12, 2011 at 15:59 | Report abuse | Reply
    • Bojan

      Good question: This could run you into a lot of $ $ $ $ $ $ if the prevdior of the machine does not understand how to bill your insurance company.There is broad differences in policy and practice of insurance companies/HMO's in how they pay for them: Some rent to own, typically after one year while others purchase outright after 2 months: Because so many people do not want to tolerate the inconvenience , they just quit using them.If billed monthly for the rental, plus any co-pay, many vendors will bill you for the tubing and humidifier(if required) too: It all adds up to a considerable amount of $ $ $ $ . Some units run as high as $ 4,000 if additional heat, humidity, and a full mask is required. My personal experience id go for a buyout at the earliest possible time. The down side is that, although under warranty, there may be maintenance costs, if the unit malfunctions: Check before hand.Re: Pressure adjustments: Ask if the Pulmonologist who interprets your sleep study will allow the Respiratory Therapist, that fits you, set your airway pressure (CPAP= Continuous Positive Airway Pressure). These are usually quite nominal and predictable depending id you have instructional apnea or central sleep apnea it's worth a try and could save you a long, sleepless night.Hope this helps you sleep better.

      July 3, 2012 at 06:28 | Report abuse |
  8. Shari

    Spindrift – Thanks for the warning! I have only been using my CPAP for about 3 months now. I'm not surprised to hear that there is potential for the effectiveness to decline over time as a person adapts, that was my biggest fear with the Provigil, that it would become ineffective over time. I'm sorry to hear your are back to the life of the sleep deprived.

    October 12, 2011 at 16:03 | Report abuse | Reply
    • DA

      I have been on my cpap for YEARS and there has been no decline in it's effectiveness. It took a few months to start using it 100% of the time, but once I did it's wonderful! Now my husband can't sleep without the sound of my machine.

      October 12, 2011 at 19:17 | Report abuse |
  9. CPAP Fan

    I have snored loud since my thirties My wife and kids were impacted My wife used to stay awake to assure I would keep breathing at night. I would be up at night every two hours. I would fall asleep at work and fight to stay awake all day long. I would doze off at traffic lights. After a sleep study and use of a CPAP I do not sore My energy level was completely restored and have uninterrupted sleep. I am grateful for this technology and to doctors who specialize in sleep disorders.I only wish it would be more affordable for people with no or limited insurance

    October 12, 2011 at 17:50 | Report abuse | Reply
  10. Erik

    If your apnea is OSA, but you can't tolerate a CPAP, you should try an oral appliance like the Somnodent. I have had mine for a month now, and it is working great! Insurance companies are starting to come around and realize that oral appliances are a viable alternative to CPAP, and are starting to cover them. My insurance covered mine 100% (after deductible).

    October 12, 2011 at 18:10 | Report abuse | Reply
    • Felipe

      Dec31Alyson I think its hard for people to pay smnhteiog like $25 if there are much cheaper anti snoring chin straps available, but I can also understand that you get more quality and better fabric

      April 9, 2012 at 13:43 | Report abuse |
  11. ArchieDeBunker

    I have had a CPAP machine for almost 10 years, and it has made a significant difference in my life. The first machine I got was pre-set to 13 (cm H20) and I never tried to adjust it. It blew so much air at that rate that it often made the mask leak, and I sometimes thought I would inflate and float away! Still, it was so much better than no treatment that I endured it for 8 years. Two years ago I got a "smarter" CPAP machine which senses how much air I actually need and regulates itself accordingly. It usually goes up to between 5 and 6. I am much more comfortable now, and I never get the feeling that I have too much air pressure. I sleep comfortably and only take a few minutes to fall asleep. My insurance paid for the cost of the CPAP (less the inevitable deductible).

    HOWEVER, after I had the CPAP for about 6 months the drs had me take another blood oxygen test and my oxygen level was still not high enough, so they had me start using an oxygen concentrator. My health insurance provider paid $165 every month, and I had to pay $35 for the oxygen machine. After a few months, I began calling the provider and asking why we couldn't just buy the damn machine instead of paying every month. Nope, can't do that. Those things are WAY too expensive. After three years, I went on line and found that I could buy an oxygen concentrator just like the one I was renting for less than $900. So my health insurance company was perfectly happy to pay out over $5000 to keep renting instead of splitting $900 with me to buy a machine. Of course, by that time, at my $35 per month, I could have bought one of them myself. Obviously, the waste of money was no problem for the insurance company, since they just kept raising the rates my employer and I had to pay for insurance. The exasperating thing was that every time I'd call the insurance company about this they would duck my question, pass me off to someone else, promise to call me back (they NEVER did) and all sorts of subtrefuge tactics, but they never once attempted to explain why they were willing to waste money in that way. After all that, I can only believe that someone at the insurance company was getting a big kickback from the people who rent out the oxygen concentrators. Now, knowing how well the Government is able to control costs and prevent graft, you can bet that this sort of thing is going to skyrocket when the socialized medicine called (euphamistically) "Obamacare" kicks in. Five years ago I gave in and bought my own machine.

    October 12, 2011 at 18:46 | Report abuse | Reply
    • serge

      Move to Canada. Not only I got my CPAP machine immediately, but the responsible people were delighted to learn that I could get a $500 machine (Elite 8) directly from California instead of paying $1,600 from a scalper in Montreal.
      Once you taste the so called "socialized medicine" there is no desire to return to the crappy private insurance industry. Think about it. No high school manager will ever call you to dispute the findings of your doctor. That is the key difference. And it does not hurt to know that there is no deductible or any fancy trick.
      Of course you pay from your taxes. 2% of your taxable income. Compare that with what you shell out every year. And the Canadian plan is simple. If you get sick, you will be fixed. As a matter of fact you do not have a choice. Everybody is IN.

      October 12, 2011 at 22:43 | Report abuse |
  12. healthfan

    HELP! Where can i get reliable information on the latest & greatest treatment options? My GP is clueless, and I cannot stand wearing the old-school CPAPs because they make lines on my face that never go away.

    October 12, 2011 at 19:21 | Report abuse | Reply
    • xeno

      Your GP should refer you to a sleep doctor. I would assume, since you say your mask leaves lines on your face, that you've already been through this. If the mask leaves any mark on your face after five minutes, it doesn't fit right. I know CPAP can be a bit of a hassle, but it's small potatoes compared to the health hassles it can prevent. Maybe there are "latest and greatest" things out there, but none of them are as tried and true as CPAP.

      October 12, 2011 at 19:29 | Report abuse |
    • Boater39

      A wonderful resource is c p a p t a l k . c o m

      There are tons of discussions on the various treatment options (cpap and non), the best machines, how to understand your numbers, what masks and accessories work best, and just about everything else you can think of regarding sleep apnea and the other sleep disorders. I spent a lot of time on that site and learned quite a bit and that information has been invaluable in getting the best treatment possible. Remember–always be an educated patient.

      October 12, 2011 at 22:06 | Report abuse |
    • Ali

      Yeah too bad its hard to prove but I really don't see the pnaeitt benefit, I just see lots of complaint which they will likely try to explain away as user error I recommend using test masks before committing to using one over another in this case you get what you pay for.

      August 2, 2012 at 05:12 | Report abuse |
  13. surgeryinstead

    I had elective surgery to have my tonsils removed as well as my uvuula (hangy ball in the back of your throat). I also had a deviated septum, which was also repaired. I'm in my mid-20's and not obese/overweight. I went from zombie-mode, to the most productive I've been in my life. No need for a CPAP. A lot of people are afraid of surgery it seems, but this was the best decision I've ever made in my entire life. My insurance paid the bulk of the surgery (about a $4500 procedure) and I can't stress enough how wonderful this is. If you're zombified every day, get checked, it WILL change your life.

    October 12, 2011 at 21:22 | Report abuse | Reply
  14. Spaceman

    I enjoyed the episode where Joey & Chandler had to go to the sleep Clinic.

    October 13, 2011 at 09:27 | Report abuse | Reply
  15. Bruce

    A CPAP is not for everyone however, it changed my life and I know that there are thousands of people who could get much better sleep if they would commit to trying it for a month rather than complaining about something that they don't understand. My machine is very quiet, but even so, I just got a longer hose, which allows me to put the machine across the room. I would recommend this for anyone who might be bothered by the noise. I have some very stubborn friends with claustrophobia, OCD, and many other maladies who swore that they would not or could not use a CPAP. Without exception, they all finally gave in, got a CPAP, and now are kicking themselves for waiting so long. Believe me ( have I every lied to you before) IT IS WORTH IT!!!!

    October 13, 2011 at 14:48 | Report abuse | Reply
  16. cupta

    Most people I've seen coming for a sleep study are extremely over weight. Geee wonder if there's a connection....... Also most I've seen are heavy smokers. Again, connection? hhhmmmm makes one wonder. Yes I work at a hospital.

    October 13, 2011 at 17:34 | Report abuse | Reply
  17. Will

    CPAP machine is a life extender, life saver literally, erection restorer and energy restorer. It is one of the best inventions that I have ever came into contact. It literally saves lives!!!!!!!!!!

    October 13, 2011 at 17:43 | Report abuse | Reply
  18. CS

    If you work in a hospital then you probably also know that OSA contributes to pain and depression, and lack of medically restoritive sleep contributes to weight gain. Most of the depression or chronic pain medication I take has a side effect of weight gain as well. Just because they are overweight doesn't mean a whole lot. I was 190 and ripped 10 years ago when I got out of the Army because of a severely restricted diet that was because of constant medical care for my in service injury. Not so much now. Things happen, and it's not all because of laziness.

    October 15, 2011 at 15:08 | Report abuse | Reply
    • Obed

      In addition, meromy issues, weight gain, headaches, even impotency can happen due to sleep apnea when not treated. After menopause ladies get sleep apnea at a rate like men. These usually include an electroencelphalogram ( EEG ) to determine brain waves and an electroculogram ( EOG ) to determine eye and jaw movement, both to observe the different stages of sleep. The CPAP machine sends air under stress thru the tube and into the mask, where it donates positive pressure to the higher airways, stopping the tissues in the back of the throat from falling down while sleeping.

      March 5, 2012 at 23:35 | Report abuse |
  19. teresa


    October 17, 2011 at 22:49 | Report abuse | Reply
  20. Dace

    After reading the numerous comments, I have a few thought to add. I have been using a cpap machine since 2005. I did not experience the miracle that some people – including a colleague – experienced after using it. It was a struggle for months, between the noise and the realities of wearing it. I learned to tune out the noise with a simple solution- I sleep on my side and so use an earplug in my ear facing the outside. The noise of the airflow is not loud but I found it irritating. Problem solved. The comfort factor was resolved by trying different masks after several months of sores under my nose or my forehead. The best mask for me is the gel profile lite, and I replace it about every 3-4 months. The rental fees are insane. For masks and anything other than the machine itself, it is far cheaper and quicker for me to buy them online (cpapexhange.com or others) then to use the home health care companies. Ex – last replacement mask thru ins company cost me $98, with an equal amount paid by the insurer. I bypass that system altogether. I get the same mask for $59 with free delivery, and I buy 2 at a time so I have a extra for when it needs to be replaced. I could seek partial reimbursement from insurer but the amount I would receive is not worth the effort. Insurers are charged 2-4 times the cost of my purchasing on my own. That's insane. Whil I did nort have that sudden dramatic change fom using it, I notice a change over time. Plus I learned what untreated apnea does to your heart and body generally. I do take provigil to help me stay alert during the day and that has helped me regain high functioning during the day. As for cost, pro vigil' patent expires next year and they more than doubled the cost during the past few years to grab as much profit as possible before that happens. So one month 's supply cost $2000. Thank god I only have a $50 copayment, and that will drop significantly next year.
    So much depends on your doc and his/her team. First sleep center at very prestigious hospital was so noisy due to the nurses/ docs talking all night on the phone outside my door that I never got enough sleep to enable a reading. 2 years later, my p-doc recommended that we try again and chose a different sleep center. Second place was fantastic. Great doc and staff makes a huge difference in quality of care and results. So while I did not get the overnight miracle, it has made a noticeable difference over time.

    October 29, 2011 at 23:54 | Report abuse | Reply
    • Jacob

      This our book description of octbrutsive sleep apnea syndrome (OSAS) : Patients with OSAS have an apnea-hypopnea index ofmore than five events per hour of sleep and usuallyhave accompanying oxyhemoglobin desaturations ofless than 90%. Neurobehavioral symptoms are frequentlypresent, with excessive daytime sleepinessbeing the most common. My comments for you :1 You need a full ENT physical examination ( from nose to larynx , also with fiberoptic telescopes ) .2 We want a simple labratory workup for Thyroid and other illness .3 You must undergo with a polysomnography for confirmation of this syndrome and detemining it's severity .4 Regarding to your polysomnography and labratory results we will be able to diagnose the cause and treat it medically or surgically .

      April 8, 2012 at 12:41 | Report abuse |
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  24. George

    I used CPAP for 18 months. Then after I got married, my new wife said she couldn't sleep with the snoring and the noise of the air and the mask. I went to a maxiofacial surgeon and got jaw reconstruction surgery as well as deviated septum surgery. No more snoring now and no CPAP! It was painful for two months of recovery, but it was worth it.

    January 14, 2013 at 13:43 | Report abuse | Reply
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