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Sleep and ED: How Does Sleep Affect Sex in Men?

11 min read
Sleep and ED: How Does Sleep Affect Sex in Men?

Sleep disorders have been linked to erectile dysfunction in many scientific studies, with much of the valuable data based on the Pittsburgh Sleep Quality Index. To minimize the effects that poor sleep quality has on our sexual health, we need to understand how it works and what it affects to improve sleep quality and reduce the likelihood of sexual dysfunction.

This article explores how sleep quality and sleep disorders directly affect erectile dysfunction, both physically and mentally. We look at how we might resolve some ED issues by encouraging better subjective sleep quality through ideal sleep hygiene practices.

At a Glance

  • Poor sleep is a key contributor to erectile dysfunction (ED) — it disrupts testosterone production, blood flow, and overall hormone balance, all essential to sexual performance.

  • Sleep disorders like sleep apnea, insomnia, and anxiety-related conditions significantly increase ED risk, with studies showing up to a 9x higher likelihood in affected individuals.

  • Mental and physical fatigue from poor sleep impacts libido, mood, stress levels, and recovery from exercise, creating a cycle of declining health and sexual function.

  • Improving sleep hygiene — including a consistent bedtime routine, reducing screen time, managing stress, and optimizing diet and exercise — can help improve ED symptoms.

  • Sleep medications may not be the best solution, as some have been linked to worsened sexual function. Professional guidance is advised if sleep issues persist.

Fundamentals: The Natural Sleep Cycle

Just before we jump into the links between sleep and ED, understanding the natural sleep cycle is useful background knowledge.

Diagram of the The Sleep Cycle

This cycle of sleep recurs throughout the night—usually 4 to 6 times, with a full cycle lasting around 90 minutes. This depends on the quality of sleep, however. Poor sleep quality, insufficient sleep, or sleep disturbances affect the time we spend in each stage and the number of cycles we experience each night.

STAGES OF SLEEP TYPE OF SLEEP EFFECT 
N1 Falling asleep Light brain activity and slow eye movements as we transition from being awake to sleep.
N2 Light sleep Body temperature drops, heart rate and breathing are regulated, and muscles relax.
N3 Deep sleep

The brain produces slow, high-amplitude waves.

This is when we're most difficult to wake and when the body carries out most of its physical repairs and maintenance.

REM Highest level of brain activity When most dreaming occurs. Characterized by rapid eye movement and brain activity.

This is when the brain unpacks daily activities and stress and organizes thoughts, solutions to problems, and memories.


Sleep's Effect on the Body's Systems

Sleep's Effect on the Body's Systems

How Can Sleep Impact Erectile Dysfunction?

"We find that erectile dysfunction, lower urinary tract symptoms, and hypogonadal symptoms all have a linear relationship with sleep, as worse symptoms occur with poorer sleep." - The effect of sleep on men’s health 

If we don't get enough of the high-quality sleep we need, it impacts our cardiovascular health, blood flow, hormonal imbalance, and testosterone production—all factors that impact sexual arousal and erectile function.

As men get older, ED becomes more prevalent (as discussed in Impotence and its Medical and Psychosocial Correlates: Results of the Massachusetts Male Aging Study). To combat natural losses, it's crucial to improve the factors we can control to minimize their effects.

Factor 1. Sleep Disorders and Erectile Dysfunction

Sleep deprivation and erectile dysfunction are often connected symptoms of general health and common sleep disorders that impact sexual performance.

The most common sleep disorder associated with erectile dysfunction is obstructive sleep apnea (OSA). However, there are numerous disorders that affect sleep health, including:

  • Narcolepsy – Excessive daytime sleepiness, often falling into deep sleep and skipping light sleep cycles during normal activities
  • REM sleep behavior disorder – Strong movement or speech during REM sleep overpowers its natural paralysis
  • Somnambulism – Sleepwalking
  • Traumatic brain injury, and
  • Anxiety and depression.


This study investigated the way several sleep disorders had a direct impact on erectile dysfunction. Those with sleep apnea showed a 9.44 higher chance of ED, and those with non-apnea-based sleep disorders showed a 3.72 higher chance of ED than the control subjects.

For the most seriously affected sleep apnea sufferers, long-term applications of CPAP therapy (continuous positive airway pressure treatment) have been shown to improve erection quality.

While there is a strong association between obstructive sleep apnea and erectile dysfunction, there are many more that impact general and sexual health: restless leg syndrome, hypogonadism, shift work sleep disorder, depression, and anxiety all result in impaired sleep, leading to erectile dysfunction complaints.

Insomnia, another incredibly common sleep disorder—affecting up to one-third of adults and impacting male erectile function—is often a symptom of other physical and mental health issues. Having trouble falling and staying asleep or waking up too early, again, impacts sleep quality, resulting in low quality of life, restlessness, stress, and sexual dysfunction.

Factor 2. Poor Sleep Can Result in Lower Testosterone Levels

Obstructive sleep apnea syndrome is the inability to breathe properly during sleep. It affects between four and nine percent of adult males, with loud snoring being a common symptom. While snorers might appear to be enjoying all the benefits of deep sleep, it results in sleep fragmentation (broken sleep) and poor-quality sleep.

This study into sleep apnea showed that almost half of its subjects secreted abnormally low levels of testosterone during the night. Testosterone is the main sex hormone, and low levels result in decreased libido and sexual activity.

The nocturnal testosterone rhythm shows that levels usually rise during sleep, peaking at the time of waking. Poor sleep quality disrupts testosterone production, typically in the first REM cycle.

Another study, this time into testosterone replacement therapy, showed an increase in sleep-related erections and erection quality. Sleep-related erections are a natural occurrence during REM sleep stages and can be used to determine natural erection strength and the causes of erectile issues:

"Sleep-related erection testing provides a physiologic, objective, diagnostically useful technique for evaluating erectile capacity" (Sleep-related Erectile Activity).

There are steps ED sufferers can take to increase natural testosterone production: strength and high-intensity training, a balanced diet, and maintaining a healthy weight can all help. Quitting smoking and reducing alcohol consumption can play an important part, too.

Factor 3. A Lack of Quality Sleep Can Damage Blood Flow and Cardiovascular Health

For adults, the recommended duration for healthy sleep is 7 to 9 hours. 'Short sleep duration' is defined as a habitual sleep time of less than 6 hours. Sleep duration impacts several of the elements that impact erectile dysfunction: cortisol, stress, inflammation, vasoconstriction, the autonomic nervous system, and testosterone levels, all areas that impact blood flow and cardiovascular health.

The National Institutes of Health recently announced how their research into disrupted sleep showed that sleep deficiency and other sleep disorders have been linked to sleep apnea and increased risk of heart disease and poor cardiovascular health.

Initial tests conducted on mice showed an anti-inflammatory mechanism broken down by frequently disrupted or poor sleep quality.

Dr. Michael Twery, director of the National Heart, Lung, and Blood Institute's National Center on Sleep Disorders Research, described this as “... the most direct demonstration yet of the molecular connections linking blood and cardiovascular risk factors to sleep health.”

Factor 4. Reduced-Quality Sleep Can Impact Mental Well-Being

Chronic sleep deprivation and sleep disorders negatively impact mood, emotions, and cognitive function, all of which lead to a higher risk of mental health issues and low quality of life.

Mental health issues regularly affect sleep quality and vice versa, creating a problematic cycle. For example, insomnia is often a symptom of psychiatric disorders, such as anxiety and depression, which frequently contribute to worsening sleep issues.

An analysis of sleep trials in the journal Sleep Medicine Reviews states,

"The association between sleep and mental health is well documented. For example, people with insomnia are 10 and 17 times more likely than those without insomnia to experience clinically significant levels of depression and anxiety, respectively." - Improving sleep quality leads to better mental health: A meta-analysis of randomized controlled trials

Despite many of the trials surrounding sleep disorders and mental health, it's not just anxiety and depression but also post-traumatic stress, eating disorders, and psychosis experiences that may result from poor sleep quality. The study goes on to say:

"Studies have also found that specific sleep disorders, such as sleep apnoea, circadian rhythm disruption, restless leg syndrome, excessive daytime sleepiness and narcolepsy, sleepwalking, and nightmares are all more prevalent in those experiencing mental health difficulties."

Factor 5. Sleep Deprivation Increases Fatigue

Given how sleep recharges our bodies' physiological and psychological systems, it's no surprise that sleep deprivation increases fatigue and, in long-term cases, may even lead to brain damage.

Poor sleep quality disrupts those natural processes, impacting energy levels, alertness, cognitive function, and mood changes—all leading to fatigue. This results in excessive daytime sleepiness, difficulty concentrating, irritability, impaired judgment, and more, all risk factors likely to increase physical and mental health problems, accidents, and relationship issues.

Factor 6. Reduced Sleep Results in Poor Recovery from Exercise and Stress

While you may not initially link erectile dysfunction to sport and exercise, anything that boosts your cardiovascular health can have a direct impact on how efficiently your body pumps blood into your penis, creating an erection.

While exercise is important for good health, poor recovery from exercise can have a negative impact.

Impaired sleep impacts growth hormone release and alters cortisol secretion. As discussed in a study on athletic performance in the Sleep Med Clinic journal, these factors impact recovery from exercise and physical stress.

Recovery also affects the production of certain proteins that affect the immune system, hindering muscle recovery and repair from training and causing imbalances in the autonomic nervous system. It also found that "there is increasing evidence that poor sleep is a good predictor for injuries and, more importantly, concussion."

Factor 7. These Problems Can Compound to Increase the Chance of ED

While all of these individual elements can result in erectile dysfunction, it's more likely to be a combination of several factors that leads to consistently poor sexual function. As you read down our list, it's hard not to see that most of those elements feed into several of the others, showing just how critical consistent sleep quality is for sexual health.

What Can You Do if You’re Experiencing ED and Think Sleep’s a Factor?

Working on sleep hygiene is an accepted CBT practice to improve sleep quality, leading to an improved quality of life and combatting sexual dysfunction. Sleep hygiene explores the habits and behaviors that lead to good quality sleep, promoting habitual sleep efficiency.

Illustration of Some Guidelines for Healthy Sleep


A healthy sleep schedule and wind-down routine are only part of the 'three pillars of health.' Sleep, diet, and exercise are all essential to sexual function. This all-round approach helps to improve sleep duration and quality, where the following practices will help to improve your quality of life and sexual performance.

Let's look at some of the most important factors in more depth:

1. Optimize Your Sleep Environment

The bedroom should be reserved for sleep and sex. Anything else should be relegated to other rooms and social spaces.

To prompt reactions to your circadian rhythms, your bedroom should be cool and dark (both encourage sleep) and quiet with no distractions (no TV, no music, and definitely no phones, tablets, or laptops). If you're waking up too early or you work nightshifts, blackout blinds will help combat the introduction of daylight that kickstarts the circadian cycle.

2. Build a Sleep Routine

To optimize sleep quality, you should slowly prepare your body in advance, starting your wind-down routine a few hours before your scheduled sleep time.

A consistent schedule will encourage your body to slow down for sleep at the same time each night, ensuring that your bedtime allows for the seven or eight hours you need before you wake up.

Blue light from digital devices and working late activates cognitive function, and eating late at night causes glucose spikes that affect internal stress levels. To combat those elements, stop eating a few hours before your usual bedtime and put your phone away; do something that relaxes you, instead, for example, reading, journaling, meditation, or even taking a warm bath.

3. Manage Your Light Exposure

Good sleep habits don't all happen at night. To encourage the natural cycle of circadian rhythms, it's crucial to get enough natural daylight during the day, aligning your sleep cycle with the rising and setting of the sun wherever you can.

At night, limiting light exposure—especially from screens—helps the production of melatonin, a hormone that promotes sleep.

4. Improve Your Diet & Hydration

Avoiding alcohol and caffeine can help with cardiovascular health, and for sleep quality, aim to have your last coffee early in the evening and avoid drinking alcohol late at night.

According to the University of Michigan, fiber-rich foods high in amino acids are associated with higher-quality sleep, along with foods high in magnesium, vitamin D, iron, and omega-3 fatty acids. On the flip side, avoiding saturated fats and refined carbs also helps.

Staying hydrated is essential to sleep health, but drinking too late could mean you'll wake up in the middle of the night to go to the bathroom. Limiting fluids to an hour or so before bed will help avoid those late-night sleep disturbances.

5. Add Physical Activity and Stress Management

Regular physical activity has been shown to boost sleep quality, reduce sleep disorders, and improve sleep latency. Studies show regular moderate-intensity activities are most effective and can combat insomnia and other sleep disorders. Timing and duration are key factors, as exercising too late in the day or evening or too strenuous sessions can lead to additional sleep problems.

Aerobic exercise releases endorphins that keep the brain awake, so releasing them earlier in the day signals it's time to relax.

Exercise also raises your body temperature, and as your body temperature falls again, it encourages the body to rest and recover, becoming tired and sleepy.

Exercise is also a great way to combat stress and anxiety. It's one of the most common suggestions for people suffering from depression and stress, both of which impact sleep quality. Stress and anxiety can also be reduced using relaxation and mental health practices. Meditation, breathing exercises, and journaling can all help you slow your heart rate, relax, and combat the underlying issues of a sleep disorder.

6. Work to Reduce Sleep Disruptions

Along with creating a healthy sleep schedule and routine, there are other practices you can try to boost your chances of improved sleep.

While a nap can provide extra energy throughout the day, napping for too long will impact nighttime sleep. Limit naps to around 10 or 20 minutes, and if you're feeling sleepy in the evening, waiting until bedtime or going to bed a little earlier is a better option.

If you're struggling to fall asleep or get back to sleep after waking in the middle of the night, don't lay awake for longer than 15 minutes. Instead, get up, move around, and go back to bed when you start to feel drowsy. This should help restart your sleep routine, encouraging your mind and body back to sleep.

Much of our wearable tech provides useful sleep-tracking data. Monitoring sleep time, sleep stages, sleep quality, and how nutrition, exercise, and stress affect you can provide valuable clues to key issues.

7. Why Medication Might Not Be The Answer

For many, taking some form of sleep medicine seems like the ideal solution for sleep disorders. However, many of those medications—typically sedatives—can add to erectile dysfunction.

For example, in this study of over 500 thousand men with an insomnia diagnosis, it was found that they had a higher risk of developing ED, and those taking insomnia medication were more often prescribed ED medication, too.

How to Find the Right Performance Enhancement Tool for You

When to See a Doctor About Sleep and ED

If you're concerned that the prevalence and associated factors of sleep disorders are preventing you from having satisfactory sexual intercourse or causing erectile dysfunction, we always recommend discussing the problem with a medical professional.

For lesser or infrequent issues, following our health and lifestyle, sleep quality, and erectile function suggestions is a great place to start. If they don't result in the positive changes you want to see, don't ignore them and hope they'll go away on their own; talk to your doctor.

Sleep and ED: A Summary

Good quality sleep is crucial to all aspects of health. While many of us manage to get by on the bare minimum for far longer than we should, at some point, it's quite likely to catch up with us and impact our physical, mental, or sexual health.

For happy and healthy sex, build a routine that gets you the necessary good sleep you need for a higher quality of life.

Poor sleep quality is a significant cause of high blood pressure and blood-flow-related illnesses, poor cardiovascular health, low testosterone, anxiety, depression, and fatigue, all of which have a direct impact on sexual performance and satisfaction.

Making sensible choices, creating a healthy sleep routine, and improving sleep hygiene can significantly improve all facets of life, and that includes combatting male sexual dysfunction and sexual health. For happy and healthy sex, build a routine that gets you the necessary good sleep you need for a higher quality of life.

 

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