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Sleep and Sexual Dysfunction

SCOFA-Sleep and Sexual Dysfunction -1

 
Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.

 
 

SD in Men & Sleep Disorders | SD in Women & Sleep Disorders | What’s the Takeaway?

 

Overview

Sexual dysfunction (SD) is the reluctance to engage in sexual activity or not get enough pleasure. SD can be seen in all people, male or female. It is an important but under-talked health problem that affects the person and their sexual partner.

SD can be seen as erection or ejaculation problems in men, inability to orgasm, inability to relax enough, or dryness of the vagina during intercourse in women. 

In addition, SD may occur in sexual reluctance, pain during intercourse, or arousal problems for both genders. 

Heart diseases, diabetes mellitus, hormonal diseases, drug and substance use, psychological conditions, sexual trauma, and alcoholism are among the most common causes of SD.

The prevalence of SD varies according to the type of disease, gender, age, etc. It’s reported as 40-50 percent in women and around 35-50 percent in men on average.[1,2] 

Today, it’s known that there is a connection between quality sleep and sexual desire. A sleep pattern of sufficient duration and quality will support sexual functions. Moreover, this relationship is not one-sided. It has been shown that sexual intercourse that results in orgasm, especially with a partner, improves sleep onset and quality.[3]

Considering all, the relationship between sleep disorders and SD is inevitable. This article will examine the relationship between sleep disorders and SD concerning different diagnoses and gender discrimination.

 

SD in Men & Sleep Disorders

SD occurs in many men mainly because of the decrease in testosterone and the process of atherosclerosis with aging. 

SD in men is most commonly seen as erectile dysfunction and affects one-third of men over 40.[4] 

There is a strong connection between sleep and sexual function; however, this connection remains unclear. Poor sleep quality causes a decrease in sexual functions independent of anxiety, stress, and depression.[5] 

 

1) Obstructive Sleep Apnea (OSA)

Erectile dysfunction (ED) is much more prevalent in patients with obstructive sleep apnea than in the normal population.[6] This statement is the most strongly supported correlation within the connection between sleep and sexual function. Men with a diagnosis of OSA appear to have low serum testosterone levels. This situation increases the risk of not only ED but also all other sexual dysfunction conditions in men.[7] 

One of the first-line treatment options for OSA patients is CPAP. There is evidence that CPAP therapy improves the severity of ED in men with OSA and even the quality of life of their female sexual partners.[8] 

Although serum testosterone levels were found to be low in OSA patients, it was observed that testosterone therapy did not positively affect ED severity, frequency of sexual attempts, orgasmic ability, or quality of life in men with OSA.[9]

 

2) Insomnia

Insomnia is another common sleep disorder. Insomnia is known to be an independent risk factor for SD, along with cardiovascular disease, depression, and diabetes mellitus in men.[10] 

The factor linking insomnia to SD in men is low serum testosterone level. Testosterone release is cyclical and is maximized in the early stages of sleep. Shortened or structurally impaired sleep in insomnia patients adversely affects testosterone release and other hormones and impairs sexual functions.[11]

In addition, it is known that shortened sleep duration increases the risk of coronary artery disease and hypertension. Both problems can lead to organic ED in men.

 

3) Circadian Rhythm Sleep Disorders

Circadian rhythm sleep disorders are pervasive in shift workers. It’s known that depression, cardiovascular disease, and some metabolic diseases are common in patients with circadian rhythm sleep disorders.[7] 

Fragmented sleep causes a decrease in REM sleep time, negatively affecting testosterone release. A decrease in testosterone secretion, which peaks in the early hours of nighttime sleep, contributes to developing sexual dysfunction in these patients. On the other hand, studies show that sexual dysfunction complaints increase independently of hormone levels in shift workers with poor sleep quality.[12]

 

4) Restless Legs Syndrome

Restless legs syndrome (RLS) is thought to be associated with ED and premature ejaculation. One study showed decreased libido in RLS patients.[13] Although this relationship’s origin is unknown, dopaminergic hypofunction is thought to play a role.[14] 

 

SCOFA-Sleep and Sexual Dysfunction - 2

 

SD in Women & Sleep Disorders

Although there are some differences in terms of diseases, there is a strong relationship between sleep and sexual functions for women. 

According to a recent study, an hour increase in sleep time in sleep-deprived women increases the odds of having partnered sexual activity by 14 percent. 

It was also found that longer average sleep duration was accompanied by better genital arousal.[15]

 

1) Obstructive Sleep Apnea (OSA)

Although its prevalence is half that of men, OSA is still a significant sleep problem for women. In menopausal and premenopausal women, OSA increases the risk of sexual dysfunction in a dose-dependent manner.[16] 

With the presence of OSA, there is a significant deterioration in all components of general sexual function, desire, arousal, lubrication, orgasm, satisfaction, and pain in women.[16] It’s believed that progesterone contributes to the hormonal aspect of this connection in premenopausal women.

 

2) Insomnia

Insomnia has also been associated with lower sexual function in women, regardless of menopausal status.[5] 

A recent study found that the diagnosis of insomnia in postmenopausal women increased the risk of sexual distress by 44 percent.[17] 

A different study found that hysterectomy increased the risk of both insomnia and sexual dysfunction in women by nearly three times.[18] 

Insomnia and shortened sleep duration seem to affect sexual satisfaction, especially in postmenopausal women, negatively.[19]

 

3) Circadian Rhythm Sleep Disorders

Circadian rhythm sleep disorder negatively affects general sexual functions in women, although the effects aren’t as prevalent as the previously mentioned diseases.[20] 

In addition, several studies show an increased risk of sexual dysfunction in women who work night shifts.[21]

 

What’s the Takeaway?

A relationship between sleep and sexual functions does exist, even though it has not been fully elucidated. There’s a bidirectional relationship between these two essential life components. In other words, a deterioration in one of them can cause disorders in the other. 

All available evidence supports a strong link between mental health, sleep, and sexual function. Stress is the most important common factor in the pathology of sleep disorders and sexual dysfunctions. Anxiety disorders and depression can also lead to sleep disorders and sexual dysfunctions. 

A positive or negative improvement in any of these three components will manifest in the others. Therefore, it would make sense to approach problems holistically in maintaining health and treating disorders.

 

Key Points:

  • Sleep and sexual function are critical to a healthy life
  • It’s essential to have the correct quantity and quality for both
  • There is a bidirectional relationship between sleep and sexual functions
  • While good sleep supports healthy sexual functions, sleep disorders are a precursor to sexual dysfunctions
  • Sleep status should be evaluated in patients seeking help for sexual dysfunction

Effective treatment of sleep disorders is necessary to maintain healthy sexual functions for both genders.

 

References:

  1. McCabe, M. P., Sharlip, I. D., Lewis, R., Atalla, E., Balon, R., Fisher, A. D., Laumann, E., Lee, S. W., & Segraves, R. T. (2016). Incidence and Prevalence of Sexual Dysfunction in Women and Men: A Consensus Statement from the Fourth International Consultation on Sexual Medicine 2015. J Sex Med,13(2), 144-152. https://doi.org/10.1016/j.jsxm.2015.12.034
  2. Briken, P., Matthiesen, S., Pietras, L., Wiessner, C., Klein, V., Reed, G. M., & Dekker, A. (2020). Estimating the Prevalence of Sexual Dysfunction Using the New ICD-11 Guidelines. Dtsch Arztebl Int,117(39), 653-658. https://doi.org/10.3238/arztebl.2020.0653
  3. Lastella, M., O’Mullan, C., Paterson, J. L., & Reynolds, A. C. (2019). Sex and Sleep: Perceptions of Sex as a Sleep Promoting Behavior in the General Adult Population. Front Public Health,7, 33. https://doi.org/10.3389/fpubh.2019.00033
  4. Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States: prevalence and predictors. JAMA,281(6), 537-544. https://doi.org/10.1001/jama.281.6.537
  5. Seehuus, M., & Pigeon, W. (2018). The sleep and sex survey: Relationships between sexual function and sleep. J Psychosom Res,112, 59-65. https://doi.org/10.1016/j.jpsychores.2018.07.005
  6. Kellesarian, S. V., Malignaggi, V. R., Feng, C., & Javed, F. (2018). Association between obstructive sleep apnea and erectile dysfunction: a systematic review and meta-analysis. Int J Impot Res,30(3), 129-140. https://doi.org/10.1038/s41443-018-0017-7
  7. Cho, J. W., & Duffy, J. F. (2019). Sleep, Sleep Disorders, and Sexual Dysfunction. World J Mens Health,37(3), 261-275. https://doi.org/10.5534/wjmh.180045
  8. Acar, M., Kaya, C., Catli, T., Hanci, D., Bolluk, O., & Aydin, Y. (2016). Effects of nasal continuous positive airway pressure therapy on partners’ sexual lives. Eur Arch Otorhinolaryngol,273(1), 133-137. https://doi.org/10.1007/s00405-015-3546-4
  9. Melehan, K. L., Hoyos, C. M., Yee, B. J., Wong, K. K., Buchanan, P. R., Grunstein, R. R., & Liu, P. Y. (2016). Increased sexual desire with exogenous testosterone administration in men with obstructive sleep apnea: a randomized placebo-controlled study. Andrology,4(1), 55-61. https://doi.org/10.1111/andr.12132
  10. Shigehara, K., Izumi, K., Mizokami, A., & Namiki, M. (2017). Testosterone Deficiency and Nocturia: A Review. World J Mens Health,35(1), 14-21. https://doi.org/10.5534/wjmh.2017.35.1.14
  11. Schmid, S. M., Hallschmid, M., Jauch-Chara, K., Lehnert, H., & Schultes, B. (2012). Sleep timing may modulate the effect of sleep loss on testosterone. Clin Endocrinol (Oxf),77(5), 749-754. https://doi.org/10.1111/j.1365-2265.2012.04419.x
  12. Pastuszak, A. W., Moon, Y. M., Scovell, J., Badal, J., Lamb, D. J., Link, R. E., & Lipshultz, L. I. (2017). Poor Sleep Quality Predicts Hypogonadal Symptoms and Sexual Dysfunction in Male Nonstandard Shift Workers. Urology,102, 121-125. https://doi.org/10.1016/j.urology.2016.11.033
  13. Ulfberg, J., Nystrom, B., Carter, N., & Edling, C. (2001). Prevalence of restless legs syndrome among men aged 18 to 64 years: an association with somatic disease and neuropsychiatric symptoms. Mov Disord,16(6), 1159-1163. https://doi.org/10.1002/mds.1209
  14. Gao, X., Schwarzschild, M. A., O’Reilly, E. J., Wang, H., & Ascherio, A. (2010). Restless legs syndrome and erectile dysfunction. Sleep,33(1), 75-79. https://doi.org/10.1093/sleep/33.1.75
  15. Kalmbach, D. A., Arnedt, J. T., Pillai, V., & Ciesla, J. A. (2015). The impact of sleep on female sexual response and behavior: a pilot study. J Sex Med,12(5), 1221-1232. https://doi.org/10.1111/jsm.12858
  16. Stavaras, C., Pastaka, C., Papala, M., Gravas, S., Tzortzis, V., Melekos, M., Seitanidis, G., & Gourgoulianis, K. I. (2012). Sexual function in pre-and postmenopausal women with obstructive sleep apnea syndrome. Int J Impot Res,24(6), 228-233. https://doi.org/10.1038/ijir.2012.20
  17. Kalmbach, D. A., Kingsberg, S. A., Roth, T., Cheng, P., Fellman-Couture, C., & Drake, C. L. (2019). Sexual function and distress in postmenopausal women with chronic insomnia: exploring the role of stress dysregulation. Nat Sci Sleep,11, 141-153. https://doi.org/10.2147/NSS.S213941
  18. Monterrosa-Castro, A., Monterrosa-Blanco, A., & Beltran-Barrios, T. (2018). Insomnia and sexual dysfunction associated with severe worsening of the quality of life in sexually active hysterectomized women. Sleep Sci,11(2), 99-105. https://doi.org/10.5935/1984-0063.20180019
  19. Kling, J. M., Manson, J. E., Naughton, M. J., Temkit, M., Sullivan, S. D., Gower, E. W., Hale, L., Weitlauf, J. C., Nowakowski, S., & Crandall, C. J. (2017). Association of sleep disturbance and sexual function in postmenopausal women. Menopause,24(6), 604-612. https://doi.org/10.1097/GME.0000000000000824
  20. Agrawal, P., Singh, S. M., Kohn, J., Kohn, T. P., & Clifton, M. (2022). Sleep Disorders Are Associated with Female Sexual Desire and Genital Response – A US Claims Database Analysis. Urology. https://doi.org/10.1016/j.urology.2022.11.017
  21. Mockun-Pietrzak, J., Gaworska-Krzeminska, A., & Michalik, A. (2022). A Cross-Sectional, Exploratory Study on the Impact of Night Shift Work on Midwives’ Reproductive and Sexual Health. Int J Environ Res Public Health,19(13). https://doi.org/10.3390/ijerph19138082