Sleep disorders, such as insomnia or sleep apnea, and several common medications may contribute to erectile dysfunction and low libido, according to two new studies presented at the AUA 2022 American Urological Conference Association in New Orleans.

Erectile dysfunction (ED) is a condition in which a man is unable to achieve or maintain an erection firm enough for satisfying intercourse, according to the National Institute of Diabetes and Digestive and Kidney Diseases. It is estimated that approximately 30 million men in the United States have ED.

“Often, erectile dysfunction is not caused by one thing, but by several different contributing factors. Generally, it is considered a blood circulation problem, especially for men in their 50s and beyond” , says Petar Bajic, MD, a urologist and male sexual health expert who moderated the press session on men’s health at AAU 2022.

Drugs most commonly associated with erectile dysfunction and low libido

In a study presented at the Men’s Health session, researchers used the US Food and Drug Administration’s Adverse Event Reporting System (FAERS) to identify drugs with the highest frequency of reports. adverse events related to erectile dysfunction from 2010 to 2020. The top 20 medications were then included. in disproportionality analysis, a method used to confirm or refute a potential association between an adverse drug reaction and a drug.

According to the analysis, the top five drugs with side effects of erectile dysfunction include:

  • Propecia (finasteride), a drug used to shrink an enlarged prostate. More than one million men in the United States take this medication for urinary retention to treat male pattern hair loss.
  • Avodart (dutasteride) is a drug used to decrease the production of the androgen dihydrotestosterone (DHT), which causes male pattern baldness and symptoms of an enlarged prostate.
  • Norvasc (amlodipine) is a calcium channel blocker that treats high blood pressure and chest pain (angina pectoris).
  • Invega (paliperidone) is an antipsychotic used to treat schizophrenia and schizoaffective disorder.
  • Celexa (citalopram) is an antidepressant.

“Many men in this age group take medications, and some commonly used ones can contribute to erectile dysfunction. For this reason, we always take a holistic look at their entire history and try to identify any reversible causes, says Dr. Bajic.

It’s hard to pinpoint how much a certain drug helps, but it can definitely tip the scales, he says. “For example, let’s say a man has had a little reduced blood flow to the penis due to high blood pressure for many years. He sees his doctor and starts taking a blood pressure medication, and that further contributes to erectile dysfunction – this is certainly a common scenario we see.

Bajic suggests speaking with your doctor if you think any of your medications are causing or contributing to erectile dysfunction. “Sometimes there may be other medication options to manage your condition that won’t contribute to erectile dysfunction,” he says.

You may need to take a drug important to your overall health for which there is no alternative, Bajic says. “It’s really a one-to-one discussion. But don’t put this discussion off any longer and keep taking your medications as prescribed, unless otherwise instructed by your doctor, he says.

Poor or not enough sleep can contribute to low libido

A study by researchers at Johns Hopkins University in Baltimore presented at the conference looked at how sleep problems can impact testosterone production, low libido and erectile dysfunction.

Investigators looked at records of health care visits and prescriptions between 2009 and 2021 among men aged 40 to 70 using data from TriNetX Diamond, a US health research network of 190 million patients , and identified cases of insomnia, sleep apnea and circadian rhythm sleep disorder. Each condition was then assessed independently to determine the association with erectile dysfunction and testicular hypofunction.

The main findings on the impact of sleep problems on erectile dysfunction and testosterone production are as follows:

  • Men with insomnia experience higher rates of hypogonadisma condition in which the testicles do not produce enough sex hormones for a healthy libido and erection.
  • Sleep apnea was linked to low libidoagain linked to testosterone production, and these men had slightly higher rates of erectile dysfunction.
  • Circadian rhythm dysfunction was associated with higher rates of low libido and erectile dysfunction. This condition involves difficulty falling asleep, waking up during the sleep cycle, or waking up too early and not being able to go back to sleep.

Lack of REM sleep can negatively impact libido in men

The researchers concluded that sleep disturbances – particularly circadian rhythm dysfunction – are strongly associated with hypogonadism and erectile dysfunction. They suggest that screening for sleep deprivation during an examination for hypogonadism and erectile dysfunction could help catch these underlying conditions, which can have a huge impact on overall health.

These findings add to the growing body of evidence that suggests a relationship between the quality and quantity of sleep and sexual function, Bajic says. “I always explain to men that testosterone – which is an essential male hormone for many different functions, including sexual function – is produced in the deep stages of sleep, in REM sleep. Not getting enough of this type of sleep – for example, people who work shifts – can have a negative impact on sexual function,” he says.

If you’re having trouble sleeping, you should talk to your doctor about it, Bajic says. “There are a number of things that could contribute to poor sleep – for example, caffeine intake, excessive alcohol consumption before bed, or screen time,” he says.

Bajic agrees that sleep apnea can be a problem. “I often ask men if they snore or not and if they feel like they’ve had a good night’s sleep when they wake up in the morning. If they say ‘yes’ to snoring and they feel tired because they often wake up at night, I recommend that they see a sleep specialist,” says Bajic.

Erectile dysfunction may be a sign of a more serious health problem

Whether you think low libido or erectile dysfunction is the result of a medication you’re taking, poor sleep, or both, it’s important to talk to your doctor, he says. “The doctor will never know you have erectile dysfunction unless you bring it to their attention.”

Erectile dysfunction isn’t just about your sex life—it can be the first sign of a more serious health problem, Bajic says. “It can be a reflection of not just cardiovascular health, but overall health as well. If you have any issues in this area, you need to talk to your primary care provider so you can be assessed appropriately,” he says. Simply getting a prescription for erectile dysfunction medication without investigating the underlying causes could have health consequences later on, he adds.