Sleep disorders, such as insomnia or sleep apnea, and several common medications can contribute to erectile dysfunction and lower sex drive, according to two new studies presented at the AUA 2022 conference of the American Urological Association in New Orleans.
Erectile dysfunction (ED) is a condition in which a man is unable to achieve or maintain a firm enough erection for satisfying sexual intercourse, according to the National Institute of Diabetes and Digestive and Kidney Diseases. It is estimated that about 30 million men in the United States have ED.
“Often, ED is not caused by just one thing, but by several different contributing factors. Generally speaking, this is considered a blood flow problem, especially for men in their fifties and older, “said Dr. Petar Bajic, a urologist and men’s sexual health expert who moderated the Men’s Health press session at AUA 2022.
Drugs most commonly associated with ED and low libido
In a study presented at the Men’s Health session, researchers used the U.S. Food and Drug Administration’s (FAERS) Adverse Event Reporting System to identify the drugs with the highest frequency of ED reports from 2010 to 2020. Then the 20 best drugs are included. in disproportion analysis, a method used to confirm or refute a potential association between an adverse drug reaction and a drug.
According to the analysis, the first five drugs with ED as side effects include:
- Propecia (finasteride), a drug used to reduce an enlarged prostate. More than a million men in the United States take this urine retention drug to treat hair loss in men.
- Avodart (dutasteride) is a drug used to reduce the production of the androgen dihydrotestosterone (DHT), which causes baldness in men and symptoms of an enlarged prostate.
- Norvasc (amlodipine) is a calcium channel blocker that treats high blood pressure and chest pain (angina).
- Invega (paliperidone) is an antipsychotic used to treat schizophrenia and schizoaffective disorder.
- Celeka (citalopram) is an antidepressant.
“Many men in this age group are taking medication, and some that are commonly used can contribute to ED. That is why we always look holistically at their entire history and try to identify reversible causes “, says Dr. Bajić.
It is difficult to determine how much a certain drug contributes, but it can certainly turn the scales, he says. “For example, let’s say a man has a slightly reduced blood flow to the penis due to high blood pressure for many years. He goes to his doctor and starts taking blood pressure medications, which further contributes to ED - which is definitely a common scenario we see.
Bajic suggests that you talk to your doctor if you suspect that any of your medications are causing or contributing to ED. “Sometimes there may be other drug options to manage your condition that won’t contribute to ED,” he says.
You may have to take medications that are important for your overall health for which there is no alternative, says Bajić. “It’s really an individualized discussion. “But don’t delay that discussion and continue to take the medication as prescribed, unless your doctor tells you otherwise,” he said.
Poor sleep or insufficient sleep can contribute to poor sex drive
A study by researchers at Johns Hopkins University in Baltimore, presented at the conference, discussed how sleep problems can affect testosterone production, low libido and ED.
Researchers reviewed records of nursing visits and prescriptions between 2009 and 2021 among men aged 40 to 70 using data from TriNetX Diamond, a U.S. health research network of 190 million patients, and identified cases of insomnia, sleep apnea and circadian rhythm disorders sleep. Each condition was then independently assessed to determine the association with ED and testicular hypofunction.
Key findings on how sleep problems affected ED and testosterone production included the following:
- Men with insomnia have higher rates of hypogonadisma condition in which the testicles do not produce enough sex hormones for a healthy sex drive and erection.
- Sleep apnea was associated with low libidoagain in connection with testosterone production, and these men had slightly higher ED rates.
- Circadian rhythm dysfunction has been associated with higher rates of low libido and erectile dysfunction. This condition includes 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 affect libido in men
The researchers concluded that sleep disorders - especially circadian rhythm dysfunction - are strongly associated with hypogonadism and ED. They suggest that screening for poor sleep during examinations for hypogonadism and ED could help detect these underlying diseases, which can drastically affect general health.
These findings contribute to a growing body of evidence linking the quality and quantity of sleep and sexual function, Bajic said. “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. Insufficient sleep of this kind - for example, people who work in shifts - can negatively affect sexual function, “he says.
If you have trouble sleeping, talk to a doctor, Bajic says. “There are a number of things that could contribute to poor sleep - for example, caffeine intake, drinking too much alcohol before bed or time in front of a screen,” he says.
Bajic agrees that sleep apnea can be a problem. “I usually ask men if they snore or not and if they feel like they have a good rest when they wake up in the morning. “If they say ‘yes’ to snoring, and they feel tired because they wake up often, I recommend that you consult a sleep specialist,” says Bajic.
Erectile dysfunction can be a sign of a more serious health problem
Whether you think low libido or ED is the result of the medication you are taking, poor sleep or both, it is important to discuss this with your doctor, he says. “The doctor will never find out that you have ED unless you pay attention to it.
ED is not just about your sex life: it can be the first sign of a more serious health problem, Bajic says. “It can be a reflection not only of cardiovascular health, but also of overall health. “If you have problems in this area, you should report it to your primary care provider so that you can be properly assessed,” he said. Just getting a prescription for ED medication without researching what the underlying causes could be could have health consequences in the future, he added.