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 stable enough erection for satisfactory 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. This is generally considered to be a blood flow problem, especially for men in their fifties, ”said Petar Baic, MD, a urologist and sexual health expert who moderated Men’s Health’s 2022 AUA press release.
Drugs that are most commonly associated with ED and low libido
In a study presented at the Men’s Health session, researchers used the US Food and Drug Administration’s (FAERS) Adverse Event Reporting System to identify the drugs with the highest frequency of AD adverse events from 2010 to 2020. Then the 20 best drugs were included. in disproportion analysis, a method used to confirm or refute a potential link between an adverse drug reaction and a drug.
According to the analysis, the first five drugs with ED as a side effect include:
- propecia (finasteride), a drug used to shrink an enlarged prostate. More than one million men in the United States are taking this urine retention drug to treat male pattern baldness.
- Avodart (dutasteride) is a drug used to reduce the production of 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.
- Celexa (citalopram) is an antidepressant.
“Many men in this age group are taking medication, and some commonly used ones can contribute to ED. That’s why we always look at their whole story and try to identify all the reversible causes, “says Dr. Baic.
It is difficult to determine how much a particular drug contributes, but it can certainly tip the scales, he says. “For example, let’s say that a man has a slightly reduced blood flow to the penis due to high blood pressure for many years. He sees his doctor and starts taking blood pressure medications and this further contributes to ED – this is definitely a common scenario we see. “
Bajic suggests that you talk to your doctor if you suspect that one of your medicines is causing or contributing to ED. “Sometimes there may be other medications to manage your condition that will not contribute to ED,” he says.
You may need to take a drug that is important for your overall health, for which there is no alternative, says Baic. “It’s really an individualized discussion. But do not delay this discussion and continue to take your medication as prescribed, unless your doctor tells you otherwise, ”he said.
Poor sleep or lack of sleep can contribute to low sex drive
A study by researchers at Johns Hopkins University in Baltimore, presented at the conference, looks at how sleep problems can affect testosterone production, low libido and ED.
Researchers looked at records of health 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 disturbance of the circadian rhythm of sleep. Each condition was then assessed independently to determine the association with ED and testicular hypofunction.
Key findings on how sleep problems affect ED and testosterone production include the following:
- Men with insomnia experience higher levels of hypogonadisma condition in which the testicles do not produce enough sex hormones for healthy sexual desire and erection.
- Sleep apnea is associated with low libidoagain associated with testosterone production, and these men had slightly higher levels of ED.
- Circadian rhythm dysfunction is associated with higher levels 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 fall asleep again.
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 an examination for hypogonadism and ED may help capture these underlying diseases that can drastically affect overall health.
These findings add to the growing body of evidence that suggests a link between the quality and quantity of sleep and sexual function, Baic said. “I always explain to men that testosterone – which is a major male hormone for many different functions, including sexual function – is produced in the deep stages of sleep, in REM sleep. Lack of enough of this type of sleep – for example, people who work in shifts – can negatively affect sexual function, “he said.
If you have trouble sleeping, you should talk to your doctor, Baic said. “There are a number of things that can contribute to poor sleep, such as caffeine intake, drinking too much alcohol before bed, or screen time,” he said.
Baic agrees that sleep apnea can be a problem. “I often ask men if they snore or not and if they feel like they have a good night’s rest when they wake up in the morning. “If they say ‘yes’ to snoring and feel tired because they wake up a lot at night, I recommend that they consult a sleep specialist,” says Baic.
Erectile dysfunction can be a sign of a more serious health problem
Whether you think low libido or ED is the result of a drug you’re taking, poor sleep, or both, it’s important to discuss it with your doctor, he says. “The doctor will never know you’re having ED unless you pay attention to them.”
ED is not just about your sex life: it could be the first sign of a more serious health problem, Baic says. “This can be a reflection not only of cardiovascular health, but also of overall health. “If you have problems in this area, you need to ask 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 may be, could have health consequences in the future, he added.