Sleep Apnea and Erectile Dysfunction: What Treatment Can and Can't Do

Sleep apnea and erectile dysfunction (ED) often show up together, more often than chance alone would explain¹. Some reviews found that CPAP treatment for sleep apnea somewhat improved scores for erections²³. But a careful Cochrane review rated that evidence as very uncertain. It also found that ED medicines such as sildenafil may work slightly better for erections¹.

Is sleep apnea linked to erectile dysfunction?

Obstructive sleep apnea (OSA) is a condition where the throat closes off again and again during sleep. This causes pauses in breathing and broken sleep. Erectile dysfunction is trouble getting or keeping an erection firm enough for sex.

Research shows that the two conditions often occur together¹². A Cochrane review noted that the link is far more common than chance would explain¹. OSA is also tied to several long-term health problems, and ED is one of them¹. Researchers are still working out exactly why the two are connected.

Can CPAP improve erectile dysfunction?

CPAP (continuous positive airway pressure) is a bedside machine. It blows gentle air through a mask to keep the airway open during sleep. CPAP improves breathing and sleep. So researchers have asked if it might also help related problems such as ED¹. Two reviews suggest it may help somewhat, though the size of the change varied:

• 2019 review — Across 26 studies, CPAP improved scores on the International Index of Erectile Function (IIEF). The IIEF is a common questionnaire about erections and sexual satisfaction. CPAP also improved the number and firmness of erections during sleep².
• 2021 review — This review looked at seven studies with 206 men. After CPAP, scores on a short, five-question version of the IIEF improved. The change was statistically significant (unlikely to be due to chance)³. The average change was modest. The authors said more evidence is needed, because the studies were small and their results varied³.

Why is the evidence called uncertain?

A Cochrane review is a strict summary. It looks only at randomized controlled trials. In these trials, people are placed in groups by chance. They are the strongest type of study.

The Cochrane team found six such trials with 315 men, all testing CPAP¹. Every trial had important weaknesses in how it was designed or reported¹. The authors compared CPAP with no CPAP. They said they were uncertain whether CPAP improves ED. The evidence was rated very low certainty¹. No trial measured how many men had their ED go away fully¹.

In other words, CPAP may help some men, but no one can promise it will improve erections.

How does CPAP compare with ED medicines?

ED medicines called phosphodiesterase type 5 (PDE5) inhibitors are a common treatment for ED. Sildenafil is one of them. Here is what the 2019 review found²:

• Medicines did better on some measures — These included erectile function and how often sex was successful².
• About equal on others — CPAP and the medicines were about equal on some other measures².
• CPAP did better on one — CPAP was better at increasing erections during sleep².
• Both together — Using CPAP together with an ED medicine worked better than CPAP alone².

The Cochrane review had a similar finding. Sildenafil may slightly improve erectile function at 12 weeks compared with CPAP, based on low-certainty evidence¹. No serious side effects were reported with either treatment. A few men using CPAP had a dry nose. A few using sildenafil had flushing (red, warm skin) or a mild headache¹.

Whether an ED medicine is right for you is a decision to make with your doctor.

Why treat sleep apnea if ED medicines work better?

Sleep apnea treatment is aimed at sleep apnea itself. The goals are steadier breathing, better sleep and less daytime sleepiness. Any help with erections may be an added benefit, not the main goal.

Some men have both conditions. For them, treating sleep apnea may be one useful part of a broader plan that can include other ED treatments².

At Universal Sleep Solutions, we offer in-lab and home sleep testing. We also offer CPAP and BiPAP setup and follow-up, Inspire evaluation and oral appliance referral.

When should you get evaluated?

Talk with your doctor about a sleep evaluation if you have erection problems and you also:

• Snore or gasp — You snore loudly, or your partner has seen you stop breathing or gasp in sleep.
• Feel sleepy — You feel tired or sleepy during the day.
• Wake up unrested — You wake up with headaches or don't feel rested in the morning.
• Have other health problems — You have high blood pressure, diabetes or obesity.

A sleep study can show whether sleep apnea is present. Contact Universal Sleep Solutions to schedule an evaluation.