We talk a lot about the health risks associated with sleep apnea. In fact, I just did a deep dive on sleep apnea on my podcast.
But you know what we don’t discuss enough? The impact of sleep apnea on sex and intimacy. A lot of my patients who are diagnosed with sleep apnea and prescribed CPAP for treatment worry about what using CPAP at night will do to their intimate lives.
I understand why my patients have these concerns. But the truth is, it’s untreated OSA that creates problems with intimacy and sexual fulfillment in couples’ lives.
There is nothing that feels sexy about living with untreated sleep apnea. The snoring, the exhaustion and irritability, the mood swings, the lack of focus, the physical symptoms (headache, dry mouth, sweating at night)—all make people feel uncomfortable and not themselves.
Problems with sex and intimacy are themselves an often-overlooked signal of a possible undiagnosed sleep apnea condition. It’s important for couples to be aware of this, and to take action by seeking an evaluation from a physician, especially when intimacy problems occur along with other symptoms of OSA. You can read more about the symptoms of sleep apnea—and just how common this sleep disorder is, here.
When it goes undiagnosed and untreated—which happens all too often, unfortunately—sleep apnea presents significant problems for emotional intimacy, sexual desire and sexual function—in both men and women. Here’s how.
Sleep apnea pushes couples apart—physically AND emotionally
Sleep apnea is a condition of disordered sleep breathing, and a hallmark symptom of sleep apnea is loud snoring. (Be aware, not everyone who has sleep apnea snores loudly all the time. Symptoms of sleep apnea vary among individuals, and between men and women. It’s possible to have sleep apnea without chronic loud snoring.)
The noisy breathing and snoring associated with sleep apnea is a problem for the snorers and for bed partners. Snoring deprives both partners of sleep—it’s a common source of frustration and tension in relationships, one that often sends partners to sleep in different beds. Sleeping separately can lead to a reduction of sex and intimacy in couples. It’s not only the act of sex that happens less often, it’s also the comfort and intimacy of sleeping together that couples miss out on. And regardless of whether you’re sleeping together or separately, the lack of restorative sleep that goes along with untreated sleep apnea will leave you exhausted, irritable, and lacking in energy—and much less likely to be feeling sexy or interested in sex.
The negative consequences for bed partners of people with OSA start with poor sleep, but they don’t end there. Research shows that one partner’s sleep problems are linked to a range of serious issues with the other partner’s mental health and relationship satisfaction, including:
- Higher levels of individual unhappiness
- A higher degree of unhappiness in the relationship
- Feeling isolated
- Symptoms of depression
Research shows that sleep disturbances—and OSA in particular—are linked to lower levels of relationship satisfaction. And there’s a two-way street here, with scientific evidence showing that dissatisfaction in couples’ relationships contributes to a deterioration in sleep.
There’s compelling research that shows sleeping poorly diminishes partners’ gratitude and appreciation for one another. When people with OSA don’t get the restorative sleep they need, isolation and conflict eat away at intimacy and connection.
I see it in my practice all the time: untreated OSA puts emotional and physical distance between partners, elevating conflict and isolation, and reducing physical and emotional intimacy.
Sleep apnea is linked to erectile dysfunction
Testosterone is important for arousal and sexual function in both men and women, and in men testosterone is critical to erectile function.
Like most hormones, the body’s testosterone production has a daily circadian rhythm. And restless, disrupted sleep has been shown to interrupt the daily chrono-rhythm of testosterone production. We know from research that testosterone levels are lower in men with OSA.
Untreated sleep apnea leads to frequent awakenings throughout the night. When breathing is disrupted during sleep, we awaken (often so briefly we’re not aware of it) in order to restore breathing and get the oxygen we need. Obesity is common among men with OSA, and may also contribute to frequent nighttime awakenings that disrupt testosterone production. And low blood oxygen
Low testosterone can create a number of sexual issues for men. For one, it reduces sex drive. Men with low testosterone also may experience erectile dysfunction and impotence.
A majority of men with sleep apnea—as many as 80%, according to research—also have erectile dysfunction. And again, there’s a two-way street here: new research shows that men with ED are more than twice as likely to have OSA.
Low testosterone appears to be a significant factor in the presence of erectile dysfunction in men with OSA. But it’s not the only factor. Fatigue, stress and anxiety from the chronic poor sleep of untreated sleep apnea may also contribute to higher risks for erectile dysfunction. But there’s good news for men with OSA: research has shown that treating sleep apnea with CPAP leads to improvements in sexual function in men with erectile dysfunction.
Sleep apnea hurts women’s sex drive and sexual function
Men aren’t the only ones to suffer complications to sexual function from untreated sleep apnea. There hasn’t been as much attention paid by science to the relationship between sleep apnea and sexual dysfunction in women. That is a big problem that needs to be addressed, stat. But there is evidence that sleep apnea directly and negatively affects several aspects of women’s sexual experience, function, and behavior including:
- Arousal and desire
- Frequency of sexual activity
- Frequency of orgasm, and of sexual fantasies
Sleep apnea can interfere with sex for both pre- and post-menopausal women. Research shows that both pre- and post-menopausal women with sleep apnea experience reduced desire, arousal and orgasm—and that the severity of OSA affects the degree of sexual dysfunction.
Women are at risk for sleep apnea before menopause, but the risks for sleep apnea rise significantly for women once the menopausal transition has begun. An estimated 20% of women develop OSA during menopause, and research indicates that somewhere between roughly half to two thirds of postmenopausal women have sleep apnea.
Women’s sexual desire and function can also be impaired the poor sleep, fatigue, depression, and anxiety that are common symptoms of untreated sleep apnea. Women experience the effects of sleep apnea differently than men do, and sometimes show different symptoms. Here’s where you can read more about how sleep apnea presents itself in women, their risk factors and the impact of sleep apnea on women’s health.
Depression is common among men and women with sleep apnea—and it hurts sex and intimacy
The depression that can go hand-in-hand with untreated OSA too often gets overlooked. A 2020 study conducted by the CDC found that OSA and its symptoms are strongly associated with major depression. Symptoms of major depression include:
- Feelings of hopelessness
- Feeling like a failure
- Severe fatigue, exhaustion, and loss of energy
- The loss of interest and enthusiasm for life’s activities and passions
- guilt, shame, and self-judgment
- sleep disruptions, including sleeping excessively and/or not being able to sleep, and an inability to sleep in a consistent routine
Depression has strong links to low levels of relationship satisfaction. There is a complex dynamic between sleep apnea, sleep deprivation, and depression. Depression creates stress, isolation, and conflict in relationships, as well as sleep problems. Relationship conflicts and disrupted sleep, in turn make depression more severe and more difficult to cope with. And sleep apnea contributes to all three: sleep problems, relationship conflicts, and depression. The result, for couples, can often be a devastating loss of intimacy, emotional connection, and sexual fulfillment.
How to bring ‘sexy’ back to your sex life
Treating your OSA will have a powerful impact on your sleep and health. Getting a sleep apnea diagnosis and working with a sleep professional to identify the right treatment is how people return to a routine of sound sleep, and how they reclaim energy, focus, and vitality. It’s also a way back to feeling sexy, regaining interest in sex, and reconnecting to a partner.
At the same time, treating sleep apnea also reduces the health risks associated with untreated OSA, including cardiovascular disease, diabetes, and mood disorders such as major depression. Improving underlying health can also improve how people feel about their own sexuality, and how partners relate to one another, physically and emotionally.
The good news is, there is a range of effective treatments for OSA, including CPAP and oral devices, as well as lifestyle changes including losing weight. There are also some exciting new treatments for sleep apnea on the horizon. Just last week, the FDA approved a sleep apnea treatment device that’s worn for a short time during the day, to help strengthen the tongue muscles and improve breathing at night for people with mild to moderate OSA. I’ll be talking more about this new development soon.
CPAP, continuous positive airway pressure, remains the most common treatment for moderate to severe sleep apnea. CPAP also raises a lot of anxiety for people, especially when it comes to sex and intimacy. Many of my patients worry about looking silly going to bed with their partner wearing a CPAP mask. And they wonder whether using a CPAP will put a big damper on their sex lives.
I’ll tell you what I tell my patients: Treating OSA with CPAP brings sex—and feeling sexy—back.
Research backs me up here. Studies show:
CPAP can increase desire and connection. Sex and emotional intimacy improve when people with OSA start using CPAP.Without the sleeplessness and fatigue, sex becomes better and more frequent, and partners feel closer to one another.
CPAP can improve sexual function. Research shows that CPAP improves sexual satisfaction and erectile function.
The sex and intimacy benefits of CPAP extend to partners, too. CPAP treatment also improves partners’ quality of life. Getting treatment for one partner’s OSA helps both partners to sleep better, and to feel more energized, enthusiastic and optimistic about their lives—and each other.
If you have a partner with sleep apnea who is using CPAP, your support can make all the difference. Research shows this, too: when they feel supported by their partners, CPAP users feel more motivated to stick with CPAP and use it more consistently. Adhering to CPAP therapy consistently is the key to maximizing the effectiveness of the treatment, and getting all the benefits that come with it—benefits for overall health, nightly rest, and the intimacy, fun, and physical passion of partnerships.
I always encourage my patients with OSA who are in relationships to think of their treatment as a shared undertaking with their partners. I’ve seen it happen again and again: when couple’s approach an OSA diagnosis and CPAP therapy with a “we’re in this together” mindset, the therapy works more effectively—and couples find a new way to re-connect in the process.
Michael J. Breus, PhD, DABSM
The Sleep Doctor™