What’s the Link Between Sleep Apnoea, Insomnia and Erectile Dysfunction?
Poor sleep doesn’t just leave you tired—it can have serious consequences for your physical, mental, and sexual health. Two common sleep conditions—insomnia and obstructive sleep apnoea (OSA)—are known to affect erectile function, often working together to make things worse. When a person suffers from both conditions at once, it’s referred to as COMISA (comorbid insomnia and sleep apnoea). This combined condition is increasingly being recognised as a risk factor for erectile dysfunction (ED).
Erectile dysfunction is the inability to achieve or maintain an erection firm enough for sexual activity. It can affect self-confidence, relationships, and overall quality of life. While many people associate ED with ageing or heart disease, sleep quality is a critical and often overlooked contributor.
In this article, we explore how COMISA and other sleep issues can contribute to ED, based on a 2024 medical review published in Sexual Medicine Reviews.
What Happens When You Have Both Sleep Apnoea and Insomnia (COMISA)?
COMISA is when a person has both insomnia and obstructive sleep apnoea at the same time.
- Insomnia means difficulty falling or staying asleep, leading to poor-quality or non-restorative sleep.
- OSA involves repeated blockages of the upper airway during sleep, often leading to snoring, choking, or gasping sounds, and low oxygen levels (hypoxia).
On their own, each of these conditions can disrupt your health. When they occur together, the impact is more serious and complex.
How Common Is Erectile Dysfunction in People With Sleep Disorders?
Studies show that men with sleep disorders are much more likely to suffer from ED:
- Around 50–70% of men with OSA may experience erectile dysfunction.
- The presence of both OSA and insomnia (COMISA) appears to increase the likelihood even more.
- People with COMISA tend to have higher levels of anxiety, depression, and daytime fatigue, all of which are known contributors to ED.
How Do Sleep Disorders Cause Erectile Dysfunction?
There are several ways in which poor sleep—particularly when due to COMISA—can impact sexual function. These include:
Hormonal Changes
- Sleep is essential for healthy testosterone production.
- Poor or disrupted sleep reduces testosterone levels, especially during the early morning hours when levels should peak.
- Low testosterone can lead to reduced libido, weaker erections, and fatigue.
Endothelial Dysfunction
- The endothelium is the inner lining of blood vessels. It plays a key role in getting and keeping an erection by allowing blood to flow smoothly into the penis.
- Sleep apnoea causes repeated drops in oxygen levels, leading to inflammation and damage to the endothelium.
- This reduces nitric oxide, the chemical that relaxes blood vessels during arousal.
Mental Health Impact
- Insomnia is closely linked to depression and anxiety, both of which are independent risk factors for ED.
- People with sleep problems often experience lower mood, irritability, and performance anxiety—all of which affect sexual interest and function.
Cardiovascular Strain
- OSA causes the body to react as if it’s under stress every time oxygen levels drop—this happens dozens or hundreds of times a night.
- It leads to high blood pressure, irregular heart rate, and long-term damage to the heart and blood vessels—all of which are linked to ED.
What Does the Research Say About Sleep Disorders and ED?
A 2024 review by Andersen et al. in Sexual Medicine Reviews looked closely at the relationship between COMISA and erectile dysfunction. Key findings included:
- COMISA increases the risk of cardiovascular diseases, low testosterone, and mental health problems—all known contributors to ED.
- People with both insomnia and OSA have worse sleep quality than those with only one condition.
- Psychological stress and chronic fatigue from poor sleep can lead to loss of sexual interest or confidence.
- Sleep problems often remain undiagnosed in men seeking help for ED.
Read the full review here: https://doi.org/10.1093/sxmrev/qeae068
Can Treating Sleep Disorders Improve Erectile Function?
Yes. There is strong evidence that improving sleep can help restore sexual function. Treatment options may include:
For Obstructive Sleep Apnoea (OSA):
- CPAP (Continuous Positive Airway Pressure): A machine that keeps the airway open during sleep.
- Weight loss: Excess weight worsens OSA.
- Surgery or oral devices to keep the airway open.
For Insomnia:
- Cognitive Behavioural Therapy for Insomnia (CBT-I): Considered the gold standard, it improves sleep long-term without medication.
- Sleep hygiene: Avoid screens, caffeine, and alcohol before bed.
- Relaxation techniques: Deep breathing or meditation.
For Erectile Dysfunction:
- Lifestyle changes: Exercise, diet, alcohol moderation, and quitting smoking can all help.
- Testosterone replacement (only if low levels are confirmed).
- PDE5 inhibitors (e.g., sildenafil) may help, but they work better when sleep and hormone levels are optimised.
Do Sleep Disorders Cause Erectile Dysfunction in Men?
If you suffer from ED—especially if you also snore, feel tired during the day, or struggle to fall asleep—it’s worth considering an underlying sleep disorder.
Look out for:
- Loud snoring or gasping at night
- Daytime sleepiness despite a full night’s sleep
- Difficulty falling asleep or waking often
- Early morning fatigue or low mood
Many sleep issues go undiagnosed for years, but treating them can have life-changing effects—not only for your sex life but also for your heart, mind, and overall wellbeing.
Why It’s Important to Treat Sleep Apnoea and Insomnia to Prevent ED
Poor sleep is not just an inconvenience—it can directly contribute to erectile dysfunction through hormonal, vascular, and psychological pathways. COMISA (insomnia plus sleep apnoea) is particularly harmful, worsening nearly all risk factors for ED.
Recognising the signs of COMISA and taking steps to improve sleep can be a powerful part of managing or reversing ED. A personalised approach, which considers sleep, hormones, mood, and blood vessel health together, offers the best outcomes for men struggling with erectile dysfunction.
