Introduction

This section explains why we sleep, it explains the different forms of sleep and what happens in the brain during sleep. It also explains why adequate sleep is crucial for a strong libido and for proper erectile functioning. In addition, this section tells my personal experience with lack of sleep and how this contributed to erectile dysfunction and reduced libido.

 

Sleep

Why do we sleep? Why – towards the end of the day, do our bodies start craving the sweet lull of sleep? And why do we spend as much as one third of the day (and our lives) sleeping? These are questions that have left scientists pondering for centuries.

Wouldn’t it be nice if we didn’t have to sleep? Instead of spending all this time sleeping, we could have fun, be with friends or be productive. Or we could for instance travel the world. All this instead of lying still under a blanket.

But that’s just not the way it works. We have evolved to become creatures that need sleep. And there are some very good reasons for why we do need this sleep.

However, a lot of effort is still going into research on sleep, as the topic of sleep is not yet fully understood. Although we don’t yet have full knowledge of sleep, we do know a lot about it, and we also know a lot about what happens to us when we get inadequate sleep.

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One key reason why we need sleep, is because our brains and bodies need time to restore, repair and rejuvenate themselves. Many of the major restorative functions in the body like muscle growth, tissue repair, protein and hormone synthesis, and formation of neuron pathways occur mostly, or in some cases, only during sleep. Sleep is also necessary for the learning of new tasks to be manifested and for overall brain development.

Although our bodies might relax and be in a state of rest while we sleep, this is not the case for our brains. Sleep for the brain is a highly active time. During sleep, the brain forms, reinforces, moves, consolidates, links and discard memories and experiences. This also includes muscle and motor memory, meaning that sleep reinforces, builds and memorizes tasks done or practiced during awake hours. New neural connections are formed during deep sleep. During deep sleep, the brain also clears out toxins and waste products generated throughout the time we were awake.

The sleep cycle consist of four stages; three stages of non-rapid eye movement (NREM sleep) and one stage of rapid eye movement (REM sleep). Stage one is the mild sleep a person experiences after falling asleep. It is gentle and people woken up from this stage often believe that they were fully awake during this sleep. As people fall into stage one sleep, it is common to experience sudden bodily jerks. Dreaming is rare in this stage.

Stage two is a deeper kind of sleep where muscle activity decreases and awareness of the outside world fades completely. The sleeper is generally not able to understand sounds during this sleep. Dreaming is still quite rare during stage two.

Stage three is a deep sleep where a person is even less aware of the outside world. Brain temperature, breathing rate, heart rate and blood pressure are all at their lowest levels during this stage, and dreaming is now common. This is also the stage during which sleep-walking, sleep-talking and bed-wetting normally occur.

Stage four is the rapid eye movement (REM sleep). A newborn baby may often be in REM sleep for 80% of the duration of it’s sleep, while for an adult, this is normally 20-25%. REM sleep becomes more prominent during the second half of this sleep stage, and especially during the hours before waking. The REM portion of each sleep cycle typically also increases as the night goes on. This sleep is associated with un-regular rapid side-to-side movements of the eyes. Scientists still don’t agree as to the reason for this movement.

The brain’s oxygen consumption is very high during REM sleep, and it is in fact often higher than when awake trying to solve a complex problem. Breathing, heart rate and blood pressure all increase during this stage. Sexual arousal often also occurs during REM sleep and the male penis (as well as the female clitoris) normally become erect for long periods during this sleep. During non-rapid eye movement (NREM sleep), muscles are normally relaxed, but during REM sleep, muscles are normally paralyzed and unresponsive, perhaps to protect us from acting out vivid dreams. Because it is during REM sleep that we normally have vivid and memorable dreams.

Both REM and NREM sleep serves different functions and purposes such as building memories, moving one experience from short-term memory to long-term memory, etc. A sleep cycle consists of all of the NREM sleep stages and REM sleep, and a person normally has 3-5 full sleep cycle per night.

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We have probably all felt the difference in energy levels and sharpness after a night of good sleep versus a night of no or little sleep. And a good way of understanding why sleep is necessary, is to look at what happens to us if we don’t sleep, or get inadequate sleep. Here are some of the key consequences of inadequate sleep:

  • Lack of sleep interferes with the ability to concentrate and to learn new things. It can negatively impact both short-term and long-term memory, attention, alertness, reaction time, concentration, reasoning, creative thinking, decision making, problem solving, ability to speak and ability to carry out cognitive functions. It will normally make a person fatigued and sluggish, and may also cause a person to fall into short episodes of sleep, known as ‘microsleeps’.
  • Sleep and mood are closely connected, and when a person doesn’t get enough sleep, he or she tends to become more stressed, angry, sad, irritable, mentally exhausted and will often experience large mood swings. Stress, anger and rapid mood changes may also lead to increased blood pressure.
  • When a person sleeps, the immune system produces infection-fighting antibodies and defense cells such as T cells. During sleep, the brain also maintains the immune system and essentially ensures that it is ready for the next battle. When a person doesn’t get enough sleep, this maintenance and preparation of the immune system is halted or interrupted. As a result, the immune system may then provide a weaker defense against invaders.
  • Sleep is essential for muscle recovery, and inadequate sleep can lead to muscle pains from muscles that have not recuperated from earlier exercise or use. It is also theorized that muscle knots are partially a result of inadequate sleep.
  • Production and re-balancing of hormone levels take place during sleep, and inadequate sleep can disturb the manufacturing of important hormones such as cortisol, testosterone, prolactin, leptin, ghrelin, etc. Hormone levels out of balance can in turn lead to high blood pressure, over-eating, stress, insulin resistance, depression, cancer development, erectile dysfunction, reduced libido, etc.
  • Sleep deprivation is also likely to lead to loss of brain tissue, less elastic and more wrinkly skin, weight gain, headaches, poor vision, increase in risk taking, increased sensitivity to pain, genetic disruption, unhappiness and a number of other problems.
  • Extreme sleep deprivation ultimately leads to death. This has been confirmed by research on animals. Therefore, sleep is actually required for life. Virtually every complex living organism that has a brain – sleeps.
 

Sleep deprivation may lead to erectile dysfunction and a reduced libido, either because the body has not produced adequate levels of testosterone (as explained below) or because there is an imbalance or deficit in other hormones or molecules in the body. To learn more about erectile dysfunction on Truelibido, please go here, and to learn more about libido on Truelibido, please go here.

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Most testosterone is produced while we sleep, and this is particularly the case during REM sleep. Therefore, testosterone levels normally peak in the morning when we wake up and are at the lowest point before we fall asleep at night.

Most men need at least 7-8 hours of sleep for adequate testosterone production to take place. If we get inadequate amounts of sleep, or the sleep is significantly interrupted, testosterone production may be reduced.

Testosterone is a hormone that is imperative for a stong libido, erectile functioning and general sexual health. If a man has inadequate levels of this hormone, reduced desire for sex and a diminished ability to perform sexually are likely outcomes. To learn more about testosterone on Truelibido, please go here.

One research study reviewed the degree of erectile dysfunction and testosterone levels in 207 men with different degrees of sleep apnea. The study found that sleep apnea was highly correlated with erectile dysfunction, as 61% of the persons with sleep apnea suffered from erectile dysfunction. The persons with the most severe sleep apnea also had the strongest correlation with erectile dysfunction, as 72% of persons with sleep apnea suffered from erectile dysfunction. Also, the persons with severe sleep apnea had significantly lower testosterone levels than the persons with the mildest form of sleep apnea.

Other studies have shown similar results: One study reported that 40% of sleep apnea patients had erectile dysfunction, another study reported 64%, a third 46% and a fourth 69%.

Another study examined the impact sleep had on morning total testosterone and free testosterone levels in 531 men. The study showed a very strong correlation between sleep and testosterone levels. In this research, those persons who slept 8 hours or more had more than 50% higher testosterone levels than those persons who slept 4 hours or less. Similar results were found for free testosterone. A separate research study found that sleep was the greatest independent predictor of morning free and total testosterone levels.

Sleep is also paramount for keeping dopamine receptors healthy and fully functioning. Lack of sleep makes these receptors less responsive to dopamine. As a result of weakened dopamine receptors, the uptake of dopamine in the brain will normally be reduced. Dopamine is a component that is necessary for a man to feel sexual desire. It is also one of the many important parts in the process of a man’s erection. Therefore, both production and utilization of dopamine is critical for a healthy libido and for proper erectile functioning. To learn more about dopamine on Truelibido, please go here.

Research has shown that sleep deprivation leads to downregulation of what are called D2 and D3 dopamine receptors in the ventral striatum areas of the brain. This means that lack of sleep numbs these receptor so that less dopamine is absorbed and used.

Sleep deprivation has also been shown to cause an increase in cortisol levels. Cortisol serves many purposes in the body, such as aiding in the metabolism of fat, protein and carbohydrates as well as being a precursor for testosterone and vitamin D.

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However, elevated levels of cortisol (over time), often referred to as the ‘stress hormone,’ have been shown to decrease testosterone levels, increase visceral fat, increase insulin resistance, promote endothelial dysfunction, increase blood pressure, and lead to a number of other factors that may have a negative impact on libido and erectile functioning.

Also, sleep and depression are two highly correlated variables. One study found that people who were sleep deprived were more likely to report psychological distress and depression. And depression has been shown to have a dampening effect on both libido and erectile functioning.

After I graduated university, I took a job at a financial company in NYC. I found myself working non-stop, normally staying in the office past most people’s bedtime and often working all night until the next morning and then keep on working the next day (without sleep). I would typically work weekends and bank holidays as well. During a normal week, I would often work more than 100 hours, and certain weeks I hardly slept at all.

I was working these kinds of hours for about three and a half years, and during this period I was running a more or less constant sleep deficit. Only at very rare occasions did my body get a chance to catch up on sleep and recover. But when these brief catchup-periods were over, the carousel started moving again and I was back to hardly sleeping and putting my body and mind through distress. It was during this period that I for the first time encountered erectile dysfunction as well as an almost non-existent libido.

Particularly towards the end of my sleep-deficit periods was I hit by severe erectile dysfunction and a lack of sex drive. It was like my penis had completely stopped working – it was like it had retired for good. It seemed like my body had just stopped functioning. When I was with a girl, there would simply be no reaction downstairs. I was simply not able to get an erection. At the same time, and probably partly because I wasn’t working sexually, I also stopped thinking about sex, it became something I was less interested in and hence my libido plummeted.

I need to say however, that I can’t with certainty say that lack of sleep was the one and only cause of the onset of erectile dysfunction and libido problems. During this time I also hardly exercised, ate poorly and stressed more than I probably should have. So there could be several contributing factors, however, I strongly believe that lack of sleep was at least one of these contributing factors.

Although I today don’t work as much as I did when I just started my first job, and therefore get more sleep, I am also more sensitive to lack of sleep now, and I feel an immediate hit to my energy levels if I don’t get enough of it. Also, in the event I build up a small sleep deficit, I am significantly less interested in sex. As a result, sleep has also become a big factor in my life. I don’t skimp on my sleep anymore and I try to get at least 8 hours every night. However, one thing that complicates the quality of my sleep is that I wake up at least once or twice every night, normally because I have to urinate. This fragments my sleep and sometimes means less sleep because I don’t always fall asleep right away again. This is something I manage as best as I can. I am however unaware of the degree to which this impacts my sexual health.

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Research Studies

Alvarenga TA, Andersen ML, Velázquez-Moctezuma J, Tufik S. Food restriction or sleep deprivation: which exerts a greater influence on the sexual behaviour of male rats? Behav Brain Res. 2009 Sep 14; 202(2):266-71. DOI: 10.1016/j.bbr.2009.04.002.

Andersen ML, Alvarenga TF, Mazaro-Costa R, Hachul HC, Tufik S. The association of testosterone, sleep, and sexual function in men and women. Brain Res. 2011 Oct 6;1416:80-104. DOI: 10.1016/j.brainres.2011.07.060.

Andersen ML, Santos-Silva R, Bittencourt LR, Tufik S. Prevalence of erectile dysfunction complaints associated with sleep disturbances in Sao Paulo, Brazil: a population-based survey. Sleep Med. 2010 Dec; 11(10):1019-24. DOI: 10.1016/j.sleep.2009.08.016.

Besedovsky L, Lange T, Born J. Sleep and immune function. Pflugers Arch. 2012 Jan; 463(1): 121–137.

Budweiser S, Enderlein S, Jörres RA, Hitzl AP, Wieland WF, Pfeifer M, Arzt M. Sleep apnea is an independent correlate of erectile and sexual dysfunction. J Sex Med. 2009; 6:3147-3157.

Budweiser S, Luigart R, Jörres RA, Kollert F, Kleemann Y, Wieland WF, Pfeifer M, Arzt M. Long-term changes of sexual function in men with obstructive sleep apnea after initiation of continuous positive airway pressure. J Sex Med. 2013; 10:524-531.

Dinges DF, Pack F, Williams K, Gillen KA, Powell JW, Ott GE, Aptowicz C, Pack AI. Cumulative Sleepiness, Mood Disturbance, and Psychomotor Vigilance Decrements During a Week of Sleep Restricted to 4 – 5 Hours Per Night, Sleep. 1997 Apr; 20 (4): 267–277.

Dombrowsky J, Lettieri C, McCarthy JG, Shah A, Holley A. The prevalence of erectile dysfunction and impact of CPAP therapy: a prospective analysis. Sleep. 2012; 35:A0574.

Drummond SP, Brown GG, Gillin JC, Stricker JL, Wong EC, Buxton RB. Altered brain response to verbal learning following sleep deprivation. Nature. 2000 Feb 10; 403(6770):655-7.

Dzirasa K, Ribeiro S, Costa R, Santos LM, Lin SC, Grosmark A, Sotnikova TD, Gainetdinov RR, Caron MG, Nicolelis MA. Dopaminergic control of sleep-wake states. J Neurosci. 2006 Oct 11; 26(41):10577-89.

Epel EE, Moyer AE, Martin CD, Macary S, Cummings N, Rodin J, Rebuffe-Scrive M. Stress-induced cortisol, mood, and fat distribution in men. Obes Res. 1999 Jan; 7(1):9-15.

Faraut B, Boudjeltia KZ, Vanhamme L, Kerkhofs M. Immune, inflammatory and cardiovascular consequences of sleep restriction and recovery. Sleep Med Rev. 2012 Apr; 16(2):137-49. DOI: 10.1016/j.smrv.2011.05.001.

Filipski E, King VM, Li X, Granda TG, Mormont MC, Claustrat B, Hastings MH, Lévi F. Disruption of circadian coordination accelerates malignant growth in mice. Pathol Biol (Paris). 2003 Jun; 51(4):216-9.

Goel N, Rao H, Durmer JS, Dinges DF. Neurocognitive Consequences of Sleep Deprivation. Semin Neurol. 2009 Sep; 29(4): 320–339.

Goh VH, Tong TY. Sleep, sex steroid hormones, sexual activities, and aging in Asian men. J Androl. 2010 Mar-Apr; 31(2):131-7. DOI: 10.2164/jandrol.109.007856

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Havekes R, Vecsey CG, Abel T. The impact of sleep deprivation on neuronal and glial signalling pathways important for memory and synaptic plasticity. Cell Signal. 2012 Jun; 24(6): 1251–1260. DOI: 10.1016/j.cellsig.2012.02.010.

Heruti R, Shochat T, Tekes-Manova D, Ashkenazi I, Justo D. Association between erectile dysfunction and sleep disorders measured by self-assessment questionnaires in adult men. J Sex Med. 2005 Jul; 2(4):543-50.

Hirshkowitz M, Karacan I, Arcasoy MO, Acik G, Narter EM, Williams RL. Prevalence of sleep apnea in men with erectile dysfunction. Urology. 1990; 36:232-234.

Hoekema A, Stel AL, Stegenga B, van der Hoeven JH, Wijkstra PJ, van Driel MF, de Bont LG. Sexual function and obstructive sleep apnea-hypopnea: a randomized clinical trial evaluating the effects of oral-appliance and continuous positive airway pressure therapy. J Sex Med. 2007 Jul; 4(4 Pt 2):1153-62.

Leproult R, Cauter EV. Effect of 1 Week of Sleep Restriction on Testosterone Levels in Young Healthy Men. JAMA. 2011; 305(21):2173-2174. DOI:10.1001/jama.2011.710.

Leproult R, Copinschi G, Buxton O, Van Cauter E. Sleep loss results in an elevation of cortisol levels the next evening. Sleep. 1997 Oct; 20(10):865-70.

Leproult R, Van Cauter E. Role of sleep and sleep loss in hormonal release and metabolism. Endocr Dev. 2010; 17:11-21. DOI: 10.1159/000262524.

Liu L, Kang R, Zhao S, Zhang T, Zhu W, Li E, Li F, Wan S, Zhao Z. Sexual Dysfunction in Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. J Sex Med. 2015 Sep 22. DOI: 10.1111/jsm.12983

M Irwin, J McClintick, C Costlow, M Fortner, J White and J C Gillin. Partial night sleep deprivation reduces natural killer and cellular immune responses in humans. FASEB J. 1996 Apr; 10(5):643-53.

Maddox WT, Glass BD, Wolosin SM, Savarie ZR, Bowen C, Matthews MD, Schnyer DM. The effects of sleep deprivation on information-integration categorization performance. Sleep. 2009 Nov; 32(11):1439-48.

Matthews KA, Dahl RE, Owens JF, Lee L, Hall M. Sleep Duration and Insulin Resistance in Healthy Black and White Adolescents. Sleep. 2012 Oct 1; 35(10): 1353–1358.

Penev PD. Association between sleep and morning testosterone levels in older men. Sleep. 2007 Apr; 30(4):427-32.

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Reilly T, Edwards B. Altered sleep–wake cycles and physical performance in athletes. Physiol Behav. 2007 Feb 28; 90(2-3):274-84.

Santos T, Drummond M, Botelho F. Erectile dysfunction in obstructive sleep apnea syndrome–prevalence and determinants. Rev Port Pneumol. 2012; 18:64-71.

Schernhammer ES, Laden F, Speizer FE, Willett WC, Hunter DJ, Kawachi I, Fuchs CS, Colditz GA. Night-shift work and risk of colorectal cancer in the nurses’ health study. J Natl Cancer Inst. 2003 Jun 4; 95(11):825-8.

Seftel AD, Strohl KP, Loye TL, Bayard D, Kress J, Netzer NC. Erectile dysfunction and symptoms of sleep disorders. Sleep. 2002; 25:643-647.

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Shin HW, Rha YC, Han DH, Chung S, Yoon IY, Rhee CS, Lee CH, Min YG, Kim DY. Erectile dysfunction and disease-specific quality of life in patients with obstructive sleep apnea. Int J Impot Res. 2008 Nov-Dec; 20(6):549-53. DOI: 10.1038/ijir.2008.39.

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