World J Mens Health.  2019 Sep;37(3):261-275. 10.5534/wjmh.180045.

Sleep, Sleep Disorders, and Sexual Dysfunction

• Cho JW
• Duffy JF

• KMID: 2455404
• DOI: http://doi.org/10.5534/wjmh.180045

Abstract

Good sleep is necessary for good health. Sleep health is increasingly recognized as important for physical and mental health by both the medical profession and the general public, and there is great interest in how to avoid and treat sleep disorders and problems. Recent research indicates that insufficient sleep, disrupted sleep, and sleep disorders affect many aspects of human health including sexual function. In fact, patients with urological disorders or erectile dysfunction (ED) may have a sleep disorder that contributes to their urological or sexual dysfunction. Obstructive sleep apnea, insomnia, shift work disorder, and restless legs syndrome are all common sleep disorders and are associated with ED and/or other urological disorders. Therefore, careful attention should be paid to the diagnosis and treatment of concomitant sleep disorders in patients with sexual dysfunction. In this review, we provide an overview of what sleep is and how it is assessed in the clinic or laboratory; our current understanding of the functions of sleep and sleep health; a description of common sleep disorders, as well as how they are diagnosed and treated; and how sleep and its disorders are associated with male sexual dysfunction. Sleep is considered to be a "˜third pillar of health', along with diet and exercise. With an understanding of common sleep disorders and how they can impact male sexual function, the urologist can ensure that sleep disorders are considered as a contributor to sexual dysfunction in their patients in order to provide them with the optimal treatment for overall health.

Keyword

Erectile dysfunction; Sexual dysfunctions, psychological; Sleep; Sleep wake disorders; Testosterone

MeSH Terms

Diagnosis
Diet
Erectile Dysfunction
Humans
Male
Mental Health
Restless Legs Syndrome
Sexual Dysfunctions, Psychological
Sleep Apnea, Obstructive
Sleep Initiation and Maintenance Disorders
Sleep Wake Disorders*
Testosterone
Testosterone

Figure

• 

  Fig. 1 Polysomnograms showing different sleep stages. (A) N1 nonrapid eye movement (REM) sleep is characterized by low amplitude mixed frequency electroencephalography (EEG) representing light sleep. (B) In contrast, high amplitude slow frequency EEG characterizes N3 non-REM sleep, the ‘deepest’ stage of sleep. Note that electromyography (EMG) tone is reduced compared with N1 sleep. (C) REM sleep is characterized by unique REMs on electrooculography (EOG) and low or absent EMG, with EEG showing low amplitude mixed frequency. ECG: electrocardiography.

• 

  Fig. 2 Obstructive sleep apnea events on polysomnogram. A full diagnostic polysomnogram includes electroencephalography, electrooculography, and electromyography, along with a series of sensors to measure nasal airflow, thoracic and abdominal wall movement, and oxygen saturation. Complete cessations of airflow (arrow) with continued thoracic and abdominal wall movements representing respiratory efforts (arrowhead) are accompanied by falling oxygen saturation. This drop in oxygen saturation triggers a brief arousal during which the patient gasps and airflow is briefly re-established, but once he falls back asleep the obstruction reoccurs.

• 

  Fig. 3 Polysomnogram from a patient with periodic limb movements during sleep. The bursts of tibial EMG (electromyogram, arrow) occur periodically in both legs. EEG: electroencephalogram, EOG: electrooculogram, ECG: electrocardiogram, Lt: left, Rt: right.

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