Why Sleep Apnea Kills Your Erection After 50

This podcast is for you, the modern man. I'm Dr. Anne Truong MD, your host. I'm an intimate health medical doctor and bestselling author of the book Erectile Dysfunction Fix. I'll do a deep dive into sexual health and performance and how it affects men of all ages and backgrounds. So let's get started and be sure to visit my website at sexualhealthformenpodcast.com for more information and resources from the show. See you on the inside. Hello there, Modern Man. In today's episode, we're gonna dive deep into sleep, and you know that is one of the four pillars of having good sexual health. And today I have a special guest, Dr. Ram Verma from Indiana. He is a sleep specialist doctor, is also a TEDx speaker, speaker. But today, we're going to talk about why should you care about sleep and how does it affect your ED and things that you need to know now to prevent your ED from getting worse. So, welcome, Dr. Varma.

Yeah, thank you. Thank you for having me.

All right. So, let's dive into this. So, let's just talk about why should men care about sleep and how does that relate to their erection?

Yeah, so sleep is very important for the erection and ED. Sleep problem start first and then ED might come later on. So try to check your sleep. If you are having snoring, breathing pauses, having low oxygen when you sleep, and your sleep is getting broken, so that disturb the activity of the brain gland to secrete hormone. If sleep is broken, those systems get broken.

Okay. So let's just kind of break it up right here. So how does sleep affect their sexual function? You mentioned that sleep is broken and it affects their hormones. How does that happen? What happened to the body that caused that?

So during sleep, like, you know, people require to have a certain amount of deep sleep, REM sleep. So during the deep sleep, the pituitary gland and some other glands in the body they secrete hormone. But if someone has sleep apnea or some sleep problem, waking up so many times, they are not able to maintain the rhythm of continuous deep sleep for certain period of time to produce those hormones. So when the sleep is broken, that system gets broken. And when the glands are not able to secrete the hormones, so the hormones level get disturbed and that affect the ED.

Okay, so let's talk a little bit about sleep apnea. What is it?

So sleep apnea is a condition in which people snore and get breathing pauses during the night when they are sleeping. And when the breathing pauses happen, their oxygen level goes low. So when person is sleeping and in certain stage like deep sleep or REM sleep and the oxygen level goes low, then the brain gets arousals. And in those moments of arousal, the sleep gets broken. And when it is broken, then that affects the ability of body to produce those hormones at certain level.

Okay. So how does the person know that they have sleep apnea? Because when you're asleep, you're asleep. You don't really know. So what are some of the things that they may notice that, hey, maybe I have sleep apnea? Because I know that— well, let's backtrack that. How common is sleep apnea in men?

So sleep apnea is very common in men, maybe 10 to 25% of men. They tend to have sleep apnea. Most of them are undiagnosed, and the symptoms are like snoring, getting breathing pauses when sleeping, stopping breathing, and frequent awakening during the night, going to bathroom multiple times during the night, and when waking up feeling tired. Sometimes they feel more tired even before going to bed, and during the daytime they or having difficulty staying awake at work, focusing on their work, or when they are driving, they feel sleepy. So those are some symptoms of sleep apnea.

Gotcha. And how long does it have to go on until they start feeling those symptoms?

Like it takes like a few years. So this problem getting ignored, people are not aware about it. And that's why like, you know, getting ignored and then they develop those things. And they develop like other, other health conditions like high blood pressure, diabetes, ED, and some other like dementia, depression, anxiety, headache. All those other, other conditions come on later on.

Okay. So how does sleep apnea cause ED?

So sleep apnea causes breathing pauses in, you know, when they are sleeping and it disturbs the quality of sleep. and it fragments the sleep. People are not able to maintain deep sleep or REM sleep, so their hormone level goes low. And the other thing is also when they're sleeping, having undiagnosed or untreated sleep apnea, so that also affects the body's ability to heal during the sleep and they are feeling tired. So when they are not having energy and not having enough hormones, that's how it affects their sexual health.

Gotcha. So that's the connection there. It's really the hormone. So it's affecting testosterone. It doesn't necessarily affect blood flow. It's just really testosterone, more of a hormonal impact. Yeah.

So there has been studies done. So it affects hormone level, but it also affects some dysfunction in the circulation system also. Their endothelial system and other things get also disturbed. So those are on chemical level and inflammation in the circulation, in the vein and arteries. So those also affect. So, so that's how it affects sexual health as well.

Gotcha. Okay. So sleep apnea, it's presented if you're, if you're sleeping, if you're tired, that's one of the main symptoms, right? And what are the risk factors that predispose somebody to have sleep apnea?

Obesity is one, and second is as like, you know, people age, these muscles become more floppy, more relaxed. So as we age, it become more common. And also some people have narrow airway passage, so they inherit from the parents. If their passage is narrow on the back of the throat, that make them prone to have sleep apnea as well.

Okay. But is it preventable?

So it is preventable in a sense that if that is like the morphology they have, they cannot change that one. But in terms of like, you know, they can control their weight, that can help. They can sleep on the side to some extent, that can reduce the snoring and chances of sleep apnea. But if someone like having symptoms, I suggest them to like get it checked. And nowadays, very easy, like home test can be done. And there are some device, some tracker comes also, Ring smartwatch. They can also give some idea if someone is at risk of sleep apnea.

But you're saying it affects about 15% of men or so, but if they feel tired. We know that a lot of things can cause tiredness because it's hard for somebody to know, do I snore? Well, most people snore. I snore. Yeah, most people snore unless you're sleeping with somebody. They're telling them that you have pauses in your breathing while you're sleeping. So should all men get a sleep study test? Because you mentioned that you can get a sleep study test at home now, which I actually have one that I'm about to do for my husband and for me. For the sleep apnea test. So you think you have sleep apnea, you can go to the doctor and get the sleep apnea test either at home or in their office. So should everyone be— for all men be tested for this, you think?

Yeah, we don't recommend all men, but men like over 40. And if they are having some fatigue, they are thinking their quality of sleep is not good, feeling non-restful when they wake up in the morning. And have been told snoring, breathing pauses, and having high blood pressure or atrial fibrillation or diabetes or any depression, anxiety indicate that they might benefit with sleep apnea testing.

Okay, got it. So we talk about what sleep apnea is. We talk about the risk factors. We talk about how percentage of men, which is about 15% or so. And then is that the only way to diagnose sleep apnea is the sleep test or the home study test? Is there any other that when they see a doctor that is the workup for this?

So like these are the two methods, like a home sleep study or in-lab sleep study. Home sleep study is more common nowadays with new technologies and more affordable and easy to do. But clinically, if they are having symptoms, they can tell the doctors or their providers and ask them to get like, you know, tested for that.

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So nowadays there are different treatment options. Most common is CPAP machine, BiPAP machine. What those machines do, they push the air with gentle force with some mask under the nose or some mask covering nose and mouth both, and that air comes with force and that air also has oxygen. So that way it controls the sleep apnea. Sometimes people run into problems if a mask is not right, if setting on the machine is not right, then they are not able to use the CPAP machine. So in those situations, I suggest them to see a sleep specialist If it is not working, follow up with different specialists as well. There are other treatment options called Inspire. So Inspire is an implant under the skin and it gives signal to your tongue to move forward. And when tongue moves forward, it opens the passage on the back. So that is an implant for sleep apnea, just like a pacemaker for sleep apnea, and that keeps moving the tongue forward. But it has certain criteria to qualify for it. There is a third option, dental device, putting into the mouth, and what it does, it keeps lowers the forward. So when it keeps lowers the forward, then keeping the passage open on the back of the throat. And if it is done by a certified dentist who is trained in sleep medicine, then this device can also work. There are some other device called positional device for sleep apnea. They are like vibration band, and that helps to avoid sleeping on the back. So that band can be put on the stomach or the neck. So that is called positional device for sleep apnea. So that can also help some people.

Okay. So who do you determine who gets what? The machine versus the Inspire versus dental prosthetics?

So CPAP is the gold standard treatment. So we start with that. But if someone having a lot of claustrophobia and they want to go try dental device, that is fine too. So they can get benefit from that. If their apnea is mild to moderate degree, not very bad, Oxygen is not running low too much, so they can benefit from dental device as well. About the Inspire, someone who has moderate to severe degree of sleep apnea, then they have tried CPAP and they qualifying for that, certain weight criteria, certain procedure to look on the back of the throat called DICE procedure. So if they qualify for Inspire, they are good candidate, they can get benefit from that as well.

Interesting. So do women get sleep apnea as common as men?

It is less common in women, but after the menopause, they they tend to have almost similar prevalence for sleep apnea too. And in women, the snoring is not that loud, just like men. So some of the women after menopause, they are having insomnia. It is presenting like insomnia, but they should also get benefit from testing for sleep apnea as well because the symptoms are a little bit subtle. They present like depression, anxiety, or insomnia. So symptoms are a little bit subtle, but prevalence goes high after menopause.

Okay. Well, I'm getting mine done. The only thing is I feel pretty good. So hopefully maybe I'll pass my test. Who knows? But if my test's not normal, I'm definitely calling you for this. So, so that's sleep apnea. Now, once you get on the machine, you stay on it forever?

So most people stay like, you know, forever until unless they lose significant weight. So some people get bariatric surgery, they lose 80, 100 pounds weight. And 60-70% of them, they get off from the CPAP also. But some of them still benefit at lower setting on the CPAP. They still get good quality of sleep with CPAP. So for them, maybe it is from the morphology, how the bones are aligned, not only the weight.

What you're saying, which I didn't know, was that if you lose weight, you can actually reverse your sleep apnea?

In some percentage.

How much percent?

After people get bariatric surgery, 60-70% of people, they get off from machine. Their sleep apnea gets reversed.

Okay. So if you lose weight, then that will help. What else can you do to not be on the machine? Is there anything else you can do besides just losing weight if you don't want to be on the sleep apnea machine?

Yes. So there are other treatment options, like I mentioned Inspire. So Inspire is without any mask. It keeps moving the tongue in the night when people are sleeping, and the movement of tongue is not painful.

Yeah, like natural therapy instead of like a machine or an implant. Any other natural therapy like diet, exercise, or anything that they can do naturally?

Yeah, naturally it does not control sleep apnea all the way, but exercise, diet, if they are losing weight, sleeping on their side, that is helpful. Sometimes people elevate their head, just leave it, and they are sleeping better. So those are other things they can do. But I still recommend to get it treated because when they go into deeper sleep, these muscles relax. And in the deeper sleep, we want our muscle relax. And that's how it happens. So that's why the treatment is necessary.

So the endpoint is if you do the test and it showed you have sleep apnea, you should use the machine and try to lose some weight. And obviously losing some weight will probably help, guess, the parameter of the machine as well too, right?

Yep, yep. And not only the machine, not only the machine is option, like other options like dental device putting into the mouth, that is one option. Positional device for sleep apnea and Inspire, those are the options without any CPAP. And there is another device called iNAP that like people put into the mouth and it creates negative suction in the oral cavity, so keeping the tongue sucked up on the front so they keep breathing from the nose. So there are some other devices also. So I see patients, a lot of them, they are doing good on the CPAP, but some who are not doing good on the CPAP, I try to use other alternative methods without any mask.

So that's good. But the bottom line, if you're going to use the machine, you use it forever.

Most of the time, yes.

Okay. I see the machine. One of my friends has one. It's very small and quiet now. Not like, you know, it was like 27 years ago when I started medicine. The machine then looked like a computer and it made so much noises. It was incredible. I think that was what the main thing was. You know, I want our listeners to know how to know if they have sleep apnea. So what happens if you don't get treated with sleep apnea? What happens?

So sleep apnea causes intermittent low oxygen in the body, and oxygen is a very important thing for our survival. If we don't get oxygen for 5 minutes, we are dead. So the brain keeps looking at the level of oxygen. If there is a drop of 3%, 4%, then brain keeps getting jerk, keeps getting arousal, and that's how it breaks the rhythm of sleep. So people don't get quality sleep. And in that way, because of that, they are not getting restful sleep, not getting quality sleep. So that is affecting overall health, so affecting the ability of brain to clear the toxins. And when toxins accumulate, then the people develop dementia and depression, anxiety, and then a lot of problem to the heart and stroke. As you mentioned, sexual health also get affected because of these things— not getting good quality of sleep, not feeling rested, and having low hormones. So, so those affect sexual health as well.

Okay, great. So to summarize, get your test and get treated. It's very unintrusive. And if you don't, you're going to be at risk for dementia and not to mention making your ED worse because your body is not getting enough oxygen while you sleep. When you're not getting enough oxygen while you sleep, it will affect everything, your brain, your heart, your sexual function as well. And you continue feeling fatigue. So that's awesome. Thank you for enlightening us about sleep apnea. Where can our listener find you to help them with their sleep apnea?

Yeah, so they can check my website, Longevity Sleep Medicine, and they can like find me online. So, so those are options.

Okay, so to find out more about you, go to longevity sleep medicine. Yep, longevitysleepmedicine.com. So I'll leave the link in description down below for you to check out. And guys, get this checked because you mentioned 15%. I think it's probably so much more. I know so many people have sleep apnea and I feel that is one of the underdiagnosed conditions with men with ED. And I think if you have ED, you need to get a sleep apnea test if you're over 40, because oftentimes it coincide because I can't tell you how often I see men for ED. And when we do blood work, we also diagnose them with diabetes or prediabetes. As well, because they don't know that their blood sugar is high. So sleep apnea is certainly an easy test to do that can honestly save your life and improve your quality of life as well too. So having said that, Dr. Verma, thank you for being on our show and get your sleep apnea checked. Check out his website and modern man, just know that you don't have to live with ED. There are alternatives, and I will see you in the next episode.

Thank you for having me.

Okay, modern men, you are not alone, and you don't have to suffer anymore. ED can feel isolating, frustrating, and even defeating. The endless guessing, the quiet shame, the weight of not feeling like yourself— it's exhausting. But here's the truth: You are not broken. You are not alone. You don't have to figure this out alone anymore. The Get Wood Now Boost program is your step-by-step path to sexual confidence and restoration. No more suffering in silence. No more trial and error. Just real solution, real result, and the confidence you deserve. It's time to take back your power. On your terms. Let's get this journey started together. Check out the course at getwoodnow.com. I'll see you there. Thanks for listening to the Sexual Health for Men podcast. If you love this episode, then please take a screenshot on your phone and post it on Facebook, Instagram, or wherever you post, and be sure to tag me and let me know why you like this episode and what you'd like to hear in the future. That will help me know what's great for you, and I would love to give you the most incredible free gift designed to help you improve performance quickly. Go to my website at sexualhealthformenpodcast.com to get the book, The 5 Common Costly Mistakes Men Make When Facing ED. I would appreciate it if you subscribe, leave a review on Apple Podcasts or wherever you listen, and just know that you can have sexual Vitality for Life. I appreciate you. Until next time.