By Marc Braman, MD, MPH

MB (Marc Braman, MD, MPH):

All of nature is built on systems and cycles of rest, from whole people with our cycle of sleeping at night, all the way down to the level of cells and how they divide and reproduce. We need regular, effective recovery and restoration, or we break down and fall apart. This is what “R&R” is all about.

Nature’s design is such that sex and reproduction work best when people are in good condition and most capable of being better able to have, and successfully raise, children. Being super tired is not that condition.

How good is sex when you are super exhausted? What is the classic stereotype reason given by the woman of a couple for not wanting to have sex? Other than a headache? “I’m too tired.”

Sleep is a big deal for sex. Sleep apnea, one of the most common conditions, when we stop breathing at night, making our sleep much less effective than it should be shows us some interesting things. Some studies show improved erectile function in men who treat their apnea with a mask and air pressure referred to as CPAP. Other studies don’t show this benefit. This is probably because sleep apnea is not just a cause of fatigue and sexual dysfunction, but is itself usually a symptom of poor lifestyle causing obesity and other problems — which are also causes of ED.

We also would do well to realize that our fatigue or energy level isn’t purely a physically driven state. Mental, emotional, spiritual, and social stresses or dysfunctions can be very draining as well, resulting in definite physical maladies — like ED. After the initial adrenaline fades from a fight with a spouse or boss, we feel really drained. On the positive side, there are many things on these other levels, like gratitude or honest appreciation for one’s good work, that can really recharge our batteries. So we really need to think of our recovery systems and energy levels as whole people.

A real rocket is actually just one part of a very complex system of electronics, fuel as energy, planning, etc, along with the right conditions of weather and timing. Erectile function is the same way — it is simply part of a system of systems. If the systems are in good condition and charged up, the rocket ship will be ready to go, and power up as needed.

Erectile dysfunction in severe sleep apnea patients and response to CPAP. Taskin U, Yigit O, Acioglu E, Aricigil M, Toktas G, Guzelhan Y. Int J Impot Res. 2010 Mar-Apr;22(2):134-9. doi: 10.1038/ijir.2009.54. Epub 2009 Nov 26.

Long-term changes of sexual function in men with obstructive sleep apnea after initiation of continuous positive airway pressure. Budweiser S, Luigart R, Jörres RA, Kollert F, Kleemann Y, Wieland WF, Pfeifer M, Arzt M. J Sex Med. 2013 Feb;10(2):524-31. doi: 10.1111/j.1743-6109.2012.02968.x. Epub 2012 Oct 22.

Sexual function and obstructive sleep apnea-hypopnea: a randomized clinical trial evaluating the effects of oral-appliance and continuous positive airway pressure therapy. Hoekema A, Stel AL, Stegenga B, van der Hoeven JH, Wijkstra PJ, van Driel MF, de Bont LG. J Sex Med. 2007 Jul;4(4 Pt 2):1153-62. Epub 2006 Nov 1.

Effect of continuous positive airway pressure therapy on sexual function and  serum testosterone in males with type 2 diabetes and obstructive sleep apnoea. Knapp A, Myhill PC, Davis WA, Peters KE, Hillman D, Hamilton EJ, Lim EM, Davis TM. Clin Endocrinol (Oxf). 2014 Aug;81(2):254-8. doi: 10.1111/cen.12401. Epub 2014 Jan 28.

Marc Braman, MD, MPH

Dr. Braman is board certified in preventive medicine/public health and occupational/environmental medicine. He is founding member, second President and first Executive Director of American College of Lifestyle Medicine and founder and current president of the Lifestyle Medicine Foundation which created He provides lifestyle medicine care in a wide variety of settings as well as initiating efforts to establish professional standards for the field of lifestyle medicine and planning and conducting national professional conferences in lifestyle medicine.

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