What’s the Link Between Erectile Dysfunction And Heart Disease?

February 1, 2013

Erectile dysfunction (ED) is a common condition that’s usually treated by urologists with medications. In the sleep medicine literature, there are numerous studies showing that many men with ED have undiagnosed obstructive sleep apnea (OSA) and that treating OSA can significantly improve or even cure ED. Here’s one of many papers (PDF). Even in my practice, men oftentimes comment that this is a positive side effect of CPAP. 

Here’s another study that reiterates the known association between ED and cardiovascular disease. There’s no mention of sleep whatsoever. We also know that obstructive sleep apnea is a major risk factor for heart disease. It’s frustrating to know that most of these men will never have their obstructive sleep apnea diagnosed or treated.

I’m not saying that all cases of ED are due to OSA. But even if 50% of patients are improved, wouldn’t it be worthwhile looking into this possibility? Not to mention that once you’re able to sleep better, things can begin looking up again :)

How Erectile Dysfunction Can Cause Alzheimer’s

September 28, 2011

Not too surprisingly, focusing on lifestyle habits that control heart disease or taking medications to lower high blood pressure or cholesterol levels can also help symptoms of erectile dysfunction (ED). 

Dr. Stephen Kopecky, professor of medicine and cardiovascular diseases at the Mayo Clinic, and author of the paper published in Archives of Internal Medicine, quotes, “It’s a fascinating thing, but all the arteries are connected. We know that the risk factors for stroke are the same as for heart disease. We know that the risk factors for ED are the same as for heart disease. And we are finding that the risk factors for dementia and Alzheimer’s are the same as for heart disease.”

It’s frustrating that doctors are connecting all the dots, but rarely ever include obstructive sleep apnea as a major component of all these conditions. In this vein, having ED could mean that you’re at higher risk for obstructive sleep apnea, which causes diminished circulation to various parts of the body, including the penis and the brain. You can make a strong argument that everyone with ED should be screened for obstructive sleep apnea. 

What’s your opinion on this issue? Please enter your viewpoints in the text area below.

 

Nasal Polyps And Erectile Dysfunction: How It May Link To Sleep Apnea

April 21, 2011

I just came across this article showing that treating nasal polyps with sinus surgery can help men with erectile disfunction (ED). My initial reaction was that any type of nasal surgery can help with sleep-breathing problems, whether or not it’s obstructive sleep apnea.

The authors studied 35 patients who were confirmed to have nasal polyps. They excluded anyone with any known risk factors for ED, such as obstructive sleep apnea, diabetes, hypertension, obesity, or any neurologic conditions. All the subjects underwent a validated questionnaire for ED, as well as nocturnal penile tumescence (NPT) testing. Before surgery, 34.5% of these patients had ED based on the validated questionnaires, compared to 3.3% in controls. After surgery, the percent of people with ED dropped to 10.3%. NPT testing improved significantly as well.

Despite the fact the they excluded everyone with obstructive sleep apnea, it’s likely that having nasal congestion potentially aggravated sleep-breathing problems, leading to increased adrenaline levels. Having a stuffy nose causes a vacuum effect downstream in the throat, which allows the tongue to fall back more easily, causing obstructions and arousals. These breathing pauses may not be called apneas, but they can cause deep sleep disruption, leading to inefficient sleep and increased states of physiologic stress. Any type of stress, whether it’s physiologic, emotional, or psychological stress, can aggravate ED by the following mechanism:

Arousal and erection in men is mediated by the parasympathetic nervous system (the relaxation response). Orgasm is activated by the sympathetic nervous system (fight-or-flight response). If there’s too much sympathetic activation, you’re not going to have enough relaxation of the smooth muscle that allows blood to fill up the penis. Relaxing this muscle can be accomplished using medications, relaxation techniques, herbs or supplements.

Add one more option to this list: Better sleep by better breathing.

Viagra, Raynaud’s & Sleep Apnea

March 16, 2011

Viagra is still a popular drug that’s used to treat erectile dysfunction (ED) in men. It works by relaxing smooth muscle in blood vessels, allowing blood to enter the penis. A recent study showed that it can also help people with Raynaud’s phenomenon, where small blood vessels in the hands or feet go into spasm and cause cold or numb extremities, sometimes to the point of infection or even gangrene. This condition is commonly seen with autoimmune conditions, especially in lupus. It makes sense that relaxing smooth muscles that constrict blood vessels may increase circulation. Unfortunately, people taking this medication had a number of side effects.

In my book, Sleep, Interrupted, I describe a young woman who had classic Raynaud’s symptoms, needing to wear socks and mittens to bed even in the summer. After undergoing multilevel upper airway surgery for her mild obstructive sleep apnea, her Raynaud’s disappeared completely! Her depression, low blood pressure, irritable bowel symptoms, and daily headaches improved significantly as well.

There are also numerous studies showing the ED is a common complication of obstructive sleep apnea. One of the more common signs that sleep apnea treatment is working (through CPAP, dental devices or surgery) is that men are having erections again upon awakening in the morning. In many cases, ED resolves completely after sleep apnea treatment.

Not getting deep, high quality sleep is known to cause a physiologic state of stress, leading to too much of an adrenaline response. This results in an inability to relax vascular smooth muscles in various parts of the body, including the hands, as well as the digestive or reproductive organs.

If you have obstructive sleep apnea or upper airway resistance syndrome, it’s a given that your body will be under a constant state of stress. This why why after properly treating these conditions, ED and Raynaud’s often improve. These common conditions are not problems specific to the respective body parts—they are the end result of a systemic problem aggravated by not breathing and not sleeping properly.

These sleep-breathing problems are often treated successfully by alternative and complementary practitioners, since they tend to focus on the whole person, including his or her surroundings, rather than the one specific neurotransmitter, hormone, or body part.

However, taking a pill, whether it’s a prescription medication, vitamin or natural herb, or breathing exercises during the day, won’t solve the problem completely if you’re not able to breathe properly at night.

How many of you have had partial or total resolution of your ED or Raynaud’s after treating your sleep-breathing condition?

 

Sleep Apnea, Restless Legs and Erectile Dysfunction

January 4, 2010

There are studies linking sleep apnea with restless leg syndrome (RLS) and sleep apnea with erectile dysfunction, but now there's a study linking restless leg syndrome with erectile dysfunction. Not too surprising, since sleep apnea seems to be the common denominator for almost every imaginable disease, known or unknown. You may think that this statement is over the top, but you'll have to admit that not breathing well during the day, and especially not breathing well at night while sleeping can potentially lead to or aggravate almost every disease known to man. 

 

In this particular study, researchers found that men with RLS  had significantly increased risk for having erectile dysfunction (ED) compared with men who did not have RLS. The lead researcher, Dr. Gao, commented that the findings indirectly support the role of dopamine as a common pathway, in light of another study of his in the past that showed an association between ED and Parkinson's disease. He also points out that these same people with ED were more overweight, more prone to depression and anxiety, and had a greater chance of having hypertension or a history of stroke (sound familiar?)

 

It sounds like dopamine deficiency is a popular explanation for a number of different conditions. For both PLS and Parkinson's, giving dopamine-like agents help with the respective symptoms. The problem is that it never cures the problem completely, with a number of serious side effects. 

 

This approach to medicine is the replenish what's missing method. If you're deficient in dopamine, replace it. If you're deficient in Vitamin C, B12, or thyroid hormone, replace it. The problem is that this approach works in some people, but not in everyone. Then the next step is to increase the dosage, and then even more people respond, but not everyone (with more side effects). Ultimately, you're not addressing what's causing the deficiency. 

 

If you have a sleep-breathing problem, it's been shown that you can easily clot in certain small and large vessels of your brain very easily. If you happen to have a clot in the dopamine area of your brain, or if the brain biochemistry changes as a result of hypoxia, then you'll get various symptoms. But I think even the neurologists will tell you that a lack of dopamine itself won't lead to Parkinsons; it's just one part of a much larger picture. Could it be that obstructive sleep apnea may be that bigger picture, since by definition, all modern humans are susceptible to sleep breathing problems to various degrees?

 

What's your opinion on this? Should we continue to treat every medical condition in isolation hoping to target that one missing protein or gene, or should we step back and try to connect the dots until we see the bigger picture? Please enter your comments in the box below.


The material on this website is for educational and informational purposes only and is not and should not be relied upon or construed as medical, surgical, psychological, or nutritional advice. Please consult your doctor before making any changes to your medical regimen, exercise or diet program.



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