ERECTILE DYSFUNCTION (ED) is known widely as ‘impotence’ and is defined as the inability to get and keep penile erection firm enough for sexual relationship. It can make sexual intercourse difficult if not treated appropriately. It is reported that 1 in 5 men affected by this problem and this number increases with age.
Prevalence: In India, the prevalence of erectile dysfunction is increasing drastically and found to be about 6% in the age group 20-29 years and 50-70% in the age group 40-79 years. It has been estimated that this number will get increased over 320 million by the year 2025.
OBSTRUCTIVE SLEEP APNEA (OSA) is defined as the recurrent complete (apnea) or partial (hypopnea) episodes of upper airway obstruction during sleep. In other words, it occurs when tissue at the back of the throat collapses and blocks a person’s airway. This results in a start-stop breathing pattern, making it difficult to sleep soundly.
Prevalence: This is the one of the most common sleep disorder. In men, the prevalence of OSA was found to be 1-5%. This prevalence rate keeps on increasing with age. In clinical studies, it has been reported that 69% of male study participants with obstructive sleep apnea also had ED.
RISK FACTORS FOR OSA
- Sleeping flat on the back
- Chronic sinusitis
- Large neck circumference
- Recent weight gain
- Large tonsils or adenoids
- Down syndrome
- Family history of sleep apnea
- Recessed chin or large overbite
OSA induces a variety of abnormalities in neural, hormonal and vascular regulation which contribute to the development of ED (erectile dysfunction).
Apnea occurring during the sleep causes hypoxia (oxygen deprivation) and oxidative stress which result in impairment in hypothalamic-gonadal axis and lead to psychological depression, decreased libido, fatigue, decrease in rapid eye movement (REM) sleep period and neurogenic dysfunction and all these factors results in decline in the testosterone (male hormone) levels which ultimately worsens the quality of erection.
Another reason associated with these co-morbidities is that men produce a large amount of testosterone during night. A disturbed sleep pattern due to sleep apnea reduces the testosterone production resulting in poor erections and decreased libido.
Prevention and treatment of erectile dysfunction associated with OSA includes either the treatment of OSA or the direct treatment of erectile dysfunction.
Treatment of OSA
OSA can be treated with
- Lifestyle changes: Majorly including weight loss because excess weight is a primary risk factor for sleep apnea in both men and women.
- Medical treatment: Including oral cavity tools and Continuous Positive Airway Pressure (CPAP) therapy
- Surgical treatment: Surgery is preferred when other treatments have failed or when treatment is needed right away. It includes Uvulopalatopharyngoplasty (UPPP), Tonsillectomy, Tracheostomy, etc.
The above given treatments have shown to improve associated ED also. Currently, CPAP therapy is regarded as the gold standard treatment for OSA. It is a device which is worn while sleeping and keeps the airway from closing. It can diminish or alleviate sleep apnea.
Men with OSA and moderate to severe ED were shown to be improved greatly with the regular use of CPAP. It has been found in a human clinical study that CPAP users experienced an improvement in overall sexual function compared with patients who did not use CPAP.
Treatment of erectile dysfunction
Overcome anxiety & stress: It has been proved that anxiety and stress worsens the erectile dysfunction. Talking about these things with a therapist can ease sexual anxiety and help to generate more confidence. Anti-stress activities should be chosen such as playing, daily exercise, yoga, keeping yourself busy, etc. This will help to lose stress and manage erectile dysfunction.
Medications: The doctors usually prescribe drugs such as Avanafil, Sildenafil, Tadalafil and Vardenafil. These drugs should be taken after careful prescription and complete guidance because they could cause side effects such as headache, stuffy nose, muscle ache and temporary blue-green shade of the vision in some cases.
Surgery: If all other ED treatments have failed, your doctor may recommend surgery. The operations are:
- Placement of an implant (prosthesis) in the penis
- Vascular reconstruction surgery to improve blood flow to or reduce blood leakage from the penis and surrounding structures. This procedure works in very few cases.
Natural treatment: Even though all the above given methods may help some men, natural alternatives can be just as effective, but they remain free of side effects.
The various plants which are clinically proven to manage ED are:
- Red ginseng
- Wild yam and soy containing DHEA (Dehydroepiandrosterone)
- Fenugreek seeds such as fenugreek seed extract in the form of food supplement (Chemforce)