How CPAP Therapy Affects Libido, Erectile Dysfunction, and Sex Life

The diagnosis of obstructive sleep apnea (OSA) may lead to concerns about how the potential treatments may impact the lives of the affected individual and their bed partner. In particular, the initiation of continuous positive airway pressure (CPAP) therapy may cause worry about how this could undermine normal sexual relations.

From snuggling to one’s sex life, what are the effects of CPAP on libido, sexual hormones, and even erectile dysfunction or impotence in men?

Potential Disruptions of CPAP

It is easy to envision the potential disruptions to a healthy sex life that CPAP therapy may entail. Putting on a face mask that covers the nose, or nose and mouth, and connects to a 6-foot tube that runs out to the CPAP machine seems to be contradictory to what people are thought to find "sexy." So, it’s natural to wonder how the use of CPAP may affect someone’s sex life.

First, it should be acknowledged that there will be some adjustments required when CPAP becomes part of someone’s sleep routine. It is put on at light’s out, potentially after having sex. Encouraging a partner to know that it is OK to ask for it to be taken off later in the night or in the morning to have sex is also acceptable.

It may affect snuggling, with the mask or tubing potentially getting in the way, or the outflow of air or mask leak being disruptive. This may be remedied if the person wearing the CPAP becomes the “little spoon” in the embrace.

The embarrassment or stigma of using CPAP therapy may present a psychological barrier, but these must be simply put aside. If someone needs glasses, there may be an initial reluctance, but once the benefits are evident, most will accept the change.

The same is true for those with sleep apnea who may need CPAP therapy to breathe normally during sleep. It is not a sign of weakness, of old age, or simply a consequence of weight gain. It is a medical condition that deserves treatment, to the benefit of someone’s well-being and long-term health.

CPAP Use and Libido

Obstructive sleep apnea more commonly affects men, with a prevalence that increases starting in middle age. Research into how CPAP affects sexual health has primarily focused on this population.

It may be helpful to highlight several studies that show how CPAP influences the sexual relationship for both partners and how women with sleep apnea, in particular, may benefit from treatment. There is some evidence that treatment with CPAP improves the sex lives of both men with sleep apnea and their female partners.

A small study of 21 subjects found that treatment improved the International Index of Erectile Function (IIEF) in men and both the Female Sexual Function Index (FSFI) and Beck Depression Inventory (BDI) in their female partners. This suggests the improved sexual function had some associated psychological benefits to the women.

There is comparatively little research into how CPAP treatment influences the sex lives of women with sleep apnea. One study of 44 women assessed their perceptions of sexual dysfunction and life satisfaction at baseline and after one year of CPAP treatment.

This was achieved with self-administered questionnaires, including the Female Sexual Function Index, Female Sexual Distress Scale, Manifest Female Sexual Dysfunction, Life Satisfaction 11, and the Epworth Sleepiness Scale. There was a positive change in manifest female sexual dysfunction and daytime sleepiness, but no significant changes in isolated sexual difficulties or sexual distress.

Another study of 182 people—63.2% of whom were men with an average age in the cohort of 47.2 years—found the sexual quality of life improved with CPAP therapy as measured with the Symptoms of Nocturnal Obstruction and Related Events-25 (SNORE-25) quality of life survey. Within the subgroup analyses, there was a large improvement noted in women, but interestingly no improvement in men.

It is theoretically possible that libido may be enhanced due to reduced sleepiness and fatigue, increased energy levels, improved mood and social interaction (including less irritability), favorable weight changes, and potentially due to alterations in sexual hormone levels.

The Effects on Sexual Hormones

Sexual desire, function, and even fertility may be affected by sexual hormones. These hormones include:

• Prolactin
• Luteotropin
• Follicle-stimulating hormone (FSH)
• Estradiol
• Progestin
• Testosterone

How are the sexual hormones affected by untreated sleep apnea? In particular, testosterone and FSH may be low, especially among men with severe sleep apnea. Importantly, can treatment with CPAP therapy help?

There have been a handful of research studies evaluating whether CPAP treatment of sleep apnea has an impact on testosterone and other sexual hormones. The data have been mixed, with some studies no significant changes after treatment, which others suggest some improvement in testosterone, FSH, and LH. 

Further research may be needed to clarify this relationship. Nevertheless, there does appear to a benefit to sexual function.

CPAP Improves Erectile Dysfunction

Erectile dysfunction (ED), or impotence, is a common condition among people with untreated sleep apnea. Low testosterone levels may contribute to this association.

One study of 207 men found the prevalence of ED was 60.6% overall, and 72.2% among those with severe OSA. This may reduce the occurrence of REM-related erections (sometimes called “morning wood”), and it may have other negative effects on sexual function.

CPAP seems to have a favorable effect on the ability to initiate and sustain an erection. Even when the testosterone levels were not noted to increase, the International Index of Erectile Dysfunction (IIEF-5) score improved in research. This questionnaire assesses numerous aspects of sexual health in men, including:

• Erectile function
• Intercourse satisfaction
• Orgasmic satisfaction
• Sexual desire
• Overall satisfaction with sex

Therefore, men in particular seem to benefit from CPAP therapy, especially when more severe sleep apnea is present at baseline.

Favorable Effects on Intimacy

Beyond these measured outcomes, there are several other considerations on the effects of treatment on intimacy. It may resolve loud, disruptive snoring. This may allow partners to again share a bed and bedroom.

This alone may increase the likelihood of intimacy and may allow more bonding time before sleep onset or after waking. This may have positive effects on the relationship, even beyond any perceived benefits to the sex life.

A Word From Verywell

If you are concerned about how sleep apnea or CPAP therapy may be affecting your sex life, consider evaluation and management by a board-certified sleep physician. Proper diagnosis and treatment may add spice to your sex life and restore a relationship’s more intimate moments.