Testosterone is a hormone. It shapes man’s physical traits and drives their sexual desires and penile erection.  Women also make testosterone but in smaller quantities; it is also linked to their sexual drive. Testosterone is responsible for increased muscle mass and good strong bones for men and women. Testosterone declines with age.

What is the relationship between sleep and testosterone? Testosterone levels rise when you sleep. It declines during waking hours. The highest levels of testosterone occur during a sleep stage known as REM sleep. We spend about 25% of our sleeping hours in REM sleep. Of note, it is also the stage we do most of our dreaming. Sleep problems and disorders such as sleep apnea disrupt the normal flow and quantity of REM stage. This eventually leads to lower testosterone levels. This decline affects men and women with sleep problems.

Sleep apnea is linked with lower testosterone levels. Men with sleep apnea are also more likely to suffer from erectile dysfunction and low libido. Sleep apnea refers to intermittent closure of the upper airway that allows you to breathe, causing snoring, sleep disruption and cuts down on the blood oxygen. A 2003 study from Italy (Journal of Endorinological Investigation) showed that the drop in oxygen levels seen with sleep apnea contribute to reduced testosterone levels. On a hopeful note, a recent study published in the Journal of Sexual Medicine in October 2012 showed that long-term CPAP therapy improved or preserved sexual function in men with obstructive sleep apnea. Therefore, if you suffer from sleep apnea or you suspect you have it, it is crucial to seek help and treat it.

Women tend to be more vulnerable to sleep problems partly because of hormonal fluctuations throughout their lives. In a study published in Sleep in 2008, women with the lowest total testosterone levels were more likely to wake up after they fell asleep than women with the highest testosterone levels.

Women with severe sleep apnea in the pre- and post-menopausal group were found to have significantly lower sexual dysfunction scores compared with the not-severe sleep apnea group, and that progesterone (rather than testosterone) might play a role in this association. This study was published in the International Journal of Impotence Research in 2012. For women, a study in Sleep and Breath in 2010 made the following recommendation: “the prevalence of sexual dysfunction is high among women with OSA [sleep apnea]. Physicians should routinely screen and evaluate women with OSA for sexual dysfunction.”


  • If you suffer from decreased libido or erectile problems, please talk to your doctor. But specifically bring up the issue of sleep. If you snore, have pauses in breathing or suffer from daytime sleepiness or disrupted sleep, you need to rule out sleep apnea or other types of sleep problems.
  • Make sure to make sleep a priority in life. Get enough sleep. Get a good night sleep.
  • You might need to see a doctor such as a urologist or endocrinologist if your testosterone is low.