HEALTH
Sleep and sex drive: the overlooked connection
Short, broken or disordered sleep affects hormones, energy and erections. For many people it is the least glamorous and most overlooked part of a healthy sex life.
Sleep and sex drive are connected in more ways than most people realise. Much of a man's daily testosterone is released during sleep, a single week of five-hour nights has been shown to lower daytime testosterone in healthy young men, and sleep disorders such as obstructive sleep apnoea are linked to erection problems.1,2
Testosterone rises during sleep, and in lab studies that rise is tied to the first period of REM sleep of the night.
Cutting sleep to five hours a night for a week lowered daytime testosterone and vigour in healthy young men.
Obstructive sleep apnoea is linked to lower night-time testosterone and to a higher risk of erectile dysfunction.
Night shifts and shift work sleep disorder are associated with worse erectile function, independent of testosterone levels.
Alcohol helps you fall asleep but delays and reduces REM sleep, and disrupts the second half of the night.
For long-standing insomnia, the recommended first treatment is a structured talking therapy called CBT-I, not a sleeping pill.
How does sleep affect sex drive?
Sleep affects sex drive through hormones, energy and mood. Short or fragmented sleep lowers testosterone and saps vigour, and sleep disorders are linked to erection problems. Studies that track people night by night also find that more sleep is followed by more desire the next day.
There are three overlapping routes. The first is hormonal: testosterone production is closely tied to the sleep cycle, and cutting or breaking up sleep disturbs it. The second is energy and mood: when you are exhausted, libido tends to slide down the list, and chronic tiredness feeds irritability and low mood. The third is physical: disorders such as obstructive sleep apnoea affect blood oxygen and blood vessels, which matter for erections.
One of the few studies to follow sleep and desire day by day was carried out in women, and it is a useful reminder that sleep affects both people in a couple. Over 14 days, 171 women reported their sleep each morning. Longer sleep was followed by greater next-day desire, and each extra hour of sleep was linked to a 14% increase in the odds of partnered sexual activity.3 If you and your partner are both running on empty, it is worth treating sleep as a shared project rather than a private problem.
How does sleep affect testosterone?
Testosterone climbs during sleep, and the rise appears to be linked to the first REM period of the night. When sleep is cut short or repeatedly broken, that rise is delayed or blunted, and daytime testosterone can fall within a week.
In a laboratory study at the University of Chicago, ten healthy men in their mid-twenties spent three nights with ten hours in bed, then eight nights restricted to five hours. Their total sleep dropped from nearly nine hours to under five, with about an hour of REM sleep lost each night. After a week, daytime testosterone averaged 16.5 nmol/L compared with 18.4 nmol/L when rested, a fall of roughly 10%, and the gap was widest in the afternoon and evening. Their self-rated vigour dropped steadily over the week.1
Why REM sleep seems to matter
Researchers in Israel measured testosterone every 20 minutes overnight while recording sleep. In earlier work they had found that the night-time rise in testosterone began about 90 minutes before the first REM period. When they broke sleep into repeated short naps, the rise was delayed by several hours, and it appeared only in the men who still managed to reach REM sleep.4
“Our findings indicate that the sleep-related rise in serum testosterone levels is linked with the appearance of first REM sleep.”
The link holds in older men too. In a study of twelve healthy men aged 64 to 74, the amount of night-time sleep measured in a sleep laboratory independently predicted their morning total and free testosterone.5 It was a small study, but it fits the idea that some of the variation in testosterone among older men reflects how well they sleep. Our guide to how testosterone changes after 40 covers the other factors.
Study
Who
Sleep change
What happened
Leproult & Van Cauter, 2011
10 healthy men, average age 24
Five-hour nights for a week
Daytime testosterone about 10% lower
Luboshitzky et al., 2001
10 healthy men
Sleep broken into short naps
Night-time testosterone rise delayed
Penev, 2007
12 healthy men aged 64-74
Natural variation in sleep
Less sleep, lower morning testosterone
Luboshitzky et al., 2002
10 men with sleep apnoea, 5 controls
Untreated sleep apnoea
Lower night-time LH and testosterone
Can sleep apnoea lower testosterone and cause erectile dysfunction?
Sleep apnoea is linked to both. Men with obstructive sleep apnoea release less testosterone overnight and have a higher risk of erectile dysfunction. Treating the apnoea with CPAP matters for health, but on its own it has not been shown to reliably raise testosterone or fix erections.
In obstructive sleep apnoea, the airway repeatedly narrows or closes during sleep, briefly lowering oxygen and jolting you towards waking, often without you knowing. Researchers noted that low libido is frequently reported by men with the condition. When they sampled blood through the night, men with sleep apnoea secreted significantly less luteinising hormone and testosterone than men without it, and four of ten had hypogonadal morning levels. The more severe the breathing disturbance, the lower the output, which the authors suggested may be driven mainly by fragmented sleep, along with lower oxygen, obesity and ageing.6
A meta-analysis of observational studies concluded that sleep apnoea is associated with a higher risk of erectile dysfunction, though the authors called for better long-term studies.2
Does CPAP help?
CPAP, a mask that keeps the airway open with gentle air pressure, is the standard treatment for moderate to severe sleep apnoea. A meta-analysis of 12 studies involving 388 men found no significant change in total testosterone with CPAP use.7 A Cochrane review of six small randomised trials was uncertain whether CPAP improves erectile function, and found some evidence that sildenafil, one of the PDE5 inhibitors, may improve it slightly more than CPAP over 12 weeks.8 That does not make CPAP pointless: untreated sleep apnoea carries wider health risks, and treating it well is the foundation for everything else.
It also matters for anyone considering testosterone therapy. The Endocrine Society advises against starting testosterone therapy in men with untreated severe obstructive sleep apnoea.9
Quick self-check: could your sleep be affecting your sex drive?
I often get far less sleep than I need on work nights.
My partner says I snore loudly or sometimes stop breathing in my sleep.
I wake up unrefreshed or with a headache, even after a full night.
I regularly doze off during the day, for example watching TV or as a passenger.
I work nights or rotating shifts and struggle to sleep on my days off.
I usually have a few drinks in the evening to help me unwind or sleep.
I have had trouble falling or staying asleep most nights for months.
Tap the statements that apply to you.
If several of these apply, sleep may be playing a bigger part in your sex drive than you think. Loud snoring with pauses in breathing, or heavy daytime sleepiness, is worth raising with your GP. The sexual health check can help you pull the rest together.
Does shift work affect erections and sex drive?
It can. In men attending an andrology clinic, those with shift work sleep disorder had worse erectile function, and men on night shifts fared worst. Shift work on its own, without sleep problems, was not linked to worse scores.
The study included 754 men, of whom 204 worked non-standard shifts and 48 screened positive for shift work sleep disorder. Men with the disorder scored 2.8 points lower on the erectile function domain of a standard questionnaire, and night-shift workers scored 7.6 points lower than men working days or evenings. Baseline testosterone was not associated with worse erectile function in this group, which suggests disrupted body-clock timing may affect erections through routes other than hormones.10
If you work shifts, the practical goal is protecting a consistent main sleep: a dark, cool, quiet room, blackout blinds for daytime sleep, and the same routine as far as your rota allows. If you are struggling, tell your GP that shift work is part of the picture, because it changes the advice.
Myth or fact?
Myth: Most testosterone is made during REM sleep.
Fact: The night-time rise appears to be linked to the onset of the first REM period rather than spread evenly through REM. Breaking sleep up delayed the rise, especially in men who reached no REM.4
Myth: A nightcap helps you sleep, so it can only help your sex life.
Fact: Alcohol shortens the time to fall asleep but delays the first REM period and disrupts the second half of the night.11
Myth: CPAP will fix low testosterone caused by sleep apnoea.
Fact: A meta-analysis of 12 studies found no significant change in total testosterone with CPAP.7 It is still important for your overall health.
Myth: Losing a bit of sleep only makes you tired.
Fact: In young men, a week of five-hour nights lowered daytime testosterone by about a tenth and reduced vigour.1
Does alcohol before bed affect sleep and sex drive?
Alcohol helps many people nod off, but it disrupts the rest of the night. At all doses studied, it delayed the first REM period, and at moderate and high doses it reduced REM sleep overall, which is not what you want if your hormones depend on sleep.
A review of all known studies of alcohol and sleep in healthy volunteers found that alcohol consistently shortens the time it takes to fall asleep and consolidates the first half of the night, then increases disruption in the second half. The onset of the first REM period was delayed at all doses, and total REM sleep was reduced at moderate and high doses.11
No study we have found has directly tested whether evening drinking lowers testosterone by delaying REM. But given the REM link described above, it is reasonable to see regular drinks before bed as working against the sleep your hormones rely on.
How can you improve sleep to help your sex drive?
Protect a regular sleep window, cut back on evening alcohol, and get snoring or breathing pauses checked. If you have had insomnia for months, ask about cognitive behavioural therapy for insomnia (CBT-I), which guidelines recommend as the first treatment.
Keep regular hours. Going to bed and getting up at similar times, including at weekends, supports your body clock.
Give yourself enough time in bed. The Chicago study restricted men to five hours in bed, and their testosterone fell within a week.1
Move alcohol earlier or drop it. Evening drinks delay REM sleep and disrupt the second half of the night.11
Take snoring seriously. Loud snoring with gasps or pauses can be a sign of sleep apnoea, which is linked to lower testosterone and erection problems.6,2
Treat insomnia properly. The American College of Physicians recommends CBT-I as the initial treatment for chronic insomnia in adults, with medication considered, through shared decision-making, if CBT-I alone has not worked.12
Look at stress too. Worry keeps people awake and dampens desire, which is why stress and libido are so often tangled together.
When to see a doctor
See your GP if you or your partner notice loud snoring with pauses in breathing, choking or gasping at night, or if you are so sleepy during the day that you nod off unintentionally. These can be signs of obstructive sleep apnoea, which is diagnosed with a sleep study.
Also see a GP if insomnia has lasted for months, if low desire or erection problems persist after you have improved your sleep, or if you notice fewer morning erections alongside other changes. If you drive for work and feel dangerously sleepy, do not wait.
Should you look at sleep before testing your testosterone?
It makes sense to look at sleep early, because it is cheap, low risk and affects testosterone within days. That does not mean waiting indefinitely: if you have clear symptoms such as low desire plus fewer morning erections, a morning blood test is reasonable alongside sleep changes.
Poor sleep can push testosterone down, and it can also make you feel exactly the way low testosterone is said to feel: tired, flat and uninterested. The Chicago study showed vigour falling alongside testosterone as sleep was restricted.1 If your blood test is taken after weeks of short nights, the result may reflect your sleep as much as your underlying hormone function.
Whatever else you are considering, whether that is a blood test, a medicine or a supplement, it helps to know what your sleep looks like first. If your testosterone turns out to be normal, our guide to how testosterone affects sex drive explains why desire often depends on sleep, stress and mood more than on a few extra points of testosterone.
Frequently asked questions
Can lack of sleep cause low libido?
How quickly does poor sleep affect testosterone?
Quickly. In healthy young men, daytime testosterone was lower after just one week of five-hour nights.1 How quickly better sleep reverses the effect has been studied much less.
Does sleep apnoea cause erectile dysfunction?
Sleep apnoea is associated with a higher risk of erectile dysfunction in observational studies.2 It has not been proven to be the direct cause in every case, and other shared factors such as weight and blood vessel health also play a part.
Will CPAP improve my sex drive?
Is it better to have sex at night or in the morning?
There is no right answer; it depends on what suits you and your partner. If tiredness keeps getting in the way at night, some couples simply find mornings or weekends easier.
Does working night shifts affect erections?
In one clinic study, men with shift work sleep disorder had lower erectile function scores, and night-shift workers had the lowest scores of all.10 Protecting your main sleep period is the most practical starting point.
[1] Leproult R, et al. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA. 2011;305(21):2173-4. PubMed
[2] Kellesarian SV, et al. Association between obstructive sleep apnea and erectile dysfunction: a systematic review and meta-analysis. Int J Impot Res. 2018;30(3):129-140. PubMed
[3] Kalmbach DA, et al. The impact of sleep on female sexual response and behavior: a pilot study. J Sex Med. 2015;12(5):1221-32. PubMed
[4] Luboshitzky R, et al. Disruption of the nocturnal testosterone rhythm by sleep fragmentation in normal men. J Clin Endocrinol Metab. 2001;86(3):1134-9. PubMed
[5] Penev PD. Association between sleep and morning testosterone levels in older men. Sleep. 2007;30(4):427-32. PubMed
[6] Luboshitzky R, et al. Decreased pituitary-gonadal secretion in men with obstructive sleep apnea. J Clin Endocrinol Metab. 2002;87(7):3394-8. PubMed
[7] Cignarelli A, et al. Effects of CPAP on Testosterone Levels in Patients With Obstructive Sleep Apnea: A Meta-Analysis Study. Front Endocrinol (Lausanne). 2019;10:551. PubMed
[8] Barbosa FT, et al. Non-invasive positive airway pressure therapy for improving erectile dysfunction in men with obstructive sleep apnoea. Cochrane Database Syst Rev. 2021;9(9):CD013169. PubMed
[9] Bhasin S, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. PubMed
[10] Rodriguez KM, et al. Shift Work Sleep Disorder and Night Shift Work Significantly Impair Erectile Function. J Sex Med. 2020;17(9):1687-1693. PubMed
[11] Ebrahim IO, et al. Alcohol and sleep I: effects on normal sleep. Alcohol Clin Exp Res. 2013;37(4):539-49. PubMed
[12] Qaseem A, et al. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2016;165(2):125-33. PubMed
Eric Stephens
Eric Stephens writes and edits every guide on Load Boosting. He reads and summarises peer-reviewed research and major medical-society guidance on men’s health, and links to every source.