Does sleep apnea cause low testosterone?
Sleep apnea, particularly obstructive sleep apnea (OSA), affects millions, causing disrupted breathing during sleep and leaving many feeling drained [1].
For men, this condition often sparks concerns about more than just fatigue—it raises questions about testosterone, a key hormone tied to energy, mood, and vitality.
Low testosterone can lead to reduced libido, low energy, and even mood changes, making it a pressing worry for many [4].
Could there be a connection between sleep apnea and testosterone levels? This article explores how these two issues might be intertwined, shedding light on their impact and what it means for men’s health.
Before exploring further, please read the disclaimer located at the end of this webpage.
Key Takeaways
- OSA affects 24M US adults, disrupting REM sleep & testosterone [8].
- Low testosterone worsens sleep, energy & mood in men [6].
- Higher AHI in OSA links to lower testosterone levels [8].
- Weight loss & CPAP may improve sleep & hormone balance [5].
- TRT with CPAP can boost vitality but needs caution [2].
What Is Sleep Apnea?
Sleep apnea, specifically obstructive sleep apnea (OSA), is a common condition where breathing repeatedly stops and starts during sleep due to a blocked or narrowed airway [2,4].
This disruption can lower oxygen levels in the blood and fragment sleep, leaving individuals feeling unrested.
In the United States, it’s estimated that about 24 million adults may have undiagnosed OSA, with higher rates among men, older adults, and those with obesity [1].
The blockage happens when the muscles in the throat relax too much, causing the airway to collapse or become obstructed [8]. This can lead to snoring or brief pauses in breathing.
Beyond physical airway changes, factors like testosterone may influence how the brain responds to low oxygen or high carbon dioxide levels, potentially worsening sleep quality [4,8].
Typical Symptoms of OSA:
- Loud snoring: Caused by vibrations in the upper airway due to narrowed passages [1].
- Pauses in breathing: Brief moments of stopped breathing, lasting 10–40 seconds, despite efforts to breathe [1].
- Daytime fatigue: Feeling excessively tired during the day, even without obvious sleepiness [2].
- High blood pressure: Linked to OSA, increasing risks for heart health [2].
OSA significantly impacts sleep quality, particularly by reducing time spent in deep sleep and REM (rapid eye movement) sleep, which are crucial for feeling refreshed [4,1].
REM sleep, which occurs in cycles every 90 minutes, is when testosterone levels typically peak. Disrupted sleep can delay or limit these peaks, potentially affecting energy and overall health [4].
Research, such as the large-scale Barrett-Connor study involving over 1,300 men aged 65 and older found that lower testosterone levels were linked with poorer sleep quality, more nighttime awakenings, less deep sleep, and more time spent with low oxygen levels during sleep.
Interestingly, when adjusting for factors like body mass index (BMI) or waist size, the link between OSA and low testosterone weakened, suggesting that obesity may be a key contributor [6].
Understanding sleep apnea's effects on the body is crucial before examining its relationship with testosterone levels, which we will explore next.
Does sleep apnea cause low testosterone?
Sleep plays an important role in keeping your hormones balanced — including testosterone, the hormone linked to energy, mood, and sex drive.
When you sleep, your body cycles through two main stages: non-REM (NREM) and REM (rapid eye movement) sleep. Each cycle lasts around 90 minutes [3].
During REM sleep, your testosterone levels rise — especially during the first REM phase — and stay high as long as your sleep isn’t interrupted [3,1]. This boost depends more on sleep itself than your internal body clock (also known as the circadian rhythm) [3].
But when someone has obstructive sleep apnea (OSA), this process gets disrupted. OSA causes repeated pauses in breathing during sleep, which leads to low oxygen levels and broken sleep [5].
This means less time in REM and deep sleep — the most important parts for hormone production — and that messes with the body’s natural testosterone rhythm [8].
As a result, testosterone levels often drop at night, which can lead to hypogonadism — a condition where the body doesn’t make enough testosterone [4].
OSA also impacts the body’s hormone system, especially something called the hypothalamic-pituitary-gonadal (HPG) axis — a system that controls how much testosterone the testicles make [5].
Studies have found that the worse someone’s OSA is — measured by things like the Apnea-Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), and lowest oxygen level during sleep — the lower their testosterone tends to be [8].
Tančić-Gajić's study in 2021 with 104 obese men found that those with higher AHI and ODI had lower levels of both total and free testosterone, even when age and body weight were taken into account. This study helps show the link between sleep apnea and testosterone drop [11].
Having low testosterone can lead to low sex drive, tiredness, mood changes, and even muscle loss [3,4]. Things like obesity and aging can make this worse.
For example, belly fat can turn testosterone into estrogen (estradiol), lowering testosterone even more. And after age 30, testosterone levels naturally start to go down [4,1].
What’s interesting is that this relationship goes both ways — not only can sleep apnea lower testosterone, but low testosterone may also affect your sleep. We’ll look into that next.
Low Testosterone Disrupts Sleep
Testosterone plays a key role in supporting the body’s natural rhythms, including the circadian rhythm that guides sleep and wake cycles [1].
When testosterone levels drop, it can throw off this balance, making it harder to fall asleep, stay asleep, or feel rested. Low testosterone is linked to poorer sleep quality, especially in older men.
A study of men aged 65 and older found that lower testosterone levels were associated with less efficient sleep, more frequent nighttime awakenings, and reduced time in deep sleep, also known as slow-wave sleep (SWS) [6].
In men with obstructive sleep apnea (OSA), low testosterone can worsen daytime fatigue. Research shows that testosterone levels are the only independent factor tied to physical exhaustion and reduced activity in those with OSA [2].
This means that lower testosterone doesn’t just affect energy—it can make everyday tasks feel more draining.
This creates a vicious cycle: poor sleep from OSA can lower testosterone, and low testosterone can further disrupt sleep, leading to more sleep fragmentation and less time in REM and deep sleep [1].
Factors like obesity and aging can intensify this cycle, as both are linked to reduced testosterone and poorer sleep quality [6]. This two-way relationship highlights the complex interplay between hormones and rest, setting the stage for exploring ways to break this cycle in the next section.
How to Break the Vicious Cycle of Sleep Apnea and Hormone Deficiency
The interplay between obstructive sleep apnea (OSA) and low testosterone creates a challenging cycle where poor sleep reduces testosterone, and low testosterone further disrupts sleep.
Addressing both issues together can improve sleep quality, hormone balance, and overall well-being. Several approaches show potential in supporting better sleep and hormone health, as shared through research and real-life experiences [8].
Approaches to Support Sleep Apnea:
- Weight Loss: Shedding excess weight can significantly ease OSA symptoms, as obesity is a major contributor. Research shows that losing weight has a direct link to higher testosterone levels in men with obesity, with improvements tied to the amount of weight lost [1]. Even modest reductions in body fat can enhance breathing during sleep and boost energy.
- Mandibular Advancement Devices (MAD): These oral devices gently reposition the jaw to keep airways open, offering a practical option for milder cases of OSA [7]. They can support better sleep quality by reducing airway blockages.
- CPAP Therapy: Continuous Positive Airway Pressure (CPAP) machines deliver steady airflow to keep airways open during sleep. Studies suggest CPAP can improve daytime energy, reduce fatigue, and enhance quality of life for those with moderate to severe OSA [7]. While CPAP may not always directly increase testosterone, it supports better sleep, which is crucial for hormone regulation [5]. A 2020 meta-analysis found CPAP has a neutral effect on testosterone but still holds potential for improving sleep-related symptoms [5].
Approaches to Support Testosterone Levels:
- Testosterone Replacement Therapy (TRT): TRT, available as injections, gels, patches, or sprays, can help address symptoms of low testosterone, such as low energy, reduced libido, and mood changes [4]. However, caution is needed, as TRT may worsen OSA in some cases, especially if OSA is severe and untreated [8]. Combining TRT with CPAP has shown promise in improving energy and vitality in men with both OSA and low testosterone [2].
A Reddit user shared their experience, noting that starting TRT with untreated OSA worsened their symptoms (AHI spiked to 44–104), but switching to daily low-dose injections (8mg) alongside CPAP therapy dropped their AHI below 1 and improved energy and sleep quality.*
They also mentioned adding pregnenolone to support restful sleep, highlighting the importance of personalized approaches.*
Combining Approaches for Better Results:Combining weight loss, CPAP, and, where appropriate, TRT can break the cycle of poor sleep and low testosterone. For example, a study showed that men using CPAP alongside TRT saw significant improvements in energy and vitality after three months [2].
Simple lifestyle changes, like improving sleep hygiene or trying breathing exercises (e.g., alternate nostril breathing, as suggested by Dr. Adam Fields), may also support better oxygen flow and relaxation, potentially easing OSA symptoms YouTube: Dr. Adam Fields.
These steps, though not a treatment, offer potential to improve both sleep and hormone health, paving the way for a healthier, more energized life.
Conclusion
Obstructive sleep apnea (OSA) and low testosterone are closely interconnected, forming a difficult cycle: poor sleep disrupts hormone balance, while low testosterone can further impair sleep quality.
OSA interferes with REM and deep sleep stages, reducing testosterone production — a problem made worse by factors like obesity and aging [1,8].
Fortunately, approaches such as weight loss, CPAP therapy, and in some cases, testosterone replacement therapy (TRT) have shown promise in improving sleep quality, energy levels, and overall well-being [2,5].
Real-life experiences shared online highlight how personalized strategies can lead to meaningful improvements.
By targeting both sleep quality and hormone health, individuals may discover a clearer path to better rest and greater vitality.
Curious how small lifestyle changes could boost your sleep and energy? Exploring these options with a healthcare professional might be your next step toward feeling your best.
Testimonial Disclaimer
*The testimonials presented on this website are provided by individuals based on their personal experiences with our products. These testimonials represent individual opinions and experiences, which may not be typical or applicable to all users of our products. Results may vary depending on a variety of factors, including individual health, lifestyle, and adherence to product usage instructions.References
- [1] Wittert, Gary. “The Relationship between Sleep Disorders and Testosterone in Men.” Asian Journal of Andrology, vol. 16, no. 2, 2014, p. 262, https://doi.org/10.4103/1008-682x.122586.
- [2] Burschtin, Omar, and Jing Wang. “Testosterone Deficiency and Sleep Apnea.” Sleep Medicine Clinics, vol. 11, no. 4, Dec. 2016, pp. 525–529, https://doi.org/10.1016/j.jsmc.2016.08.003.
- [3] Andersen, Monica Levy, and Sergio Tufik. “The Effects of Testosterone on Sleep and Sleep-Disordered Breathing in Men: Its Bidirectional Interaction with Erectile Function.” Sleep Medicine Reviews, vol. 12, no. 5, Oct. 2008, pp. 365–379, https://doi.org/10.1016/j.smrv.2007.12.003. Accessed 25 July 2019.
- [4] “Obstructive Sleep Apnea and Testosterone Therapy.” Sexual Medicine Reviews, vol. 9, no. 2, 1 Apr. 2021, pp. 296–303, https://doi.org/10.1016/j.sxmr.2020.04.004. Accessed 18 Dec. 2023.
- [5] Tančić-Gajić, Milina, et al. “Obstructive Sleep Apnea Is Associated with Low Testosterone Levels in Severely Obese Men.” Frontiers in Endocrinology, vol. 12, 26 July 2021, https://doi.org/10.3389/fendo.2021.622496. Accessed 30 May 2022.
- [6] Barrett-Connor, Elizabeth, et al. “The Association of Testosterone Levels with Overall Sleep Quality, Sleep Architecture, and Sleep-Disordered Breathing.” The Journal of Clinical Endocrinology and Metabolism, vol. 93, no. 7, 1 July 2008, pp. 2602–2609, https://doi.org/10.1210/jc.2007-2622. Accessed 20 Apr. 2021.
- [7] Cignarelli, Angelo, et al. “Effects of CPAP on Testosterone Levels in Patients with Obstructive Sleep Apnea: A Meta-Analysis Study.” Frontiers in Endocrinology, vol. 10, 21 Aug. 2019, https://doi.org/10.3389/fendo.2019.00551. Accessed 20 May 2022.
- [8] Kim, Sung-Dong, and Kyu-Sup Cho. “Obstructive Sleep Apnea and Testosterone Deficiency.” The World Journal of Men’s Health, vol. 37, no. 1, 2019, p. 12, https://doi.org/10.5534/wjmh.180017. Accessed 16 Nov. 2019.
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