Erectile dysfunction, diabetes and sleep disorders: A troubling combination

An erection results from a temporary influx of blood into the corpus cavernosum, swelling the penis. This influx requires that the blood supply be sufficient and that its evacuation from the penis be slowed down. These mechanisms are controlled by the vascular system, the nervous system and testosterone levels.(3)
All it takes is for an external cause to interfere with any of these systems to cause erectile dysfunction. These risk factors(4) are relatively numerous:

• Heart disease, atherosclerosis, high cholesterol or hypertension
• Diabetes, obesity or metabolic syndrome
• Parkinson’s disease or multiple sclerosis
• Smoking, alcoholism or the use of certain medications or drugs
• Sleep disorders
• Prostate surgery or pelvic surgery or injury
• Peyronie’s disease (condition causing a curvature of the penis)
• Low testosterone
• Stress, depression, anxiety or other mental disorders
• Embarrassment and low self-esteem
• Unsatisfactory sex life
• Relationship or procreation problems

Each of these factors alone is enough to cause erectile dysfunction. But when two or three of them occur at the same time, the prognosis is rather bleak. This is particularly the case when an individual suffers from diabetes or a sleep disorder. To find out more, refer to the section entitled “How sleep disorders and diabetes promote erectile dysfunction.”

If there are various risk factors behind reduced sexual vigour, how can the main culprits be identified?

The first step is to analyze the symptoms experienced by the patient (sometimes in the form of an online questionnaire) and conduct a physical examination of the penis and surrounding organs, such as the prostate. The attending physician may also request blood tests, including an assay for testosterone and other markers (diabetes, lipids, thyroid function, etc.). A Doppler ultrasound to assess blood flow in the penis during a drug-induced erection may also be performed. In addition, a psychological evaluation is often necessary, especially when no physical cause can be identified.

Once it is known why a patient is suffering from erectile dysfunction, treatment can begin.

The doctor will first try to resolve the health problem(s) that may be the cause. If diabetes is an issue, the patient’s blood sugar and dyslipidemia will need to be controlled, either with oral medication or insulin injections. If the patient has a sleep disorder, the doctor can suggest various options, including the use of a continuous positive airway pressure (CPAP) machine.

Very often, erections are restored using oral medications such as sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra), which help relax blood vessels and increase blood flow to the penis. However, contrary to popular belief, these medications are not aphrodisiacs. They help maintain erections, not create them.

Making it easier to attain an erection is all well and good, but not at any price. Doctors and pharmacists are typically on the lookout for the many side effects of these drugs: flushing, nasal congestion, headaches, blurred vision, backaches and digestive problems. They must ensure that the necessary precautions are taken for individuals suffering from hypotension or heart disease or for those taking nitrates (for angina).

Fortunately, in cases of absolute contraindication, there are other solutions. For example, they can receive alprostadil, either through self-injection (Caverject®) or urethral suppositories (MUSE®). They could also use a vacuum pump or resort to surgery to compensate for insufficient blood flow to the penis.

Regrettably, sleep disorders, diabetes and erectile dysfunction go hand in hand. These pernicious factors have a damaging effect on the physical and mental health of many men.

Obstructive sleep apnea and diabetes

The link between sleep disorders and diabetes has been known for many years. Nearly half of all people with type 2 diabetes also suffer from obstructive sleep apnea (OSA). This proportion rises to 86% in type 2 diabetics who are obese.(7)

Although the link between the two pathologies has not yet been fully established, there is no doubt that they are related. The momentary drop in oxygen levels repeatedly during the night can cause hypertension and alter the response to the effects of insulin (insulin resistance), factors closely associated with diabetes.(8)

Diabetes and erectile dysfunction

Intermittent or permanent erectile dysfunction affects 34%-45% of men with diabetes and almost half of those who have had type 2 diabetes for more than six years.(5) Erectile dysfunction occurs earlier in diabetic men and may even be the first symptom of the disease.(4)

Diabetes impedes the ability to attain a satisfying erection in several ways: * It hardens the arteries and compromises the efficient circulation of blood in the corpus cavernosum of the penis. * It raises blood glucose levels, narrowing the vessels that supply the nerves. As a result, their function is diminished, potentially leading to erectile dysfunction. * It lowers testosterone levels, which are closely linked to libido * It reduces the number of immune cells capable of fighting infections, especially painful penile yeast infections, which make attaining an erection difficult.

Diabetes Canada estimates that 29% of the Canadian population is diabetic or pre-diabetic. The number of cases of diabetes is rising steadily, mainly due to the increase in obesity. In light of such data, it can therefore be assumed that the number of cases of erectile dysfunction associated with diabetes will increase over the next few years.(6)

Obstructive sleep apnea and erectile dysfunction

Several studies have demonstrated that, even without diabetes, the poorer the sleep quality, the more frequent the erectile dysfunction problems. Testosterone levels tend to be lower in people with OSA,(9) which is not conducive to the development of an erection.

The very first step in regaining a satisfying quality of life and a fulfilling sex life is to obtain an accurate diagnosis. A health care professional can help you do just that.

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