Case Study: Sleep Apnea and Erections

“Effectively treating your sleep apnea will have the greatest impact of all on your overall health. And that includes your erections.”
— Steven Lamm, M.D.
Steven Lamm, M.D., has reported extensively on a variety of medical issues on television and radio. A great communicator, Dr. Lamm has been the long-time medical correspondent for The View (ABC-TV) because of his ability to talk to women about their important health issues, and the health issues of the men they love. As a practicing Manhattan internist for over twenty-five years, Dr. Lamm has provided medical care and compassion to thousands of patients. Dr. Lamm has published four books that have explored the intersection of medicine, science, and health.
I was pleasantly surprised when Rob, 55, came to see me last month. I had not seen him in two decades, ever since this genial man moved out of state to take on a new job several hundred miles away. Now he was back in Manhattan and he was at least 45 pounds heavier than my last notation in my medical records. Although he was now taking multiple diabetes medications and several blood pressure medications, the reason he came to see me was about his faltering erections. “After being divorced for six years, I remarried last year, and Marion is a much younger woman,” he confided. “But my erections are not reliable, and this is really becoming an issue.”

It was clear that while his erections were his greatest concern, they were the least of Rob’s medical problems.

In order to improve his erectile function, I had to first regain control of him medically. Yes, he had low testosterone, which impacted his sexual desire, which is not an uncommon problem for an older man. And yes, he had some vascular issues with his type 2 diabetes, but that was well controlled, as was his high blood pressure. But after going over his medical history, I was convinced that Rob also had sleep apnea.

His body mass index, or BMI, of 31 indicated obesity and a strong possibility for apnea. His collar size was 18, another apnea tipoff, and his admission that his loud snoring bothered his new wife, almost completed the sleep apnea diagnosis.

More importantly, however, not until a definitive sleep apnea diagnosis was made and treatment was started for this sleep-robbing ailment, would his diabetes and hypertension medications ever achieve their full efficacy. Furthermore, Rob’s very real risk for cardiovascular events and stroke would not be lowered until his sleep apnea was corrected.

With all of his other medical conditions being treated to reduce Rob’s heart and stroke risk, why ignore the sleep apnea, which poses a significant medical risk?
Sleep apnea creates an unhealthy and dangerous domino effect: Sleep apnea disrupts sleep and sexual relations. This creates fatigue, stress, and marital discord. People with sleep apnea are typically tired during the day, then tend to eat more and become less physically active, which then leads to a cascade of medical issues, including cardiovascular disorders, hypertension, obesity, insulin resistance, cognitive problems, and depression. This dangerous downhill medical direction has to be stopped and reversed because severe cases of sleep apnea can cause heart attack and stroke.
[leadTreatment All Starts with a Medical Diagnosis of Sleep Apnea[/lead] I took out a WatchPAT and explained what I wanted Rob to do. WatchPAT is an elegant and sophisticated testing device, but simple enough for any patient to use. After one night’s use, it would collect important data that would let me know if Rob had sleep apnea and how severe it was. The WatchPAT exam was covered by his health insurance policy, and he wouldn’t have to go to a hospital sleep laboratory to have the testing done. Instead, he would use the WatchPAT that night while he slept in his own bed.

The beauty of WatchPAT is that it is takes medical technology to the modern era. This unique testing device was not available until just recently, and it has married science and medicine in a way that no other at-home sleep testing device has ever come close to doing. In the past, patients suspected of having sleep apnea had to be referred to a sleep specialist who would conduct an overnight sleep test in a laboratory. The wait for an appointment, however, could typically stretch for weeks.

With WatchPAT, family doctors can now offer this specialized sleep apnea testing to their patients, with the overnight exam done in their own beds. Medical diagnosis doesn’t get any easier, and for a serious ailment such as sleep apnea that is woefully underdiagnosed, doctors can make inroads in getting more patients diagnosed and treated.

Rob was happy to hear about WatchPAT and its ease of use. His previous doctor had also suspected sleep apnea and had recommended a sleep lab test, but Rob, like countless other patients, balked at the notion of having to spend a night away from home. The fact that a doctor had already thought about sleep apnea and testing for Rob was a good sign, but it was obvious that the sleep lab testing was an issue that he was unable to overcome.

Rob returned his WatchPAT to me four days later. I downloaded the information into my computer and we reviewed the printout together. The report noted that the apnea was worse than even I had suspected. Rob had severe sleep apnea and significant episodes of oxygen desaturation. His Apnea-Hypopnea index (AHI), an indication of sleep apnea severity, was severe, meaning that he had as many as 40 interruptions in his breathing per hour for the seven hours that he slept with the WatchPAT in use.

When you have sleep apnea, you struggle to breathe throughout the night, waking briefly—hundreds of times in many cases—when your brain signals that it’s not getting enough oxygen. Imagine someone tapping you on your shoulder 40 times an hour as you slept. You’d wake just for an instant and then go back to sleep. But I can assure you that when your alarm went off in the morning, you would not feel rested when you went about your daily activities.

Daytime fatigue was an issue for Rob and is quite common with sleep apnea. He admitted that he often felt tired when he drove in to work from his suburban home, and one time he actually nodded off at the wheel, narrowly avoiding a collision with an oncoming vehicle.

Most sleep experts use a cutoff of 10 events or more per hour before considering sleep apnea therapy. With his sleep diagnosis now confirmed, I then explained the various options Rob could pursue. I reviewed the surgical approach, the dental approach using a special mouth guard, and the use of CPAP, a continuous positive airway pressure device. Armed with this information, as well as referrals to meet with local medical experts to review apnea treatment possibilities, Rob was ready for his next step.

Before he left, I wrote Rob a prescription for Viagra. “You originally came to me for your erection difficulties,” I reminded him. “And this medication will certainly help. But effectively treating your sleep apnea will have the greatest impact of all on your overall health. And that includes your erections.”