This podcast is for you, the Modern Man. I'm Dr Anne

Truong, your host. I'm an intimate health medical doctor

and best selling author of the book, Erectile Dysfunction Fix.

I'll do a deep dive into sexual health and performance and how

it affects men of all ages and backgrounds. So let's get

started, and be sure to visit my website at

sexualhealthformenpodcast.com for more information and

resources from the show. See you on the inside.

Hello there, Modern Man. In today's episode, we're dive deep

into sleep, and you know that is one of the four pillars of

having good sexual health. And today I have a special guest, Dr

Ram Verma from Indiana. He is a sleep specialist doctor, is also

a TEDx speaker. But today we're going to talk about, why should

you care about sleep, and how does it affect your ED, and the

things that you need to know now to prevent your ED from getting

worse. So welcome, Dr Verma.

Yeah, thank you. Thank you for having me.

All right, so let's dive into this. So let's just

talk about why should men care about sleep, and how does it

that relate to their erection?

Yeah, so sleep is very important for the erection

and ED. Sleep problem start first and then ED might come

later on. So try to check your sleep. If you are having

snoring, breathing pauses, having low oxygen when you

sleep, and your sleep is getting broken, so that disturb the

activity of the brain gland to secrete hormone. If sleep is

broken, those system get broken.

Okay, so let's just kind of break it up right here.

So how does sleep affect their sexual function? You mentioned

that sleep is broken and it affect their hormone. How does

that happen? What happened to the body that caused that?

So during sleep, like you know, people require to have

certain amount of deep sleep, REM sleep. So during the deep

sleep, the pituitary gland and some other like gland in the

body, they secrete hormone. But if someone has sleep apnea or

some sleep problem waking up so many times, they are not able to

maintain the rhythm of continuous deep sleep for

certain period of time to produce those hormones. So when

the sleep is broken, that system get broken. And when the glands

are not able to secrete the hormones, so the hormones level

get disturbed and that affect the ED.

Okay, so let's talk a little bit about sleep apnea.

What is it?

So sleep apnea is a condition in which people snore

and get breathing pauses during the night when they are

sleeping. And when the breathing pauses happen, their oxygen

level goes low. So when person is sleeping and in certain

stage, like deep sleep or REM sleep, and the oxygen level goes

low, then the brain get arousals. And in those moments

of arousal, the sleep get broken, and when it is broken,

then that affect the ability of body to produce those hormone at

certain level.

Okay, so how does the person know that they have

sleep apnea? Because when you're asleep, you're asleep, you don't

really know. So what are some of the things that they may notice

that, Hey, maybe I have sleep apnea. Because I know that,

well, let's backtrack that how common is sleep apnea in men?

So sleep apnea is very common in men, maybe 10% to

25% of men, they tend to have sleep apnea. Most of them are

undiagnosed. And the symptoms are like snoring, getting

breathing pauses when sleeping, stopping breathing, and frequent

awakening during the night, going to bathroom multiple time

during the night, and when waking up feeling tired.

Sometimes they feel more tired even they before going to bed.

And during the daytime, they are having difficulty staying awake

at work, focusing on their work, or when they are driving, they

feel sleepy. So those are some symptoms of sleep apnea.

Gotcha. And how long does it have to go on until

they start feeling those symptoms?

Like it takes, like, few years. So this problem

getting ignored, people are not aware about it, and that's why,

like no getting ignored, and then they develop those things.

And they develop like other other health condition, like

high blood pressure, diabetes, ED and some other like dementia,

depression, anxiety, headache, all those other other conditions

comes on later on.

Okay, so how does sleep apnea cause ED?

So sleep apnea causes breathing pauses in you know,

when they are sleeping and it disturb the quality of sleep.

And it fragments the sleep. People are not able to maintain

deep sleep or REM sleep, so their hormone level goes low.

And the other thing is also when they are sleeping, having

undiagnosed or untreated sleep apnea, so that also affects the

body's ability to heal during the sleep, and they are feeling

tired. So when they are not having energy and not having

enough hormones, that's how it affects their sexual health.

Gotcha, that's the connection there, it's really

the hormone. So it's affecting testosterone. It doesn't

necessarily affect blood flow, it just really testosterone more

of a hormonal impact?

Yeah. So there has been studies done. So it affects

hormone level, but it also affects some dysfunction in the

circulation system also. Their endothelial system, and other

other other things get also disturbed. So those are on

chemical level and inflammation in the circulation, in the vein

and arteries. So those also affect so. So that's how it

affects sexual health as well.

Gotcha. Okay, so sleep apnea is presented if

you're if you're sleeping, if you're tired, that's one of the

main symptoms, right? And what are the risk factor that

predispose somebody to have sleep apnea?

Obesity is one and second is as like you know,

people age, these muscles become more floppy, more relaxed. So as

we age, it become more common. And also, some people have

narrow airway passes, so they inherit from the parents, if

their passes is narrow on the back of the throat, that make

them prone to have sleep apnea as well.

Okay, but is it preventable?

So it is a preventable in your sense that

if that is like the morphology they have, they cannot change

that one. But in terms of like, you know, they can control their

weight, that can help. They can sleep on the side, to some

extent, that can reduce the snoring and chances of sleep

apnea. But if someone like having symptoms, I suggest them

to, like, get it checked. And nowadays, very easy, like home

test can be done. And there are some device, some tracker comes

also, ring, smart watch. They can also give some idea if

someone is at risk of sleep apnea.

But you're saying it affects about 15% of men or

so. But if they feel tired, you, we know that a lot of things can

cause tiredness because it's hard for somebody to know. Do I

snore? Well, most people know I snore. Yeah, most people snore.

Unless you're sleeping with somebody, they're telling them

that you have pauses in your breathing while you're sleeping.

So should all men get a sleep study test? Because you

mentioned that you can get a sleep studies test at home now,

which I actually have one that I'm about to do for my husband

and for me for the sleep apnea test. So you think you have

sleep apnea, you can go to the doctor and get the sleep apnea

test either at home or in their office. So should everyone be

for all men be tested for this?

We don't recommend all men, but men like over 40,

and if they are having some fatigue, they are thinking their

quality of sleep is not good, feeling non restful when they

wake up in the morning and have been told snoring, breathing

pauses and having high blood pressure, or diabetes or any

depression, anxiety indicate that they might benefit with

sleep apnea testing.

Okay, got it. So, we talk about what sleep apnea

is. We talk about the risk factors. We talk about how

percentage of men, which is about 15% or so, and then is

that the only way to diagnose sleep apnea? Is the sleep test

or the home study test? Is there any other, when they see a

doctor that can work up for this?

So like these are the two methods, like home sleep

study or in lab sleep study. A home sleep study is more common

nowadays, with new technologies and more affordable and easy to

do. But clinically, if they are having symptoms, they can tell

the doctors or their providers and ask them to get like tested

for that.

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All right. So you take the test, and then the doctor read, and

let's say you have sleep apnea. So what are the treatment for

sleep apnea?

So nowadays, there are different treatment options.

Most common is CPAP machine, BiPAP machine. What those

machine do? They push the air with gentle force with some mask

under the nose, or some mask covering nose and mouth both,

and that air come with force, and that air also has oxygen, so

that way it controls the sleep apnea. Sometime people run into

problems if a mask is not right, if sitting on the machine is not

right, then they are not able to use the CPAP machine. So in

those situation, I suggest them to see a sleep specialist if it

is not working, like no follow with like no different

specialist as well. There are other treatment option called

Inspire. So Inspire is an implant under the skin, and it

gives signal to a tongue to move forward, and when tongue move

forward, it open the passage on the back. So that is the implant

for sleep apnea, just like a pacemaker for sleep apnea, and

that keep moving the tongue forward. But it has certain

criteria to qualify for it. There is a third option, dental

device putting into the mouth. And what it does it keep lower

jaw forward, so when it keep lower jaw forward, then keeping

the passage open on the back of the throat. And if it is done by

a certified dentist who is trained in sleep medicine, then

this device can also work. There are some other device called

positional device for sleep apnea. They are like vibration

band, and that helps to avoid sleeping on the back. So that

band can be put on the stomach, then, or the neck. So that is

called positional device for sleep apnea, so that can also

help to some people.

Okay, so who do you determine who gets what? The

machine versus the Inspire versus dental prosthetics.

So CPAP is the gold standard treatment, so we start

with that. But if someone having lot of claustrophobia and they

want to go try dental device, that is fine too. So they can

get benefit from that. If their apnea is mild to moderate

category, not very bad, oxygen is not running low too much. So

they can benefit from dental device as well. About the

Inspire, someone who has moderate to severe degree of

sleep apnea, then they have tried CPAP, and they qualifying

for that, certain weight criteria, certain procedure to

look on the back of the throat, called DISE procedure. So if

they qualify for Inspire, they are good candidate. They can get

benefit from that as well.

Interesting. So do women get sleep apnea as common

as men?

It is less common in women, but after the menopause,

they tend to have almost similar prevalence for sleep apnea too.

And in women, the snoring is not that loud, just like men. So

some of the women after menopause, they are having

insomnia. It is presenting like insomnia, but they should also

get benefit from testing for sleep apnea as well, because the

symptoms are little bit subtle. They present like depression,

anxiety or insomnia. So symptoms are a little bit subtle, but

prevalence goes high after menopause.

Okay, well, I'm getting mine done. Only thing

is, I feel pretty good, so hopefully maybe I'll pass my

test. Who knows? But if my test is not normal, I'm definitely

calling you for this. So that's sleeping. Now, once you get on

the machine, you stay on it forever.

So most people stay like, you know, forever until,

unless they lose significant weight. So some people get

bariatric surgery. They lose 80, 100 pounds weight, and 60%, 70%

of them, they get off from the CPAP also. But some of them is

to benefit at lower setting on the CPAP. They still get good

quality of sleep with CPAP. So for them, maybe it is from the

morphology, how the bone are aligned, not only the weight.

What you're saying, which I didn't know, was that if

you lose weight, you can actually reverse your sleep

apnea?

In some percentage.

How much percent?

After people get bariatric surgery, 60% to 70% of

people, they get off from a machine. Their sleep apnea get

reversed.

Okay, so if you lose weight, then that will

help. What else can you do to not be on the machine? Is there

anything else you can do besides just losing weight if you don't

want to be on the sleep apnea machine?

Yes. So there are other treatment option. Like I

mentioned, Inspire. So Inspire is without any mask. It keep

moving the tongue in the night when people are sleeping and the

movement of tongue is not painful.

Yeah, like natural therapy, instead of, like a

machine or an implant. Any other natural therapy, like diet,

exercise or anything that they can do naturally?

Yeah, naturally, it does not control sleep apnea all

the way. But exercise, diet, if they are losing weight, sleeping

on their side, that is helpful. Sometimes people elevate their

head, just leave it and they are sleeping better. So those are

other things they can do. But I used to recommend to get it

treated, because when they go into deeper sleep, these muscle

relax, and in the deeper sleep, we want our muscle relax, and

that's how it happens. So that's why the treatment is necessary.

So the end point is, if you do the test and it

showed you have sleep apnea, you should use the machine and try

to lose some weight. Obviously, losing some weight, will

probably help guess the parameter of the machine as

well, too, right?

Yeah, yep. And not only the machine, not only the

machine is option. Like other options, like dental device

putting into the mouth that is one option. Positional device

for sleep apnea and inspire, those are the options without

any CPAP. And there is a another device called iNap that, like

people put into the mouth, and it create negative suction in

the oral cavity, so keeping the tongue sucked up on the front so

they keep breathing from the nose. So there are some other

device also. So I see patients. Lot of them, they are doing good

on the CPAP. But some who are not doing good on the CPAP, I

try to use other alternative method, without any mask.

So that's good. But the bottom line, if you're going

to use the machine, you use it forever?

Most of the time, yes.

Okay, I see the machine. One of my friend has

one. It's very small and quiet now, not like, you know, it was

like 27 years ago when I started medicine. The machine then look

like a computer, and it makes so much noises, it was incredible.

I think that was what the main thing was, you know, I want our

listeners how to know if they have sleep apnea. So what

happens if you don't get treated with sleep apnea? What happens?

So sleep apnea causes intermittent low oxygen in the

body, and oxygen is very important things for our

survival. If we don't get oxygen for five minutes, we are dead.

So the brain keep looking the level of oxygen. If there is a

drop of 3% 4% then brain keep getting jerk, keep getting

arousal, and that's how it break the rhythm of sleep, so people

don't get quality sleep.And in that way, because of that, they

are not getting restful sleep, not getting quality sleep. So

that is affecting overall health. So affecting the ability

of brain to clear the toxins. And when toxin accumulate, then

they people develop dementia and depression, anxiety and then lot

of problem to the heart and stroke. As you mentioned, sexual

health also get affected because of these things, not getting

good quality of sleep, not feeling rested, and having low

hormones. So those affect sexual health as well.

Okay, great. So to summarize, get your test and get

treated. It's very unintrusive. And that if you don't you're

going to be at risk for dementia, and not to mention,

making your ED worse because your body is not getting enough

oxygen while you sleep. When you're not getting enough oxygen

while you sleep, it will affect everything. Your brain, your

heart, your sexual function as well, and you continue feeling

fatigue. So that's awesome. Thank you for enlightening us

about sleep apnea. Where can our listener find you to help them

with their sleep apnea?

Yeah, so they can check my website, longevity,

sleep medicine, and they can, like, find me online. So those

are options.

Okay, so to find out more about you, go to

longevity sleep medicine.

Yep.

Longevity sleep medicine.com. So I'll leave the

link in description down below for you to check out. And guys

get this check because you mentioned 15%, I think it's

probably so much more. I know so many people have sleep apnea,

and I feel that is one of the under diagnosed condition with

men with ED. And I think if you have ED, you need to get a sleep

apnea test, if you're over 40. Because oftentimes it coincide.

Because I can't tell you how often I see men for ED, and when

we do blood work, we also diagnose them with diabetes or

pre diabetes as well, because they don't know that their blood

sugar is high. So sleep apnea is certainly an easy test to do

that can honestly save your life and improve your quality of life

as well too. So having said that, Dr Verma, thank you for

being on our show and get your sleep apnea checked. Check out

his website. And, Modern Man, just know that you don't have to

live with ED. There are alternatives and I will see you

in the next episode.

Thank you for having me.

Okay, Modern Man, you are not alone and you don't

have to suffer anymore. ED can feel isolating, frustrating, and

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there.

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