Poor Sleep and Low TestosteroneInsomnia hormone imbalance or sleeplessness is both a cause and effect. Basically, hormone imbalance resulting from low testosterone and insomnia, menopause, adrenal fatigue or any of its other symptoms, may cause sleeplessness which in turn worsens the hormone imbalance. Sleeplessness also has many testlsterone non-hormone related causes. These hormonal and non-hormonal causes of insomnia include:. Insomnia in low testosterone and insomnia causes hormone imbalance and worsens the symptoms of menopause ttestosterone the body needs sleep for the body's hormones to do their job who uses anabolic steroids. Sleep is absolutely essential for repair and rejuvenation.
How Low Testosterone Levels Affect Sleep Patterns in Men
Plasma testosterone levels display circadian variation, peaking during sleep, and reaching a nadir in the late afternoon, with a superimposed ultradian rhythm with pulses every 90 min reflecting the underlying rhythm of pulsatile luteinizing hormone LH secretion. The increase in testosterone is sleep, rather than circadian rhythm, dependent and requires at least 3 h of sleep with a normal architecture.
Various disorders of sleep including abnormalities of sleep quality, duration, circadian rhythm disruption, and sleep-disordered breathing may result in a reduction in testosterone levels. The evidence, to support a direct effect of sleep restriction or circadian rhythm disruption on testosterone independent of an effect on sex hormone binding globulin SHBG , or the presence of comorbid conditions, is equivocal and on balance seems tenuous.
Obstructive sleep apnea OSA appears to have no direct effect on testosterone, after adjusting for age and obesity. However, a possible indirect causal process may exist mediated by the effect of OSA on obesity. Treatment of moderate to severe OSA with continuous positive airway pressure CPAP does not reliably increase testosterone levels in most studies. In contrast, a reduction in weight does so predictably and linearly in proportion to the amount of weight lost.
Apart from a very transient deleterious effect, testosterone treatment does not adversely affect OSA. The data on the effect of sleep quality on testosterone may depend on whether testosterone is given as replacement, in supratherapeutic doses, or in the context abuse. Experimental data suggest that testosterone may modulate individual vulnerability to subjective symptoms of sleep restriction.
Low testosterone may affect overall sleep quality which is improved by replacement doses. From a neurophysiological standpoint, there are two types of sleep: The first two phases of NREM sleep phases 1 and 2 are light and often alternate with brief waking episodes. Two deeper phases of NREM sleep phases 3 and 4 together known as slow wave sleep SWS tend to occur predominantly in the earlier part of the night and become lighter thereafter.
Usually four to six cycles of REM sleep occur at intervals of approximately 90 min becoming longer and more frequent over the course of the night. The term sleep architecture is used to describe the pattern of sleep that occurs through the night. From approximately middle-aged onwards, less time is spent in the deeper phases of sleep and there is more stage I sleep and more awakenings.
The effect of ageing on REM sleep is more variable and it tends to be preserved until quite late in life. Plasma testosterone levels vary in a circadian manner, higher on waking and decreasing to a low point at the end of the day. Superimposed on this are burst-like increases in testosterone production that occur every 90 min or so. It was originally thought that there is an endogenous rhythm of testosterone production similar to what occurs for cortisol. The increase in testosterone with sleep time and a decrease during time awake is stable within an individual, but in turn there are large individual differences.
Sleep restriction is an increasing problem of an electrified, digitalized, and constantly connected lifestyle. In the USA, average nocturnal sleep time is 6. They are a number of definitions of shift work. Typically it is defined as at least half of the work shift being outside the standard work time of In night workers or those working rotating shifts, as compared to night sleep, day sleep is associated with a reduction in SWS.
There are a number of syndromes characterized by disordered breathing during sleep. One group of these relates to increased upper airway resistance. Vibration of the upper airways during the passage of air results in snoring. Apneas are repetitive pauses in breathing lasting 10—40 s despite efforts to breathe. The AHI describes the number of apneas or hypopneas per hour of sleep. A normal AHI is less than 5.
The severity of OSA is considerably worse during daytime sleep after night shift as compared to normal nighttime sleep and this may intensify the unfavorable health effects of OSAS. While studies confirm the effect of total sleep deprivation 12 , 13 to lower testosterone, data on the effect of sleep restriction on the hypothalamo-pituitary-gonadal axis remains contradictory.
The effect of sleep deprivation on testosterone may be dependent on age. Moreover, the timing of sleep may be more important sleep length itself in determining testosterone levels.
Restriction of sleep for eight nights to 5 h In a subsequent study where sleep was restricted during the first half of the night and permitted from — hours for five nights there was no significant change in testosterone, although SHBG decreased. The most common form circadian rhythm disruption is that which occurs as a result of shift work.
Shift work as such, appears not to have any adverse effect on morning testosterone levels. There is, however, a relationship between disturbed sleep and wakefulness, increased need for sleep and recovery, reduced morning cortisol, lower testosterone levels, and dissatisfaction with the shift system.
The authors suggested that the reduced testosterone levels may be part of a mechanism of shift work maladjustment. After adjusting for BMI or waist circumference significant associations were either absent or markedly attenuated. Although limited data suggests that treatment of OSA by CPAP or palatal surgery results in an increase in morning plasma testosterone levels at 3 months, the majority of other studies show that CPAP applied for durations that range from a single night 26 to 39 months is without effect on luteinizing hormone LH , follicle stimulating hormone FSH , or testosterone even when compliance is assured.
In contrast to the effect of CPAP, there is a linear relationship between a decrease in weight and an increase in plasma testosterone in obese men. Based largely on anecdotal evidence exogenous testosterone has been considered to have a deleterious effect on obstructive sleep apnea OSA.
Despite the paucity of evidence, current guidelines indicate that it is contraindicated in the presence of untreated OSA.
Testosterone treatment resulted in a mild worsening of the ODI at 7, but not 18 weeks. There were no relationships of ODI to the testosterone levels, 35 but positive correlations were observed between changes in serum testosterone and hyperoxic ventilatory recruitment threshold and between changes in hyperoxic ventilatory recruitment threshold and time spent with oxygen saturations during sleep at 6—7 weeks but not at 18 weeks.
Both insufficient and excessive testosterone levels have been shown to affect sleep. In a cohort study of men aged 65 years and over, those with lower testosterone levels had reduced sleep efficiency, increased nocturnal awakenings, and less time in SWS. In mice, the loss of testosterone following gonadectomy results in a very small reduction in the amount of SWS, which is increased by the replacement of testosterone. Testosterone replacement in these mice also increased the amount of SWS after 6 h of sleep deprivation.
Healthy young men with higher endogenous testosterone levels have greater degradation of cognitive functioning and increased subjective sleepiness after 5 days of sleep restriction as compared to those with low endogenous testosterone levels. Testosterone is not subject to circadian variation in the same way that cortisol. There is sleep-dependent increase in testosterone that requires 3 h of SWS or perhaps a bit longer with increasing age.
Testosterone remains elevated for the duration of sleep. The subsequent decrease in testosterone depends on the duration of wakefulness; decreasing more with prolonged wakefulness. OSA per se is not a cause of low testosterone, rather it is due to obesity, and is increased by weight loss but not CPAP. Shift work does not affect testosterone and unless severely disrupted, sleep quality is not a determinant of testosterone.
Testosterone deficiency may have a deleterious effect on sleep quality that may be improved with testosterone replacement. Further clarification is required about the relationships between sleep and testosterone in older age, psychiatric disease depression, post a stress disorder, and psychotic disorders such as schizophrenia as well as any interaction with the presence of other chronic diseases. The author is a member of the advisory board for Eli Lilly.
The author has received consulting fees and undertaken contract research for Lawley Pharmaceuticals. National Center for Biotechnology Information , U. Journal List Asian J Androl v. Published online Jan 7. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC.
Abstract Plasma testosterone levels display circadian variation, peaking during sleep, and reaching a nadir in the late afternoon, with a superimposed ultradian rhythm with pulses every 90 min reflecting the underlying rhythm of pulsatile luteinizing hormone LH secretion.
Sleep and the regulation of the hypothalamo-pituitary-gonadal axis Plasma testosterone levels vary in a circadian manner, higher on waking and decreasing to a low point at the end of the day. Prevalence and nature of sleep disorders including short sleep, circadian rhythm disruption, and sleep-disordered breathing Sleep restriction is an increasing problem of an electrified, digitalized, and constantly connected lifestyle.
Submitted The severity of OSA is considerably worse during daytime sleep after night shift as compared to normal nighttime sleep and this may intensify the unfavorable health effects of OSAS. Circadian rhythm disruption The most common form circadian rhythm disruption is that which occurs as a result of shift work.
Effect of continuous positive airway pressure CPAP on testosterone Although limited data suggests that treatment of OSA by CPAP or palatal surgery results in an increase in morning plasma testosterone levels at 3 months, the majority of other studies show that CPAP applied for durations that range from a single night 26 to 39 months is without effect on luteinizing hormone LH , follicle stimulating hormone FSH , or testosterone even when compliance is assured.
Open in a separate window. The effect of treatment of obstructive sleep apnea on plasma testosterone in men. Effect of testosterone on obstructive sleep apnea Based largely on anecdotal evidence exogenous testosterone has been considered to have a deleterious effect on obstructive sleep apnea OSA.
Testosterone and sleep quality Both insufficient and excessive testosterone levels have been shown to affect sleep. Middle-aged men secrete less testosterone at night than young healthy men. J Clin Endocrinol Metab. Decreased pituitary-gonadal secretion in men with obstructive sleep apnea. Relationship between rapid eye movement sleep and testosterone secretion in normal men.
Disruption of the nocturnal testosterone rhythm by sleep fragmentation in normal men. Circadian rhythm of serum testosterone and its relation to sleep: Effects of acutely displaced sleep on testosterone.
Association between sleep and morning testosterone levels in older men. Banks S, Dinges DF. Behavioral and physiological consequences of sleep restriction. J Clin Sleep Med. Obstructive sleep apnea in shift workers. American Academy of Sleep Medicine; American Academy of Sleep Medicine. The international classification of sleep disorders: Sleep timing may modulate the effect of sleep loss on testosterone.
Clin Endocrinol Oxf ; Pituitary-gonadal and pituitary-thyroid axis hormone concentrations before and during a hypoglycemic clamp after sleep deprivation in healthy men.