Vol.25: Not getting an erection in the morning is a warning sign of ED: Part 3

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【Not getting an erection in the morning is a warning sign of ED: Part 3】


We previously explained about the relationship between nocturnal penile tumescence and quality / time of sleep in the [Vol.21: Not getting an erection in the morning ” is a warning sign of ED: Part 2]. This time, let us discuss this relation in more detail. As I mentioned in the previous column, the factors which decrease or weaken the “nocturnal penile tumescence” are shown as below.
(1)The change of quality and time of sleep which accompanies aging
(2) Sleep disorder (sleep apnea syndrome, alcoholic sleep disorder and insomnia due to the anxiety and depression).
(3)Due to the intake of anti-depressants and antihypertensive medication (especially with tricyclic antidepressant drug)
(4) Decrease of Male hormone secretion (testosterone)
(5) Diabetic peripheral neuropathies disorder
(6) High blood pressure, diabetes and vascular endothelial disorder (arteriosclerosis) caused by hyperlipidemia
(7) blood circulation disorder caused by thrombotic disease
(8) Penile fault caused by trauma
The change of quality and time of sleep which accompanies aging
We are going to explain in detail about the above (1), (2). The nocturnal penile tumescence occurs mainly during REM sleep (REM sleep: rapid eye movement sleep) which is a shallow sleep. When REM sleep is longer and more frequent, the possibility of getting the nocturnal penile tumescence becomes higher. The length of REM sleep is longest in pubescent males and becomes 30 percent or more of the whole sleeping hours (1 cycle is approximately 90 minutes, and the REM sleep is 30 minutes and non-REM sleep 60 minutes). As it is known that the nocturnal penile tumescence is seen in approximately 90% of the REM sleep time during the period of puberty, when waking up during REM sleep, the male should have the nocturnal penile tumescence most of the time. After the end of puberty, the rate of REM sleep becomes stable at the age of 20-50 years old (30% or less, approximately 100 minutes every night). It decreases to about 20% at the age of 60-70 years old. Also, the length of time for getting the nocturnal-penile-tumescence reduces to about 5-10 minutes for each time because of aging. Also, the nocturnal penile tumescence starts to be seen during non-REM sleep with aging, but roughly speaking, we can still say that, a decrease of the REM sleep = a decrease of the nocturnal penile tumescence, as a whole. So therefore, the frequency of getting the nocturnal penile tumescence is decreased with aging due to the quality change of sleep. Also, as for the relation between the sleep disorders (apnea syndrome, alcoholic sleep disorder, insomnia caused by the anxiety and depression, taking of a long acting-type sleeping pills, periodicity disturbance of movement of extremities (paralytic), nocturnal-myoclonus and so on) and the nocturnal penile tumescence, it’s known that with men with these symptoms are getting less and weaker with the nocturnal penile tumescence.
As for the men who are getting less and weaker nocturnal penile tumescence which is caused by (1) or (2) as key factors, you don’t have to be worried so much about ED. Because the decrease and weakening of nocturnal penile tumescence due to the change of the quality and quantity of sleep has no direct relation to the ED symptom which is seen during sexual intercourse with a partner, so it may be a cause of ED indirectly but we can’t say that “not getting nocturnal penile tumescence = the sign of ED” directly.
This time, we explained about the case which you don’t have to take too seriously about not getting nocturnal penile tumescence as a sign of ED. However, if you find out that you aren’t getting the nocturnal penile tumescence recently or don’t remember when you had it last time, Please be careful because the reason could be because of the other factors of the above (3)-(8). These factors are related directly to ED. Please feel free to see our doctor if you have any question or concerns.

Vol.21: Not getting an erection in the morning is a warning sign of ED: Part 2
Vol.9: Not getting an erection in the morning is a warning signal of ED


【Supervisor of this article】

Ken Takemori, MD. An anesthesiologist and Director of Shibuya 3rd Block Clinic.


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