Sex and the CPAP

Tracy Nasca - September 12, 2011

The very thought of using CPAP is enough to make a lot of newly diagnosed people just say no. 

Many who say no have issues with the look of CPAP and how it will affect their intrapersonal lives; their relationships and their sex life.  Many fear their spouse will no longer find them attractive.  Single people looking for Mr. or Mrs. Right are especially vulnerable to saying no, embarrassed and worried about frightening off potential relationships.  The medical device, 6 feet of tubing and a mask worn over the face can present in a very intimidating manner.  It’s true; there is nothing visually attractive about any of it.  Is that a good enough reason to say no?

Thanks to increased awareness about sleep apnea, people are being diagnosed at younger ages in their 20’s and 30’s.  Apnea used to be thought of as a middle aged and older health issue.  Today, newlyweds, singles and young people just starting their careers are receiving the diagnosis.  One’s romantic and sex life is important.  While curious minds want to know, it’s not always comfortable to bring up this issue with our doctors.  Let’s address the facts and the psychology of this subject from my patient perspective in hope that those of you who are tempted to say no, will recognize that the prudent conclusion is to say yes.

When you say no, the ravages of untreated apnea include fatigue, daytime sleepiness, snoring, memory loss, depression, GERD, increased night time urination, hypertension, weight gain and risk of heart attack or stroke.  While it’s true that there is nothing attractive about CPAP, 6 foot tubing and masks, there is also nothing attractive about that laundry list of symptoms.  You may be surprised to learn that untreated apnea can cause impotence and low libido and sex drive in both men and women.  Leaving apnea untreated can be life threatening and increase the risk of comorbidities and an early demise.

Those diagnosed at a young age may be more apt to have a mild form of apnea and therefore not be as concerned about treatment.  Chances are they have not yet developed that long list of symptoms mentioned above and have a false sense of security when considering CPAP therapy.  The truth is, apnea rarely gets better when left untreated; it worsens.   The truth is that too many wait until the serious symptoms disrupt life and health before diagnosis or beginning therapy.  The truth is, mild, moderate or severe, any one apnea event during sleep has the potential to be the last breath your ever take.

If you are young and building your career, leaving your apnea untreated means you are not at the top of your game.  Life is hard enough, why would you neglect treating a medical issue that negatively impacts your energy, mood, memory and overall health?  As you aspire to climb the ladder of success, don’t miss an important rung of the ladder – your health and well being.

If you are middle aged or older you may find it increasingly difficult to perform well at work.  You may be worried about losing your job to a younger more energetic person.  Are you being passed over for job promotions?  You have the acquired experience, and know you have the skills but you also are aware that your drive is diminished and health is failing.  CPAP therapy can give back renewed energy and put you back at the top of your game where you rightly belong.  What are you waiting for?

Common objections to CPAP use

There goes the romance and my sex life, who wants to have sex with someone hooked up to a machine and wearing a mask?

I must admit, I had this very thought when I was diagnosed at age 35.  My symptoms began at age 20 and progressed rapidly.  Honestly, I did not have much of a sex life anyway because the affects of my untreated apnea had really taken hold.  Daily migraines, body ache, and extreme fatigue, I was so tired when night time came, all I really wanted to do was sleep.  Although I enjoyed having sex, the desire was gone thanks to my low energy level, depression from sleep deprivation and of course my weight gain certainly made me feel less attractive. 

At diagnosis, I took one look at CPAP and mask and was horrified.  I blurted out to my doctor, “well, this is not attractive, there goes my sex life”.  He must have heard this before, because he chimed right in and said, “Tracy, your sex life will improve.  You don’t have sex while you are wearing your mask.  You use the equipment when it’s time for sleep; after the romance.”

My sex life will improve?  Huh?  That got my attention!

He explained that when the body is sleep deprived, a man’s testosterone levels diminish and can cause erectile dysfunction (ED).  Sleep deprivation also causes low libido or sex drive in both men and women.  He suspected in my case, I was so severely sleep deprived that with CPAP therapy, my interest in having sex would return.  He was right.  Research shows that sleep apnea can cause ED and be reversed by CPAP use.

I don’t want that big old medical device on my night stand; it’s a red flag that hey, I have a problem

Hey, we all have problems; none of us are perfect nor immune to health issues.  But, the manufacturers heard you, and now offer sleek, modern units that look anything but medical.  It’s not your father’s CPAP anymore.  Some even have built-in alarm clock with mp3 music playing ability. Fisher& Paykel Healthcares CPAP called ICON offers the SmartStick Studio software which can be used to upload your songs and have the ICON's alarm start your morning with the song or sounds of your choice. ResMed and Philips Respironics both offer units with a sleek non-medical look.  If you are still concerned, place your cpap in your night stand drawer during the day, or just slip under the bed; they really are that small and light weight.  Once you get past the adjustment period of CPAP use, and feel the benefits, chances are your CPAP will be proudly displayed on your nightstand and no longer perceived as any kind of embarrassment.

I’m not wearing that ugly mask on my face, it’s unattractive

Ask any bed partner and they will tell you that what is unattractive is sleeping next to someone who snores loudly all night long.  It disrupts their sleep as well as yours.  Patients who are untreated are frequently restless sleepers who toss and turn, flail their arms and kick their legs.  It’s why so many couples sleep in separate bedrooms.  CPAP therapy stops the snoring and gives a peaceful night’s sleep to both of you.  You don’t think you snore, gasp or make choking sounds at night?  Tape record yourself to hear what your bed partner puts up with!  I did that and it was shocking.  We really have no clue what we do in our sleep.

“Unattractive” is a perspective, an attitude.  Only you can determine what is more important to you, how you look in bed at night after the lights are off, or how you feel when you awaken each morning to  begin the next day of your life.  Despite our age, don’t we all want to live life to its fullest with vigor and energy?  Is compromising our health an attractive characteristic?

It is a strange feeling at first, to sleep with a mask strapped on our face.  But in the scope of things, is it really that dreadful when the benefits are so great?  Today’s masks are available in smaller frame sizes and many even have colored headgear in soft pastels if that makes you feel prettier.    Headgear is now more hair friendly.  Yes, you may awaken with slight mask strap marks on your face, but after your morning shower, they will disappear.  Those who have anxiety about masks should consider nasal pillow systems which offer simplistic use ability.  When CPAP works, the benefits far outweigh the vanity issues.

I don’t want my relationship ruined because I have a medical problem

Whether you want to admit to it or not, you do have a medical problem and not addressing it will probably have a much greater negative impact on your relationship than saying yes to treatment.

It’s hard enough being single and looking for Mr. or Mrs. Right, I don’t need CPAP as added baggage.

CPAP may be the best way to find Mr. or Mrs. Right!  Most people have some medical issues and they will be disclosed at some point during a relationship.  Having sleep apnea is no secret when you share a bed.  Only Mr. or Mrs. WRONG would object to you treating your sleep disorder, especially one that can be so devastating.  A healthy relationship is a partnership that should include honesty, mutual respect, understanding, consideration and support.  If someone runs from a medically necessary CPAP machine, what else would they run from?  You want to find someone to share your life with, to grow old together long after the outside of our bodies cease being attractive and the inside of our bodies start to show the natural wear and tear of age. 

I am single and know I should use CPAP but I keep it hidden from view and don’t use it on the nights my boyfriend sleeps over.  Honestly, I don’t see that it makes me feel any better anyway, I’m thinking about giving it up.

CPAP benefits best with nightly use.  Using it as often as you can is better than nothing, but each time you sleep, including daytime naps, you have apnea episodes and stop breathing which compromises your heart.   You acquire sleep loss/debt that must be paid back.  Think of sleep deprivation as a checkbook in the red.  You must pay back the debt before you are in the black again.  For every night of quality sleep you miss, it may take two or three nights to pay back, digging yourself further and further in to that black hole of sleepiness.

You probably feel better the morning and daytime after you use CPAP but not so much on the days you didn’t.  If sleepovers occur on back to back nights, your sleep debt and sleep apnea symptoms mount and so of course you are not feeling better.  You cannot expect to feel the daily benefit of CPAP if you don’t use it each time you sleep. 

The following are all true stories from people I have worked with.  They too, were faced with the personal decisions to say yes, or no to treatment.

• Thank you so much for encouraging my husband to use his CPAP.  A big burly macho police officer, he wanted no part of it.  I was most concerned about his health.  After you talked with both of us by phone, he finally relented and with our new understanding of sleep apnea, our world has been changed.
  
  A year later, he has lost over 50 pounds, is no longer hypertensive and now off all medications.  We are in our 40’s but he thinks he’s 20 again.  We have rediscovered each other and feel like newlyweds.  We have Friday date nights and just as you told us, the romance has returned.  I’m not quite sure how I feel about being chased around the dining room table for sex, but joy has reentered our lives and we are both smiling more.  I am now getting great sleep too because I don’t lay awake all night hearing him snore, stop breathing, and waiting for him to have a heart attack. 
  

• I ‘m the one dumped by my boyfriend and was blaming CPAP.  I was devastated because we had been talking about getting married.  After I got the CPAP he made fun of it and told me it was gross. Well, you were correct, he was Mr. WRONG for me.  I have found Mr. Right and am engaged.  You have no idea how close I came to quitting CPAP to try to hold on to the other guy. 
  
  
• I finally got used to CPAP, am losing weight and feeling so much better about myself.  It was hard to tell my fiancé about my apnea, but when I finally got the courage, he understood how important it was and he is all about supporting me because he loves me.  I am so glad the jerk is gone; otherwise I might never have found the true love of my life!  THANK YOU
  
  
• Hello CPAP, goodbye Viagra.  Not only has my sex life returned naturally, my wife saw so much improvement in me that she had a sleep study too and now we are both on CPAP and living happily ever after.
  
  
• From a commercial airline pilot:  I’m the one suspecting I had apnea but was afraid to have it appear in my medical records.  You urged me to have the sleep study and I am happy to report that I am now on CPAP, feeling more confident about my job security.  My wife thanks you because my depression and mood swings are gone and I hope you don’t mind me saying we’re both enjoying a fantastic sex life again.
  
  
• Tracy, wanted to get back with you about my husband the fireman who was too embarrassed to take his CPAP to the firehouse to use.  The guys complained about his loud snoring but he did not want to be teased about using a CPAP.  When a Chief at another station told him that he had apnea and used CPAP, hubby finally confessed and admitted he left CPAP at home.  The Chief scolded him in a nice way, and helped transfer him to a  firehouse that had several guys on CPAP.  He is well and his health has improved so much.  He is no longer embarrassed, in fact has become a kind of spokes person about apnea and encourages other firemen who snore to be tested.
  
  
• I lost my wife and my kids through divorce because I was stupid and in denial about my sleep apnea. I refused to use CPAP.  I called you about surgery options which you promptly talked me out of.  At first I did not like what you said, but after reality hit, it did make sense so as you advised I worked with my doctor and tried CPAP.  It was hard to get used to; you were right about having to try a lot of different masks, but I did it. 
  
  It was too late to repair my marriage, I was a jerk and my ex wife has moved on.  But I now have a much better relationship with my 2 kids.  I am dating and enjoying life.  The funny thing is that since I started using CPAP, my acid reflux went away, I don’t get up to use the bathroom two or three times every night, I’m off my high blood pressure medication, my depression is gone and I don’t feel like an old man any more.  My sex life had become nonexistent.  And now let’s just say that is in good working order too.  I had no idea that CPAP therapy would impact so many things in my life.  Thanks for talking to this stubborn man; I regret not wising up sooner, but I wanted to let you know I think you saved my life.

So, there you have it.  A lot of excuses to say no but even more reasons to say yes. 

For most of us, there is no cure for sleep apnea.  When we are young, we don’t think much about our mortality.  We are too busy living life to think about becoming obese and developing Type 2 diabetes.  We don’t think about high blood pressure, heart attack and stroke; those things only happen to old people.  What we don’t realize is that these things are all caused by untreated sleep apnea.  If you want to live to be an old people, and you have been told you have sleep apnea, even if mild, consider this news a gift.  You have been given the opportunity to say yes to treatment and avoid the certain devastations down the road.