Some research suggests that improving testosterone levels may help improve sleep quality. In fact, even one week of restricted sleep can reduce testosterone levels in otherwise healthy men. For example, men with low testosterone levels are more likely to report trouble falling asleep, frequent waking, and daytime tiredness. When testosterone is low, people may experience restless nights, frequent waking, and poor sleep quality. 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.25 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.36 Superimposed on this are burst-like increases in testosterone production that occur every 90 min or so.2 Plasma testosterone levels begin to increase with the onset of sleep, and in young men peak at the first REM sleep episode and remaining at that level until waking;3 the longer the REM sleep latency the slower the rise in testosterone.4
Weight management, regular exercise, stress reduction, and good sleep habits help both testosterone and sleep. The right treatment plan depends on the person’s health history, current conditions, and lifestyle. But if his testosterone is low, the problem may not improve until the hormone imbalance is corrected. Others may develop sleep apnea, a condition where breathing stops and starts during sleep. It plays an important role in the body’s daily rhythms, the way the brain regulates sleep, and how refreshed a person feels after rest.
Strategies other than CPAP should thus be considered in these patients, including weight loss, exercise, and optimization of concomitant chronic diseases to improve gonadal function (43). However, since CPAP per se does not lead to a decrease in body weight, no effects on the HPT axis should be expected (41, 42). Overweight and obesity are regarded as a major risk factor for OSA syndrome, acting through both mechanical and biochemical mechanisms, such as changes in peri-pharyngeal soft tissues and depression of neuromuscular control (34). An adequate treatment with CPAP could be sufficient for the correction of hypogonadism, indeed (20). Two hypotheses have been formulated in order to describe the interactions between OSA syndrome and serum testosterone.
This complex relationship creates a challenging scenario for those affected, as addressing one issue without considering the other may lead to incomplete treatment and suboptimal results. Sleep apnea, a common sleep disorder characterized by repeated interruptions in breathing during sleep, affects millions of people worldwide. TRT may help some men feel more energetic and improve overall well-being, but it doesn’t always fix sleep issues. Many men with Low T report fatigue and insomnia-like symptoms. Low T can disrupt the sleep–wake cycle, leading to difficulty falling asleep, staying asleep, or experiencing restorative deep sleep.
A bidirectional relationship between obesity and low testosterone underpins this association, as indicated by the hypogonadal-obesity cycle and weight loss leading to increased testosterone levels (Fig. 1). Obesity is strongly linked to low testosterone levels in men, as is increased fat mass, especially abdominal fat. The increase in testosterone at the time of sleep, the decrease during the time of awakening, is stable within an individual, although there is large variability among individuals . Serum testosterone levels vary in a circadian manner, being higher during waking hours and the decreasing to a low level at the end of the day . These two categories of sleep have a 90 minutes cycle, and normal adults repeat this cycle four to six times during the night. NREM sleep accounts for 75% to 80% of total sleep time, and REM sleep accounts for the remaining 20% to 25% .
It’s worth noting that the relationship between hormonal imbalances and sleep disorders extends beyond just testosterone and sleep apnea. Given these varying outcomes, it’s crucial to monitor sleep apnea symptoms closely during TRT. The potential benefits may include improved muscle tone in the upper airways, reduced fat accumulation in the neck area, and enhanced overall sleep quality.