THE ROLE OF SLEEP IN THE EVALUATION OF SEXUAL DYSFUNCTION

Penile erections occur three to five times per night during rapid eye movement (REM) sleep. The association between these sleep-related erec tions (SREs) and REM sleep begins around the age of 3 months. In patie nts with diabetes, spinal injuries, end-stage renal disease, pelvic tr auma, or other organic pathologies, SREs differ from those of healthy males, whereas patients with performance anxiety have a normal SRE pat tern. Monitoring SREs is an objective method for determining erectile pathophysiology. There is a strong but not perfect correlation between the degree of SRE impairment smd the ability to function sexually For example, people with diabetes who report the ability to function sexu ally also have SREs that differ Corn normal control subjects. Measures of SREs appear more sensitive to subtle physiological changes than do tests of erectile functioning when patients are awake. Studies of SRE s indicate that in addition to peripheral vascular and autonamic probl ems, central autonomic dysfunctions may contribute to SRE abnormalitie s and erectile failure. Finally, the monitoring of SREs has led to the detection of other pathophysiologies, such as sleep apnea, that contr ibute to impotence, apparently because of associated cardiovascular an d endocrine problems.