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In the dual clamp condition, we observed a significant decrease in PYY after sleep restriction, which would be expected to worsen, not improve, insulin resistance (84, 85). As such, we found no evidence that proinflammatory mechanisms accounted for the insulin resistance effects in our study. Additionally, sleep restriction decreased TNFα, which would be expected to reduce, not increase, insulin resistance (79, 80).
A cohort study of community-dwelling men aged 65 shows that men with lower testosterone levels had lower sleep efficiency, increased nocturnal awakenings, less time in slow-wave sleep, a higher apnea-hypopnea index, and more sleep time with O2 saturation levels below 90%. Yes, having both too low and too high testosterone levels can cause sleep problems such as insomnia, more nighttime awakenings, and more shallow sleep. These sleep apnea episodes cause sleep deprivation, sleep fragmentation, and shorter REM time — all of which can sabotage your testosterone production. In the study above, losing out on sleep in the second half of the night, compared to the first half of the night, lowered testosterone levels. 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 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 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.
As food intake during the study and the days preceding it was controlled as well, there was no evidence that the gut and fat hormones we measured could explain the insulin resistance effects in our study. Further, leptin levels were found to be increased after sleep restriction; however, this would be expected to improve, not worsen, insulin resistance (14). Effects of sleep restriction with placebo vs dual clamp treatment on cortisol (left) and testosterone (right). 6 shows the effects of sleep restriction and the dual clamp on cortisol and testosterone measured immediately before the OGTT. Effects of sleep restriction with placebo vs dual clamp treatment on hyperinsulinemia (top left), hyperglycemia (top right), pancreatic beta cell function (bottom left), and pancreatic response to insulin resistance (bottom right).
Studies suggest that up to 30% of men experience some form of sleep disruption when initiating testosterone therapy. Starting testosterone replacement therapy (TRT) can be a game-changer for men with low testosterone, improving energy, mood, and overall quality of life. Most sleep issues resolve within 4-12 weeks as your body adjusts, but proper timing, dosage optimization, and sleep hygiene can help manage symptoms.
Association between low total testosterone (vs. ≥250 ng/dl) and sleep outcomes In a post hoc analysis, the association of total testosterone with sleep efficiency and wake after sleep onset was statistically significant only for those in the upper median BMI group. Although we did test for an interaction between continuous total testosterone and continuous BMI (which was not significant), we did not look at the effect between sleep outcomes and quartiles of total testosterone stratified by median BMI value, which was 27. These results were not changed after further adjustment for other covariates including comorbidity at the time blood was obtained for testosterone assays (data not shown). Partially adjusted association between total testosterone and sleep outcomes Table 2 shows the age, race, and clinic site adjusted sleep outcomes by quartiles of total testosterone.
Only one clinical trial in 12 hypogonadal men (35) showed that administration of testosterone increased metabolic rate and hypoxic ventilatory responses. Given the number of sleep-related outcomes reported, this single independent association could be spurious. No similar analyses were performed for bioavailable testosterone because there is no agreed-on cut point for bioavailable testosterone deficiency. They did not differ by sleep duration, slow wave sleep, arousal index, or AHI. The final multivariable models were adjusted for age, clinic site, race, and BMI only because none of the other covariates changed the results when included in the model (data not shown). Linear trends of participant characteristics across categories of testosterone quartiles were assessed using least-squares models for continuous variables and Mantel Haenszel χ2 tests for categorical variables. Height (centimeters) was measured on Harpenden stadiometers, and weight (kilograms) was measured on standard balance beam or digital scales using standard protocols, with participants wearing light clothing without shoes.
Known or suspected determinants of testosterone and each sleep outcome were examined for potential confounding in age-, race-, and clinic-adjusted models. Participants also completed a sleep diary that was used in the editing of the data to determine when the participant got into and out of bed and when the actigraph was removed. To minimize night to night variability, the average of the sleep parameters over all nights was used in all analyses.
Sleep disorders, including undiagnosed sleep apnea, are common in men on TRT and require their own evaluation. Ask whether bedtime timing makes sense given your cortisol pattern or any testing that has been done. Clinicians who work in hormone optimization have noted that some of these residual symptoms may relate to DHEA and its metabolites, including compounds that the brain and nervous system use for functions beyond reproduction. When a man starts TRT and his testosterone reaches a healthy range, the expectation is that energy, mood, libido, and drive will all follow. DHEA is a hormone, not a supplement in the conventional sense, and its effects vary considerably from person to person. Most men on testosterone replacement therapy expect to feel like a new person, and many do, until they notice that sleep is still broken, mornings still feel heavy, and something they can't quite name is still missing. Some however do note having a harder time sleeping, which can sometimes be the case if they're less exhausted.
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