Here's Why You Get Nocturnal Erections
An erection is often considered a sign of male sexual arousal, but it’s not uncommon to experience erections even when you’re not turned on. Nocturnal erections refer to erections you develop while sleeping. When you wake up with an erection, it’s often colloquially known as morning wood.
These sleep erections are normal and can even be a sign of good overall circulatory and sexual health, because these nighttime erections rely on healthy blood flow to the penis. They usually occur during rapid eye movement sleep, which is also the period of sleep where dreaming occurs.
Regularly experiencing nocturnal erections but experiencing erectile dysfunction during sexual activity can be a clue that the issue may be psychological, as opposed to circulatory or neurological problems. In cases of psychological erectile dysfunction, nocturnal erections tend to remain unaffected.
Before we get into the useful information that sleep-related erections might provide about your health, the best place for us to start this conversation is actually at the beginning — why do they happen in the first place?
Why Do People Get Erections During Sleep?
The medical term for experiencing nighttime erections is nocturnal penile tumescence (NPT).
nocturnal means at night
penile refers to your penis
tumescence refers to swelling or filling with blood
Nighttime erections are a normal reaction that can be a sign of good overall and sexual health. It’s normal to experience penile erections three to five times per night, although these will go unnoticed while you’re sleeping.
Sleep time erections are highly associated with rapid eye movement sleep, also called REM sleep.
While you sleep, you cycle through various sleep cycles:
non-REM sleep, consisting of:
Stage 1: The lightest phase of sleep that usually lasts one to five minutes.
Stage 2: A deeper phase of sleep characterised by a drop in heart rate and body temperature that lasts for about 25 minutes
Stage 3: The deepest phase of non-REM sleep where the body repairs and regrows tissue.
REM sleep, the phase of your sleep cycle associated with increases in brain activity, heart rate, and rapid eye movement with closed eyes. Most dreaming occurs in this period.
During a normal night, you usually cycle through four to five sleep cycles that last roughly 90 minutes each.
Erections that occur during REM sleep aren’t usually related to sexual thoughts, dreams, or sexual stimulation. They’re simply the result of your body cycling through the normal sleep cycles.
Changes during these sleep stages lead to fluctuating levels in neurotransmitter levels, such as decreases in norepinephrine production during REM. Norepinephrine plays a critical role in activating your “fight or flight” sympathetic nervous system.
It’s been theorized that reductions in sympathetic activity and upregulation of parasympathetic “rest and digest” activity allow pro-erectile pathways to take over and facilitate erections while sleeping.
Having a full bladder may also stimulate nerves that lead to your spinal cord and could potentially trigger a spinal reflex that leads to an erection.
Some nighttime erections may be linked to sexual dreams also called wet dreams, which can give you an erection and possibly even lead to nighttime ejaculation.
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Are Sleep Erections A Sign of Something? | Night Erections
Night erections are not a sign that something is medically wrong with you. If anything, they can be a sign of good overall health since they show that your nervous system and circulatory system are functioning as they should.
Most healthy men experience nighttime erections, even if they never realise that they’re occurring.
In fact, medical professionals often measure changes in blood flow in your penis as a test to differentiate physical causes of erectile dysfunction from psychological ones.
You may receive a test for sleep erections at home or in a special sleep lab. The test is known as an NPT test, stamp test, or rigidity test. During the procedure, you wear a special device over your penis while you sleep that can measure changes in size and blood flow in your penis. The test is painless and generally needs to be performed multiple nights in a row.
If it’s found that you have normal blood flow to your penis during the night, it likely means that psychological factors are contributing to the development of sexual dysfunction.
The Connection Between Sleep Erections and Erectile Dysfunction | Why Do I Wake up Hard?
Not experiencing nighttime erections might be a sign of problems with your circulatory, neurological, or hormonal health. You may also experience erectile dysfunction when trying to engage in sexual activity or could be at risk of developing erectile dysfunction in the future.
Erectile dysfunction is when you’re unable to achieve an erectile firm enough for sexual intercourse or masturbation. It’s normal to occasionally have trouble maintaining an erection, especially when drinking alcohol.
Many problems can contribute to erectile dysfunction such as those affecting your:
hormone levels (low testosterone)
nerves in your central nervous system and pelvis
psychological and psychiatric health
blood vessels and heart
Not achieving spontaneous erections while sleeping and when waking can be a sign that there’s a problem with your nerves or blood vessels. However, it’s worth noting that you may be experiencing these erections without ever realising it.
If you’re concerned about your sexual health, it’s a good idea to talk to your primary healthcare provider. They can run tests to help you understand the underlying cause or might refer you to other medical professionals such as an endocrinologist or urologist.
Connection between Erectile Dysfunction and Sleep Apnea
Sleep apnea is a common sleep disorder where your breathing stops periodically while you’re sleeping. These disruptions to your normal breathing can cause disruptions to blood flow to essential organs.
Research consistently shows that sleep apnea increases the risk of erectile dysfunction, as well as many other conditions.
Multiple factors likely play a role in the connection such as:
decreased libido
reduced production of a molecule called nitric oxide that allows your blood vessels to relax
cellular stress due to low oxygen flow
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Other Causes of Erectile Dysfunction
Many different factors can contribute to the development of erectile dysfunction, which include the following:
lifestyle factors such as:
consuming too much alcohol
using illegal drugs
being overweight
not exercising enough
psychogenic or emotional issues, such as:
depression or anxiety
guilt or shame
low self-esteem
stress
medication side effects such as:
blood pressure medicines
antidepressants
sedatives
appetite suppressants
certain medical conditions such as:
heart and blood vessel disease
high blood pressure
chronic kidney disease
multiple sclerosis
injury to your penis, spinal cord, prostate, bladder, or pelvis
Sleep-related painful erection
Developing painful erections in your sleep is a rare problem but it does occur in some men. Some men who experience these painful erections have normal erections in the daytime without pain.
Sleep-related painful erections might lead to you waking up repeatedly throughout the night and disrupt your overall sleep quality. The underlying cause and predisposing factors aren’t known.
Have Morning Wood but Still have ED
If you regularly wake up with morning erections but find you have trouble maintaining an erection when it comes to engaging in sexual activity you may benefit from speaking with your primary healthcare provider.
If you’re having problems with your genitals, your primary care doctor might refer you to a specialist in the reproductive and urinary system called a urologist.
If they suspect other problems, they may send you to other types of specialists such as a neurologist or endocrinologist.
How to Treat Erectile Dysfunction Regardless of Sleep Erections
The best way to treat erectile dysfunction depends on the underlying cause.
The first line of treatment for erectile dysfunction often involves lifestyle modifications such as:
improving your diet
increasing physical activity
quitting smoking
reducing alcohol intake
taking steps to improve your mental health
If psychological factors such as anxiety, stress, or depression are playing a role, you might benefit from undergoing counselling or therapy, possibly with your partner.
Medications such as phosphodiesterase-5 inhibitors are widely prescribed and effective in improving blood flow to the penis and facilitating erections. These drugs are taken orally before sexual activity, but they require sexual stimulation to be effective.
Medications approved in the United States include:
sildenafil (Viagra®)
tadalafil (Cialis®)
vardenafil (Levitra®, Staxyn®)
avanafil (Stendra®)
Most of the common side effects of these medications are minimal. One rare but serious complication that requires immediate emergency medical attention is priapism, a prolonged and painful erection lasting for more than 4 hours.
For men who do not respond to oral medications, other options include:
urethral suppositories
hormone replacement therapy, for individuals with low testosterone levels
In severe cases, surgical interventions such as penile implants or surgery are considered. These procedures are typically reserved for cases where other treatments have failed.
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Nocturnal Erections: The Final Word
Getting an erection (or multiple) while you sleep is perfectly normal and healthy. Not experiencing them at all can suggest problems with your health.
Detecting nocturnal erections can be challenging since they typically occur during the rapid eye movement (REM) stage of sleep, and you won’t be aware of them happening. One sign of having nighttime erections can include waking up with a boner, because humans tend to wake up coming right out of REM sleep.
If you’re waking up with erections in the morning but have trouble maintaining an erection firm enough for sexual intercourse, it may suggest that the underlying cause is psychological rather than physical.
It’s a good idea to talk to your healthcare provider about your sexual function if you’ve been experiencing sexual problems. Talking to your doctor about your sexual health can be embarrassing but there’s nothing you’ll tell your doctor that they haven’t heard before.
Your doctor can help recommend treatment options and prescribe medications that may help make it easier to achieve an erection such as sildenafil or tadalafil. They may also refer you to a specialist in urology who can perform further tests to look for problems with your erectile function.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment or medication.