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Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out certain psychological causes of ED. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then ED is likely to have a physical rather than psychological cause. Tests of nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be applied for best results. The causes of erectile dysfunction include aging, high blood pressure, diabetes mellitus, cigarette smoking, atherosclerosis, depression, nerve or spinal cord damage, medication side effects, alcoholism or other substance abuse, and low testosterone levels. Common adverse effects include headache, flushing, rhinitis, dyspepsia, or indigestion; assess cardiovascular status before use; caution with left ventricular outflow obstruction or conditions aggravated by hypotension or prolonged QT interval; caution with hepatic impairment (decrease dose); may cause prolonged or painful erection (<2%) The report was published in the July issue of The American Journal of Medicine. looking for cheap viagra online? 150mg viagra online without prescription