As you read through the numerous articles and research on this blog you will quickly see that we have found that imbalances with certain neurotransmitters (which are brain chemicals that control most of the body’s functions) can lead to a great many disorders, including trichotillomania and the urge to pull, depression, anxiety, compulsive and/or obsessive thoughts and behaviors, food cravings, binging behavior, addictions, migraines and many others, including sleep disturbances. Therefore, it would not be surprising to find a relationship between these seemingly varied imbalances.

A quick look at the literature shows exactly that; an example:  there is a strong association between sleep disturbances and mood disorders, including depression. (1, 2) In fact, insomnia is reported by more than 90% of depressed patients. (3) This is all well and good, but how do we know that this correlation is due to neurotransmitter levels?


Research shows that in people suffering from insomnia, balancing the brain’s neurotransmitter levels can improve sleep. (4) This has led many researchers to believe that complete relief of insomnia may improve the symptoms of depression. (3) But what does this have to do with trich and the urge to pull?


Well, as we have talked about in previous articles, the urge to pull is often due to or intensified by imbalances in neurotransmitters, including serotonin and dopamine. Decreased sleep can cause, as well as be caused by, imbalances in these same neurotransmitters. This means that if a person has insomnia or purposefully does not get enough sleep over time (i.e., goes to bed late, has odd sleep habits, etc.), neurotransmitter imbalances can result. These imbalances will then lead to increased urges to pull. Incidentally, they also usually lead to increased cravings for carbohydrate or sugar-laden foods, particularly in the afternoon or evening, along with the need for stimulants of one kind or another to keep focused and alert (think coffee, soda, ‘energy’ drinks and chocolate). Unfortunately, in addition to keeping you a little more alert in the short term, these stimulants can also cause further neurotransmitter imbalances that keep you awake – and pulling.


Here are some simple things that you can do to begin lessening the effect of too little sleep on your urge to pull:

  1. Get as much sleep before midnight as possible; set a time and go to bed, say at 9-10 PM. Even if you can’t go to sleep right away, do some deep breathing and/or meditation and don’t worry about it. Your body is resting and eventually sleep will come.
  2. Set an alarm and get up at the same time daily, even if you don’t fall asleep well the night before. You may be in for a few rough days, but eventually, most people will begin to get into a more normal sleep cycle.
  3. Make your bedroom peaceful – turn off the lights, TV, radio and anything else that may distract you or keep you engaged. Sometimes, peaceful music or sounds can help, as can ‘white-noise’ such as a fan. Earplugs often help.
  4. Stop drinking liquids 2-3 hours before bed to limit the number of times you need to get up to use the bathroom
  5. Keep a notebook by your bed and write down everything that is churning through your mind and make a ‘to-do’ list for the next day. If new things come to you during the night, write them down and forget about them – they’ll be waiting for you in the morning.
  6. In the morning, so some exercise or yoga to help you wake up and minimize the need for stimulants. If you still need something, try green tea (Earl Grey Green Tea is a bit heavier for those die-hard coffee drinkers.)


If you have insomnia or long-standing sleep issues, these simple steps are unlikely to be of much help. In this case, a more thorough workup is often necessary and additional therapies may be needed. Luckily, we have found (as have numerous other researchers) that re-establishing optimal neurotransmitter balance can safely and effectively improve sleep over time. This, combined with giving yourself the opportunity to get enough sleep will not only have you sleeping better, it will help you eliminate your urge to pull. Small things really can make a big difference over time and sleep is KING when it comes to maintaining neurotransmitter balance.



  1. Ohayon MM, roth T. Place of chronic insomnia in the course of depressive and anxiety disorders. J Psychiatr Res. 2003 Jan-Feb;37:9-15.
  2. Germain A, Kupfer DJ. Circadian rhythm disturbances in depression. Hum Psychopharmacol. 2008 Oc;23(7):571-85.
  1. Thase ME. Antidepressant treatment of the depressed patient with insomnia. J Clin Psychiatry. 1999;60 (Suppl. 17):28-31.
  2. Irwin MR, Wang M, Ribeiro D. et al. Sleep loss activates cellular inflammatory signaling. Biol Psychiatry. 2008 Sep15;64(6):538-40.