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Hair Loss and Sleep

By the age of fifty, 50% of men and 40% of women will experience androgenetic alopecia (male and female-pattern hair loss), while many others every year suffer from some other form of hair loss.

The emotional toll is enough to make some people want to do nothing but hide in bed. As it turns out, there might be something to that: hair loss and sleep are connected on multiple levels. From the impact of sleep apnea to the role of circadian cycles, there is much to learn from the relationship between hair loss (particularly androgenetic alopecia) and sleep.

We’ve put together the article below to explain hair loss, illuminate the relationship between hair loss and sleep, and inform you of your options in treating both hair loss and sleep dysfunction. Keep reading to learn more.

What is Hair Loss and Why Does it Happen?

Most people have about 100,000 hairs on their head. The majority of these — more than 90% — are anagen hairs. Anagen is the growing stage, when strands are anchored deeply in subcutaneous fat and are difficult to pull out. After 3 to 7 years, hair enters the telogen phase. Hair in this phase becomes anchored higher in the skin and can easily fall out or be pulled out. Diagram of the hair follicle

Healthy hair falls out at a rate of about 50-100 telogen strands a day. Hair loss occurs when we begin to lose more hair than grows back, which may initially present as finding more lost hair than usual in the shower or noticing a widening in the part of your hair.

There are many genetic and medical factors which can lead to hair loss. Androgenetic alopecia, the most common reason, is covered below, but other common causes include:

Cause Explanation
Telogen effluvium A sudden, temporary loss of hair in the months after childbirth, stress, or trauma.
Traumatic alopecia Hair loss from hairdressing techniques, heat, chemicals, or other physical causes.
Medications Many common drugs have hair loss as a side effect.
Illness Some hair loss can be attributed to medical conditions such as lupus, thyroid disorders, or hormone imbalances.
Fungal infection Funguses like tinea capitis can cause hair loss and a patchy, scaly scalp.

Androgenetic Alopecia

The most common form of hair loss in both men and women is androgenetic alopecia, also known as male-pattern or female-pattern hair loss. Men have the highest rates, with approximately 58% showing signs before the age of 49, but up to 38% of women are also affected.

Researchers are still investigating what genetic and environmental factors might aggravate or effect androgenetic alopecia. However, they do know that the primary cause is androgen hormones, particularly one called dihydrotestosterone.

Androgens, particularly dihydrotestosterone, are produced and used more in men than in women, but are essential for both male and female sexual development. Unfortunately, high levels of androgens in the hair follicle leads to a shorter anagen cycle, thinner and shorter hair strands, and delayed new hair growth. Together, these effects create androgenetic alopecia.

(It should be noted that despite the importance of androgens in this form of hair loss, researchers believe there may be a form of female androgenetic alopecia which could develop even in the absence of androgens. However, they also speculate this may be due to related genetic factors.)

Men and women are impacted differently by androgenetic alopecia, which is why the resultant hair loss is categorized as “male pattern” or “female pattern”.

Type Pattern
Male A receding hairline (beginning at the temples) and thinning hair over the crown of the scalp.
Female Thinning hair over the entire head, but no loss of hairline. (A receding hairline in females is often related to traumatic alopecia or other forms of hair loss.)

Because androgens are related to sexual development, hair loss usually begins at some point after puberty. The rate of hair loss can vary dramatically between individuals: most lose theirs gradually over 15-25 years, while others may lose the majority of their hair within 5 years. Overall, the average rate of hair loss for androgenetic alopecia appears to be 5% a year.

Effective treatments are available for androgenetic alopecia, ranging from medication and medical intervention to surgical options. However, lifestyle changes can also play a role in managing hair loss. Specifically, there is a significant amount of evidence suggesting that sleep is closely related to hair loss, particularly androgenetic alopecia.

How Sleep Can Affect Hair Loss

If you are concerned about hair loss, it’s worthwhile to examine the quality of your sleep. Studies on the subject have determined that everything from poor sleep to conditions like sleep apnea can affect your hair, while your circadian cycle may partially govern the life of your hair follicles.

Keep reading to learn more about this link, as well as the exciting new treatments which may result from this research.

Stress and Hair Loss

There is a significant three-way link among hair loss, stress, and sleep loss. Each of these factors impacts the others, potentially leading to a vicious cycle where anxiety over hair loss can lead to poor sleep, which then provokes further stress and sleep loss. Luckily, disturbing one stage of this cycle can lead to improvements throughout.

Hair loss, particularly androgenetic alopecia, is unquestionably a stressful condition. Among men, for example, 50-75% of men with some level of androgenetic alopecia are worried about going bald. Women are also severely impacted psychologically, particularly because society is less well-informed about female pattern baldness.

Given this, it can be exquisitely frustrating that stress can aggravate hair loss. Some scientists suggest that there is a “brain-hair follicle axis” which allows for this relationship, as stressful life events have been shown to create changes to the hair follicle which lead to premature hair death.

There are also indications that stress can impact mast cells in skin. Skin cells and hair follicles have a complex relationship, and skin or scalp conditions can prompt or worsen hair loss. Whether this is related to the proposed “brain-hair follicle axis” is unknown, but it provides another reason to avoid stressful situations.

Stress and Sleep

As anyone who has ever slept poorly can attest, sleep helps us cope with stress and poor-quality sleep is stressful in and of itself. Of course, you don’t have to rely on personal experience; many studies have confirmed that sleep deprivation has a wide range of stressful effects on the body.

These effects are sometimes surprising. For example, sleep deprivation causes people to anticipate the worst in situations, increasing stress through excessive worrying.

Sleep’s stress-beating properties can partially be explained via hormone levels. Our bodies communicate stress through a chain of hormones; a chain-reaction occurs and elevates levels of a hormone called ACTH, which then prompts the adrenal gland to create stress hormones like adrenaline. These, in turn, create the sensations which are felt as “stress”.

When we get enough sleep, this reaction is blocked. During sleep, the pituitary gland slows down its production of ACTH and the adrenal gland — along with the rest of the body — can recover from the day. Sleep deprivation, of course, prevents this chance to rest.

There is also a flip side to the stress-sleep connection: not only does lack of sleep induce stress, but stress can also make it much more difficult to sleep. However, disrupting this cycle can create improvements throughout. If you lower your stress levels, for example, you’re more likely to get a good night’s sleep and improve your levels further.

Researchers have been able to calculate the potential impact of sleep-related stress on hair loss, particularly androgenetic alopecia. The relationship is close enough for them to list poor sleep as a risk factor for hair loss, meaning that anyone concerned about androgenetic alopecia should consider the quality of their sleep and whether it could be improved.

Obstructive Sleep Apnea

Also known as sleep apnea, obstructive sleep apnea is a common sleep-related breathing disorder which affects approximately 12% of adult Americans. There is also strong evidence that in men with a family history of androgenetic alopecia, sleep apnea may be a risk factor for developing it yourself.

People who suffer from sleep apnea stop breathing multiple times a night when relaxed muscle and tissue blocks their airway. This causes both snoring (due to the muscle and tissue vibrating) and, more dangerously, a decrease in blood oxygen levels (called hypoxemia). Other symptoms include daytime sleepiness, headaches in the morning, weight gain, mood changes, dry mouth, and high blood pressure.

Men have a higher rate of sleep apnea than women, and they are also the focus of the connection between sleep apnea and hair loss. In one study, sleep apnea did not appear to have an impact on androgenetic alopecia. However, closer analysis showed that among men with a family history of male pattern baldness, sleep apnea was indeed a risk factor for hair loss.

This disparity may reflect a factor we’re not yet aware of, or different mechanisms at work in men with a family history of hair loss than in men with no family history.

Interestingly, sleep apnea and hair loss are also both seen in women with disorders which impact androgen hormone levels. While both conditions are secondary symptoms in these cases, the connection may one day shed light on how sleep conditions and androgenetic alopecia may be connected in men.

What is clear is that if you have a family history of male-pattern hair loss or any symptoms of sleep apnea, it’s worth speaking to your doctor. Sleep apnea is a serious condition on its own, and its potential role in androgenetic alopecia offers another reason to look closer at your sleep.

Circadian Rhythms and Melatonin

The hair follicle cycle — from anagen to telogen, and then replacement — is governed partially by your circadian rhythm. These rhythms (from the Latin circa, for “around”, and diem, for “day”) function as your body’s “internal clock” and control many other bodily processes, including when you feel alert, when you feel tired, and when you sleep.

In studies with animal subjects, disturbing their circadian sleep-wake cycle also disturbed the  circadian rhythms of hair follicle stem cells. While the jury is still out as to whether this may have an impact on androgenetic alopecia in humans, these studies still indicate that hair loss may be caused or exacerbated by sleep dysfunction.

One interesting factor in the circadian rhythm-hair loss relationship is the role of melatonin. A hormone produced by the pineal gland, melatonin impacts many bodily functions but is most well-known for its function in circadian rhythms and the sleep-wake cycle.

Melatonin and hair loss graph

The objective and subjective effects of topical melatonin on androgenic alopecia.

There is some evidence that melatonin also helps control the circadian cycle of hair follicles. Additionally, melatonin has been investigated as a topical treatment for hair loss. As an antioxidant, it combats the oxidative stress on hair follicles which can lead to generalized hair loss.

However, the most exciting news is that melatonin also reversed the appearance of androgenetic alopecia. Not only did the researchers confirm the lessening severity, but they found that research participants had an even more dramatic subjective experience of melatonin’s effect. Melatonin is a fascinating avenue for hair loss research, but as studies are still ongoing, it will be some time before doctors regularly prescribe it for androgenetic alopecia.

Treatments for Hair Loss

When diagnosing your hair loss, your doctor will make a physical examination as well as considering how you style your hair, your medical history, and medications you are on. They may also take a hair or skin sample, or refer you for blood testing if they suspect an underlying condition. After diagnosis, they will speak to you about your treatment options.

Medication

Pharmaceutical treatment is often the first line of defense against fungal or illness-related hair loss, but drugs are also available for androgenetic alopecia.

While some other drugs may have some effect on hair loss, only two have been approved by the FDA for use with male-pattern hair loss:

  • Minoxidil (Rogaine) is a topical, over-the-counter treatment for male-pattern hair loss. Effects usually take up to six months, and treatment must continue to retain the improved growth. New hair is sometimes shorter and thinner than it was previously, but otherwise, the drug is considered very effective.
  • Finasteride (Propecia) is a once-daily pill for male-pattern hair loss. As with minoxidil, users must continue taking it to continue seeing improvements. In most people, finasteride is well-tolerated and has a positive impact on both hair loss and new hair growth.

Because of the different ways male and female bodies respond to androgens (and, therefore, the various mechanisms of androgenetic alopecia), these medications are not appropriate for female-pattern hair loss. Instead, doctors are more likely to prescribe “androgen receptor antagonists” or hormonal birth control.

All medications come with side effects, and many hair loss drugs have challenging ones. Your doctor will work with you to determine the best choice for your needs, as well as how you can effectively control or avoid any unwanted effects.

Surgical Options

Many androgenetic alopecia sufferers decide on a surgical treatment option such as hair transplants. These procedures are constantly improving, and the latest generation is known to be safe and often very effective.

There are four common surgical treatments for hair loss:

Procedure Name Description
Hair Transplant Skin with healthy hair (from elsewhere on the scalp) is removed and grafted to areas with hair loss.
Flap Surgery The surgeon removes part of the scalp with hair loss, then covers the open area with a piece of skin with healthy hair. This piece is still connected on one side, forming a “flap” with excellent blood flow.
Scalp Reduction Bald areas of the scalp are removed before the remaining skin is pulled together. Hair transplants may or may not be used in conjunction.
Scalp Expansion A tissue-expanding device is inserted beneath an area of the scalp with healthy hair, next to a bald spot. Over time, the expander encourages the growth of new skin cells, which are then placed over the bald spot in a follow-up surgery.

Not everyone is a candidate for surgical hair loss treatment. As artificial hair is poorly accepted by the body, candidates must still have healthy “donor hair” to be transplanted or otherwise used to grow new cells.

There are also side effects associated with these procedures, despite their relative safety. Infection, scarring, bleeding, and patchy regrowth of hair are all concerns, and worth discussing with your doctor if you’re interested in surgical treatment.

Lifestyle Changes

  • Alone or in conjunction with other treatments, wigs can have a dramatic impact on self-esteem and help prevent the negative psychological effects of hair loss. Realistic styles are available at all price points and with both natural and synthetic fibers.
  • If you’re uninterested in a full wig, aesthetic products like shading lotions, building fibers, and spray thickeners can all mask hair thinning and loss.
  • Gentle hairdressing choices are the treatment for traumatic alopecia and a useful addition to treatment for other forms of hair loss. Try to avoid hairstyles which pull hard on hair roots, as well as harsh chemicals or weaves.
  • Nutritional supplements are a complicated subject. While nutrition imbalances can cause or aggravate hair loss, simply guessing at which supplements might help is not useful, as some can even make hair loss worse at high levels. Speak to your doctor or a nutritionist about what might work for you.

How to Sleep Better

Practice Good Sleep Hygiene

Everyone has habits and rituals they indulge in before going to sleep, routines which can have a positive or negative impact on their sleep. Your habits around sleep — when you go to bed, where you sleep, and even whether you charge your phone in your room — are collectively called your “sleep hygiene”.

Here are some proven tips on creating excellent sleep hygiene and achieving better sleep:

  • Choose a reasonable bedtime and stick to it as much as possible, even on the weekend. This will provide structure for your circadian rhythm and prevent sleep debt.
  • Light aerobic or weight-training exercise, as well as natural light exposure, are both beneficial in the morning or early afternoon.
  • Morning or early afternoon napping is beneficial, but avoid napping later or for longer than 30 minutes to avoid grogginess or sleep problems at night.
  • Electronic screens (and energy-efficient bulbs) emit what is called “blue light”. This wavelength mimics natural light and therefore plays havoc with our circadian rhythms, particularly at night. To mitigate the impact, try limiting screen use to before nightfall, or try a pair of blue-light-blocking glasses.
  • The ideal bedroom is both dark and quiet. Even if you think your room is dark, consider that light pollution from a window, night-lights, the hall light, and even electronic charging lights can all add up. Try blackout curtains and turning off lights to keep your room dark. As for noise pollution, a white-noise machine or earplugs can be very beneficial.
  • Most people sleep best at a cool temperature. If your room is warm and a fan isn’t enough, there are mattresses, mattress pads, and pillows meant to cool you down.
  • Your bedroom should be used only for sleeping and sex. Distractions like TVs, laptops, and other electronics confuse your brain about whether you’re going to sleep, as well as emitting blue light and often noise.

Mindfulness & Meditation Techniques

Given the impact of stress on both sleep and hair loss, relaxation techniques such as mindfulness and meditation are a useful skill to learn.

Enough studies have been done to indicate that these techniques are a valid and effective way of reducing stress. For example, mindfulness meditation is known to improve insomnia, sleep dysfunction, exhaustion, and depression.

Mindfulness is worth defining, as it is the focus of many of the successful studies on meditation. A secular philosophy based on Buddhist practice, mindfulness involves sitting in calm, neutral acceptance of yourself and the moment.

Yoga, as a blend of meditation and exercise, may also be worth looking into. 55% of yoga participants say they sleep better because of it, which is then reflected in the studies which show yoga can indeed improve sleep quality.

There are multiple ways of learning new relaxation techniques. There are almost certainly yoga classes near you, and meditation classes are available in many places. If you want to start on your own time, YouTube videos can be a helpful introduction. Here at Tuck, we like meditation apps for their ease of use, focus on mindfulness, and low cost.

Whatever method you choose, a commitment to lowering your stress should not result in further stress! If you find what you’ve chosen no longer works for you, try something new. Focus on small, achievable steps towards a less stressful tomorrow.

Conclusion

Whether you suffer from androgenetic alopecia or some other form of hair loss, you know that sleepless nights can be a side-effect. By focusing on sleeping better and lowering your stress, you’ll combat the sleep-hair loss connection and be clear-headed enough to focus on your next steps.

We hope this article has helped clarify hair loss for you, as well as its treatments and its complex relationship with sleep. Treatment is available for both hair loss and sleep dysfunction, so if reading this has raised any concerns, please speak to your doctor.

Additional Tuck Resources

To learn more about why we sleep, how to achieve better sleep, and our favorite sleep products, follow the links below:

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