What Do My Sleep Test Results Mean?

Dr. Robert Rountree: 

This is The Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet, supplements, and lifestyle approaches to good health. I'm Dr. Robert Rountree, Chief Medical Advisor at Thorne and functional medicine doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who express them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease.

Dr. Robert Rountree:

Hi, everyone, and welcome to The Thorne Podcast. This week we're going to be exploring all of the insights and offerings inside of Thorne's sleep at-home test kit. As always, when we do one of these test kit deep dives, in addition to our audio episode, we're releasing a video from this recording along with it, so be sure to check that out on Thorne.com or on our YouTube page so you can follow along as we go over our results. Joining me to talk about this test is my friend, my colleague, and returning guest, Thorne's Vice President of Medical Affairs, Dr. Amanda Frick. Welcome, Amanda!

Dr. Amanda Frick:

Hi! Thanks for having me.

Dr. Robert Rountree:

Yeah, you bet’cha. How are you doing? What's new in your life?

Dr. Amanda Frick:

Not a lot new in life, but getting ready for holiday, taking some trip home to Michigan to visit family, so excited about that.

Dr. Robert Rountree:

It's great to be back with you again. I'm really excited about this particular episode because we're going to talk about sleep! Why is sleep important? An obvious question, but some people don't think sleep’s important!

Dr. Amanda Frick:

Who doesn't think sleep's important?

Dr. Robert Rountree:

You know, I had a client recently and I told the client, “You've got to read Matthew Walker's book, ‘Why We Sleep,’” which I recommend to anybody. If you've never read it, he makes such a strong case for why we're sleep deprived as a nation, and people that have really busy jobs think, “I just don't have time for it.” So it isn't that they don't think it's important. They just don't think it's a priority. Right? So, you know, “If I need to stay up all night and get a project done, I'll do that.” What about a typical student who stays up all night? I did that in college! I missed many a night's sleep in college, preparing for exams. According to Dr. Walker, that's not good for your memory.

Dr. Amanda Frick:

Haha!

Dr. Robert Rountree:

Staying up all night is not good for your memory because you need the sleep to help you consolidate memories.

Dr. Amanda Frick:

Right.

Dr. Robert Rountree:

So, who might want to take a sleep test? What? Why would you want to do this?

Dr. Amanda Frick:

I mean, I think the obvious would be if you're not sleeping well and you’re not really sure why. We'll see when we look at these that you're kind of looking at how your stress is affecting your sleep, too. I mean, this isn't just about sleep, which is really great. So you could also take it if you think stress is affecting your sleep. And then, like you said, if you maybe if you have memory struggles, maybe if you're you know, things aren't quite clicking the way you would like or cognitive ability is feeling like it's suffering a little bit. I think those are some other really good reasons other than the obvious like “you don't really sleep well.”

Dr. Robert Rountree:

I mean, I got to say, I've sent patients to sleep specialists and it seems like they're interested in one thing – “Does the person have sleep apnea?”

Dr. Amanda Frick:

Mm-hmm.

Dr. Robert Rountree:

Right? So we'll, you know, we'll have you do a conventional sleep study where you put on all the machines and we measure your oxygen, and that's all they do! And I guess I'm a little shocked by that.

Dr. Amanda Frick:

Yeah. They only give you one option, too. You're doing one test looking for one thing, and then the outcome is either you get one option or you don't, and that's it.

Dr. Robert Rountree:

Yeah, it doesn't make any sense. Like, “Well, you don't need CPAP, so there's nothing I can do to help you.”

Dr. Amanda Frick:

So bye!

Dr. Robert Rountree:

Yeah, bye-bye. And that's the end of the story. So again, people that might want to do this test are anyone that has trouble with sleep, anyone that's gotten feedback from their sleep tracker that something is off, or perhaps a person who's chronically fatigued may not think that they're having trouble with sleep. And I certainly have patients like that all the time. “Yeah, I sleep just fine.” And then again, I might get feedback from the sleep tracker that says that's not really the case. They think they're sleeping fine. They're maybe a little curious about why they wake up in the morning and their sheets are out in the hall, right? “Yeah, I slept just fine last night. I don't know how the sheets got out there!”

Dr. Amanda Frick:

Haha! For example...

Dr. Robert Rountree:

For example, like. And that's a question I ask patients, like, “Do you ever wake up and find your sheets, you know, on the floor?” “Yeah. Never move during the night. I don't know how those sheets get torn up.” Right? Completely ripped off the bed. So, the bottom line is that sleep disorders are very common in our society. So this is not a rare thing at all for somebody to have a problem with sleep. And that means to me, the threshold for ordering the tests is very low.

Dr. Amanda Frick:

Right.

Dr. Robert Rountree:

So walk me through what you do. You order the tests online and then?

Dr. Amanda Frick:

It gets sent to your house so you'll get everything that you need to get shipped to your home. You have to activate the kit with a code that's on the back of the container, which is really easy. You just log into your Thorne account, fill out your health profile if you need to, or you haven't already, put in a code that's on the back of your test, and then you're ready to collect.

Dr. Robert Rountree:

Okay, very cool. So, we've both taken the test. Why don't we walk listeners through what it looks like?

Dr. Amanda Frick:

Sounds good!

Dr. Robert Rountree:

All right! So, Amanda, these are my results, and... Okay, I have to admit, I'm not a great sleeper. One thing that I learned is that it takes me a long time to fall asleep. Right? And as a result of that, I started going to bed much earlier because I realized that even though I was in bed for 9 hours, I may only be getting 8 hours of sleep. And I think this test may explain something. So what the results showed to me – in measuring my melatonin – is that my melatonin levels are basically pretty low all the time. They never peak at night. And something I've noticed, I don't really take melatonin on a regular basis every now and then I think about it when I travel, I take melatonin with me to help adjust, although it generally is not easy for me to adjust to new time zones, especially when I've gone to other parts of the world. You know, if I'm in Singapore, I'm just bleary eyed for days on end. So I've noticed when I do take melatonin, I hardly notice anything. I can take 20 milligrams and it doesn't do anything. What does this tell you? If I was your patient and you saw somebody whose melatonin levels were just in the gutter, what would you tell them?

Dr. Amanda Frick:

So I would like to start with the good news with my patients. And I would say I am very glad that you feel like you're getting a good night's sleep!

Dr. Robert Rountree:

Yeah, I am now that I allow more time.

Dr. Amanda Frick:

Okay. Really, what this shows me is that because there's no change, it's almost a flat line level when it really should... You can see that sort of green bar that you should have a wave. That wave is like an on-off switch for your brain, like the melatonin is not doing on or off. It just doesn't move. And so there's not any clear sort of indication to your brain that it's time to go to sleep. So it doesn't surprise me at all that it would take you a long time because you almost have to have your body decide it's time to go to sleep because your brain's not getting the cue.

Dr. Robert Rountree:

I guess the million-dollar question is, does this mean I should take melatonin on a regular basis? I mean, if I don't naturally make... so, I just don't naturally make it for whatever reason. It doesn't necessarily mean there's pathology. And that's you know, what is said is in the text right here is that there's no evidence this negatively affects your sleep or health. It's just that I don't... I'm just one of those people that doesn't make it.

Dr. Amanda Frick:

And I do think melatonin declines with age. So it could be that maybe.

Dr. Robert Rountree:

I’m old! Haha!

Dr. Amanda Frick:

Maybe 20 years ago...and no, I wasn't trying to call you old!

Dr. Robert Rountree:

Yeah. You know, I actually think I did do a test like this 20 years ago, and I think my melatonin was fine. So, so you're right. This could be a consequence of not getting younger! But what do you think? Should I take melatonin?

Dr. Amanda Frick:

I think you could. You could consider it if it helps you. I think of melatonin or I always did in my practice as a reset or like a retrain.

Dr. Robert Rountree:

Like when you travel.

Dr. Amanda Frick:

Right. Exactly. Like you were saying or if you have jet lag or to get your sort of circadian rhythm back on cycle, it doesn't know what time night is supposed to be anymore. So helping like get your brain back into the groove, but I do think I think some people feel like they need it on a nightly basis to help them fall asleep.

Dr. Robert Rountree:

And there's no reason they can't do that.

Dr. Amanda Frick:

Exactly.

Dr. Robert Rountree:

Especially if they do this test and they get results like mine, which I don't I don't really know. I haven't seen this kind of curve too often.

Dr. Amanda Frick:

That's not a curve, Bob, that’s a line.

Dr. Robert Rountree:

I haven't seen the flat...this flat line. I've...my melatonin is flatlined. I haven't seen that that often...would suspect that you know, this indicates they could benefit from taking some.

Dr. Amanda Frick:

Yeah exactly.

Dr. Robert Rountree:

So now let's look at my... so the two things that are measured in the sleep test are melatonin. And unlike some tests that only measure melatonin in the morning, this measures it four different times during the day.

Dr. Amanda Frick:

Right, exactly.

Dr. Robert Rountree:

And I think it's not actually measuring melatonin. It's like 6-sulfatoxymelatonin...it’s some metabolite. So now we look at my cortisol, isn't this great? Haha! So I start out in the morning with enough cortisol, but I have to say that I enjoy a cup of espresso.

Dr. Amanda Frick:

Mm-hmm. Me too.

Dr. Robert Rountree:

An espresso really helps get me going. And if I don't have my morning coffee, you know, 8:00 or so, then generally by 9 or 10, I can tell it. I'm clearly making cortisol and I'm doing fairly well on the quote “curve.” It's not so much a curve. I mean, it's relatively flat, but I am making reasonable amounts in the evening. But something about that morning tells me my adrenal glands are just not great at getting going until... it actually... the insight says, “As a result of your low levels, you might be experiencing a tough time getting out of bed.” I am not a morning person, right? I can... I can stay up really late and be completely alert and feeling good. So, does that kind of explain why?

Dr. Amanda Frick:

It could, it could. It could be that melatonin cycle thing, too. I mean, the melatonin signal to wake up is the same. So you have a little bit of a double whammy. So you don't have the... you don't have the thing dropping to tell your brain it's time to get up. And you also don't have the cortisol sort of jump starting you in the morning. So it makes sense to me that it would be hard for you to get up and out of bed.

Dr. Robert Rountree:

So what you're saying is that when you when you look at these results, you would diagnose me as somebody that doesn't have great circadian rhythms.

Dr. Amanda Frick:

I definitely would.

Dr. Robert Rountree:

Okay. So maybe I need to do a little something to get into a more rhythmic pattern in my life, perhaps more bright light early in the morning?

Dr. Amanda Frick:

Yeah, bright light, some sleep hygiene things, maybe. Also, there are supplements that help to sort of reset. We have data about NA – proper levels of NAD+ helping to reset circadian rhythm. So that may be something to think about as well.

Dr. Robert Rountree:

So if I was going to take something to reset my NAD, what I want to do that in the morning, or would it matter?

Dr. Amanda Frick:

I don't think you necessarily have to, no. I don't think it would necessarily matter. But I like to recommend NAD in the morning or things that support NAD in the morning because you can kind of get an energy jump or some clarity and a lot of people would like that earlier in the day and not later in the day. But if it's something that didn't affect you in that way, you could take it whenever worked best for you.

Dr. Robert Rountree:

Recommendations: Mediterranean Diet, that’s a good thing. Melatonin-rich foods, which a lot people don't realize there's melatonin in tart cherries and walnuts and tomatoes. So that seems like a good thing. Should probably not have a nightcap, which I don’t. So that... that won't be hard to change. But you know that that nighttime schnapps, you know, if somebody... if somebody is having a pattern like mine, cut back on the schnapps. The caffeine, I do only limit it to morning, so I think that's very reasonable. Licorice or grapefruit juice. And interestingly enough, I do love a shot of grapefruit juice when I first get up. I am really fond of the flavor. Is that weird? I don’t know but...

Dr. Amanda Frick:

Mmm I love grapefruit juice.

Dr. Robert Rountree:

I love grapefruit juice.

Dr. Amanda Frick:

The white kind, the super bitter sour kind is like...

Dr. Robert Rountree:

Yeah. Yeah, ah! Just... I couldn't love it too much. So it looks like I need to work on my sleep routines and I need a little more exercise in the morning. Maybe I need to meditate. And then melatonin! We talked about melatonin and then Cortex. You're going to have to remind me, is that pantothenic acid?

Dr. Amanda Frick:

Cortex is, no, botanical, nutrient, and adrenal.

Dr. Robert Rountree:

And adrenal glandular. Okay, so that makes sense. I, I wouldn't want to take prednisone. Right?

Dr. Amanda Frick:

Haha no!

Dr. Robert Rountree:

So, something like Cortex would be a better choice and Phytisone [renamed to Stress Balance] is kind of an anti-inflammatory. Great! Well, why don't we switch over and look at yours, and we're going to put you on the spot, okay?

Dr. Amanda Frick:

Oh boy.

Dr. Robert Rountree:

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Dr. Robert Rountree:

Okay, so Amanda, now let's move on to your test results. First thing I have to ask you – are you a good sleeper or not?

Dr. Amanda Frick:

I'm the person that would say, “I sleep. I feel like I have good sleep.”

Dr. Robert Rountree:

Alright, so you sleep like a baby?

Dr. Amanda Frick:

I think I do! I fall asleep. I fall asleep really quickly. Although some people say that's not a great sign. I do feel like I sleep well. Although I'm struggle bus in the morning. I could... I could watch some funny Instagram videos for a minute before I can get up and get going.

Dr. Robert Rountree:

Oh, I see. All right. Well, I'm a little bit envious that you can do that. And I'm very curious to see what your test results are going to show.

Dr. Amanda Frick:

So mine starts a little bit better. It does say my sleep cycle is in rhythm and my wake cycle’s a little out of rhythm. So really what that's referring to is a melatonin... my melatonin curve compared to my cortisol curve, but this is what my melatonin curve looks like, so...

Dr. Robert Rountree:

Whoa, look at that.

Dr. Amanda Frick:

Look at those pretty green dots!

Dr. Robert Rountree:

Pretty green dots right in the middle of the normal range.

Dr. Amanda Frick:

Yep, I'm pretty happy with that. I honestly have never measured my melatonin before, so this is really self-validating for me saying that I sleep well because I think I'm right. But I was pleased with what my melatonin curve looked like here.

Dr. Robert Rountree:

I'm curious, have you ever taken melatonin?

Dr. Amanda Frick:

I haven't.

Dr. Robert Rountree:

So you... you have no idea how you might respond to it?

Dr. Amanda Frick:

Nope. I try not to take hormones if I don't need them, and I haven't ever felt like I needed [to]. I also have never taken a nice international travel trip that would require me to... to come back from jetlag, because if I did, I would probably take it. I did recommend it for my patients, but I have never taken it myself.

Dr. Robert Rountree:

So the reason I ask is because I occasionally have a patient who I think needs melatonin. And I'll say, “Well, if you start with a low dose, you know, maybe a milligram or milligram and a half, you'll be fine.” And they come back and say, “Boy, that just knocked me out! You know, I take a milligram before bedtime. And then 10 hours later, I couldn't even think.” And I'm going, “How is that possible?” Clearly everyone responds in a little bit different way. So I wonder if somebody like you who's already got plenty of melatonin around, if you took melatonin, you might be one of those people that seems to be super sensitive to it.

Dr. Amanda Frick:

Yeah, that’s possible.

Dr. Robert Rountree:

Cause you got plenty.

Dr. Amanda Frick:

And because I don't have trouble sleeping, I would have never thought of it. Like I said, I have more of the opposite problem. If I'm tired, we don't have any... there's no time. It's like people that get hangry. If we're out and I say, “I'm tired, I need to go to bed,” it's time to go home and go to bed right now.

Dr. Robert Rountree:

Yeah, time to go.

Dr. Amanda Frick:

Yeah.

Dr. Robert Rountree:

Okay, so let's look at your cortisol.

Dr. Amanda Frick:

This one is not as pretty.

Dr. Robert Rountree:

And then you say you're not a morning person?

Dr. Amanda Frick:

I am not a morning person. And I'm obviously not a night person either, so I guess I'm just a sleep person! Haha!

Dr. Robert Rountree:

It's interesting. Your cortisol goes up a little bit towards bed, towards you know, the middle of the night.

Dr. Amanda Frick:

Yeah, I actually wanted to talk about that. So that's the one thing that's a green. I mean, we didn't talk about it so much with yours, but in good and bad ways. So I have three red and one green. You know, green is supposed to be in range and red is out. But to me, that green one at the end, because it comes up, is worse. So if you didn't have the one come up at the end, the pattern is closer to that sort of curve that looks like either like a ski slope, like should be high in the morning and lower at night. And mine's actually coming up when it shouldn't. So now, even though it looks like that's the only one that's right. To me, that's the one that's most wrong because the pattern overall doesn't look good instead of the number. I have seen mine look way worse than this. I've done stress tests multiple times. And so to me, this guy is like a win! So the one that's higher in the morning and actually they drop three times in a row – I haven't had one and that looked like that in many, many years. So I'll take that as a success!

Dr. Robert Rountree:

You’ll take it! Does this mean your adrenal glands are just getting stirred up at night? I mean, not... obviously not a lot, because they're not... it's not going through the roof it’s not spiking, it’s just that your adrenal glands seem to be waking up a little bit.

Dr. Amanda Frick:

Yeah, I think that that's what's happening. I think that trying to get them back into pattern without... I've had a history of having spikes sort of in the middle of the day and having really low at night and just having a completely abnormal pattern. So I think that's what's happening. I am really bad about screen time. I'd be first to admit that I am not good with my sleep hygiene. I think, I think I get away with it because I fall asleep easily enough. But I don't think that that's helping with that sort of uptick that I'm getting later at night.

Dr. Robert Rountree:

Now, I'll be curious to see what the recommendations are, but I know in the functional medicine community, a typical response to something like this would be to say, “Maybe you'd benefit from a little bit of Phosphatidylserine or Iso-Phos [renamed to Phosphatidylserine] towards the end of the day.” And there's actually some pretty interesting research showing that that really works!

Dr. Amanda Frick:

I love Iso-Phos, this is exactly what I would tell me to take is Iso-Phos. Haha! Yeah.

Dr. Robert Rountree:

I would tell me to take Iso-Phos and you know, Iso-Phos, I mean, it has no side effects. It seems to improve memory, cognition, and a lot of other things. So the main indication would be the elevated cortisol, but it's got all these other side benefits.

Dr. Amanda Frick:

Exactly. It's like good brain juice, but...that helps you...

Dr. Robert Rountree:

Good brain juice, yes! So should we scroll down and see what the recommendations were? Curious about...

Dr. Amanda Frick:

So I got some similar ones to yours. So by following a Mediterranean diet, I... not every night, but probably a couple of nights a week, am the nightcap person and not meant to the purpose of a nightcap but because I'm enjoying myself.

Dr. Robert Rountree:

Yeah?

Dr. Amanda Frick:

I promptly sent a message to someone else on our clinical team who helped write these and told her she probably needed to reconsider her employment because she wasn't going to tell me what to do with my booze at night. Haha! It was that I also have a double espresso every morning and I do love grapefruit juice. Mine talks about getting a healthy sleep routine and that's similar to yours and working out in the morning. And then I got two products, so I did not get Iso-Phos, but I got Cortrex, which makes sense to me to help get that sort of morning level in a little better spot and support my cortisol being a little bit higher in the morning. And then Relora, as the one I got at night.

Dr. Robert Rountree:

Have you ever taken Relora?

Dr. Amanda Frick:

I have.

Dr. Robert Rountree:

A very interesting product. I think it's mag... It's magnolia, right?

Dr. Amanda Frick:

Mm-hmm, magnolia phellodendron and B vitamins!

Dr. Robert Rountree:

And B vitamins and works in a similar way to the Phosphatidylserine.

Dr. Amanda Frick:

Right. Exactly.

Dr. Robert Rountree:

It's blunting both of those herbs together, blunt that rise in cortisol.

Dr. Amanda Frick:

I think it's possible... we talked about when you get ready to do a test, you're filling out your health profile, I do have some indicators on my health profile about food cravings... and it's possible that that's what helped contribute to getting a Relora recommendation over an Iso-Phos.

Dr. Robert Rountree:

I see. Okay, so they were individualizing your recommendations based on your questionnaire?

Dr. Amanda Frick:

Yeah, we like to do that.

Dr. Robert Rountree:

We like to do that. Okay. And then Cortrex and was there anything else?

Dr. Amanda Frick:

Nope, I got two.

Dr. Robert Rountree:

That was it. Okay, so the Cortrex to get you going a little bit more in the morning. Maybe... so Cortrex in your espresso, that might be the recommendation for the day! Sprinkle a couple of cups in with your espresso shots and you're ready to go!

Dr. Amanda Frick:

Not sure how I'd feel about that B vitamin flavor in my espresso...

Dr. Robert Rountree:

Oh, yeah, yeah, yeah.

Dr. Amanda Frick:

Well, see.

Dr. Robert Rountree:

So maybe someday Effusio will come up with a disk that's got everything flavored just right.

Dr. Amanda Frick:

Yeah, that would be nice!

Dr. Robert Rountree:

All right, folks, that's all the time we have this week. Amanda, thank you so much for coming on the podcast again! And just as a reminder, if people want to follow more of your work, find out what you're up to, what the latest developments are, the latest tests, etc., what's the best way to keep in touch?

Dr. Amanda Frick:

I think you'll get the best updates by signing up for email updates on thorne.com. Watch our Take 5 Daily blogs which we post regularly, and we feature those on social media and then sign up to get Research Extract emails if you're a physician, and then watch for those in a blog post if you're a consumer.

Dr. Robert Rountree:

Terrific. Well, that was Thorne's Vice President of Medical Affairs, Dr. Amanda Frick. As always, thank you, everyone, for listening. If you like what you've heard, tell a friend about our show and keep on tuning in.

Thanks for listening to The Thorne Podcast. Make sure to never miss an episode by subscribing to the show on your podcast app of choice. If you've got a health or wellness question you'd like answered, simply follow our Instagram and shoot a message to @ThorneHealth. You can also learn more about the topics we discussed by visiting Thorne.com and checking out the latest news, videos, and stories on Thorne's Take 5 Daily blog. Once again, thanks for tuning in and don't forget to join us next time for another episode of The Thorne Podcast.