When is it Time to Have Your Melatonin Tested?
Michael Breus
Psychologist/ Board Certified Sleep Specialist/ Speaker (100+)/ Media (300+ appearances: Oz, CBS, Rachel Ray, etc)
We talk a lot about melatonin in relation to sleep. It’s a central hormone in the sleep process. Melatonin regulates our daily sleep-wake cycles and keeps our 24-hour circadian rhythms in sync. Melatonin isn’t a sedative—but it is a powerful facilitator. In addition to regulating our daily sleep rhythms, melatonin prepares the body to fall asleep and stay asleep throughout the night.
When melatonin levels are low, and melatonin’s natural production cycles are disrupted, that has a significant impact on sleep. Many people don’t know, melatonin also plays a widespread role in protecting our health, as an antioxidant, and anti-inflammatory, an immune-boosting hormone, and an anti-cancer agent in the body. We need to maintain healthy melatonin levels to protect our sleep, and for the protection of our general health.
How do you know if your body is producing the melatonin it needs? What should you do if you think you might have a melatonin deficiency? When should you get your melatonin levels tested? What should you do if you get a low melatonin test result? Read on for answers.
Melatonin 101
First, a quick review of how melatonin works in the body. We produce melatonin naturally. Melatonin is made in the brain’s pineal gland, as well as in the gut and other tissues in the body. But it’s pineal melatonin that appears to be responsible for sleep-wake cycle and circadian rhythm regulation, and preparing the body for the onset of sleep.
The production of pineal melatonin is stimulated by darkness and suppressed by light. Melatonin production in the body follows a 24-hour circadian rhythms that, broadly speaking, looks like this: melatonin levels rise significantly during the evening hours and peak around 3 a.m. before falling to a 24-hour low early in the morning, as the sun rises as we wake for the day. Melatonin levels remain low during the day, before beginning a gradual rise in the late afternoon that’s followed by an evening surge that begins after sunset.
High levels of nighttime melatonin pave the way for sleep—both the onset of sleep and the continuity of our sleep throughout the night. Melatonin assists in lowering body temperature and blood pressure, and helps the body’s nervous system shift into rest mode, including helping to inhibit production of other hormones that stimulate wakefulness. And melatonin supports sleep by keeping circadian rhythms in sync, and our master circadian clocks aligned with the 24-hour cycles of day and night (light and dark).
Low levels of melatonin contribute to problems falling asleep and staying asleep, and can be a factor in sleep disorders, including insomnia and circadian rhythm sleep disorders.
What causes melatonin deficiency?
There are a number of factors that can contribute to low and dysregulated melatonin.
Age: As we get older, our bodies naturally produce less melatonin, and the production of nighttime melatonin appears to shift to later in the night. Age-related melatonin decline begins in early middle age, around age 40-45. Some research has shown that a 70 year old adult has roughly 10% of the melatonin production of children before puberty (when melatonin levels are at a lifetime high).
Stress: Research indicates that stress contributes to dysfunction in the pineal gland, where melatonin is produced. Cortisol, a primary stress hormone, exists in an opposing relationship to melatonin. When cortisol levels are high, melatonin levels are low, and vice versa. Overproduction of cortisol can impair healthy melatonin levels.
Irregular sleep-wake routines: Shift work, and irregular schedules for sleeping and waking, throw circadian rhythms and melatonin production out of sync.
Some medications: Non-steroidal anti-inflammatory medications (NSAIDS), beta blockers (often taken for high blood pressure and other cardiovascular issues), and some medications for depression and anxiety can interfere with melatonin production.
Stimulants: Both caffeine consumption and alcohol consumption are linked to reductions in melatonin production.
LIGHT EXPOSURE: Light has a defining effect on melatonin levels and on sleep. Exposure to light at night is a major contributor to low melatonin levels and shortened nightly cycles of melatonin production. Not getting enough light exposure during the day can also have a negative impact on melatonin levels. Light exposure in the morning helps keep circadian rhythms aligned and stimulates an earlier peak time for nighttime melatonin production.
What are the signs of melatonin deficiency?
Given its fundamental role in sleep physiology, it’s no surprise that problems with sleep are signals of a possible melatonin deficiency. Signs of low melatonin include a range of sleep symptoms and issues with daytime functioning as well as mood:
When to test your melatonin levels
A lot of my patients have questions about when, and how, to have their melatonin levels tested. Low melatonin can be a significant factor in sleep disruption. There are many factors that can contribute to sleep problems, and that affect sleep and melatonin at the same time.
Here’s what I tell my patients. The first best step in addressing disrupted sleep, daytime fatigue and concentration problems is to take an inventory of your sleep hygiene, and identify areas that need adjustment. Before you opt to test your melatonin levels, ask yourself:
Am I sleeping on a consistent schedule? A routine of sleeping and waking at the same time every day reinforces circadian rhythms and keeps our circadian clock in sync, and gives the body the consistency it needs to function optimally, including its melatonin production.
Am I managing my light exposure? Limiting excess exposure to artificial light at night is critical to protecting sleep and promoting healthy melatonin production. And it’s easier than you think, even with all the digital devices that fill our lives. Blue light blocking glasses filter out the light that’s most disruptive to the nighttime melatonin surge we need to facilitate our sleep. I use them all the time, and I designed a pair for adults, and a pair for kids.
Don’t forget about morning light, as part of your wake-up routine. Getting a 10-minute dose of sunlight in the morning will drive melatonin levels down—exactly what you want to have happen first thing in the a.m. This will help keep melatonin’s circadian rhythm in sync, and keeps sleep-wake cycles from shifting to later in the night.
Am I limiting caffeine and alcohol consumption, and consuming at the optimal times of day? There’s evidence that caffeine inhibits the production of melatonin. And caffeine consumption late in the day delays the evening upswing in melatonin production and delays circadian sleep-wake cycles. There’s also evidence that higher lifetime consumption of caffeine is associated with a loss of volume in the pineal gland, which may contribute to reduced melatonin production and problems with sleep in older age.
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Alcohol can inhibit melatonin production—and how much it affects melatonin depends on how much you consume. One study found no effects on melatonin from a single drink over a 24-hour period, in a group of healthy adult women. But consuming two drinks in 24 hours was associated with a 9% reduction in melatonin, and 3 or more drinks were associated with 15% and higher reductions in melatonin levels.
Here are the basics on alcohol’s relationship to sleep, and some recent science on how alcohol can interfere with the sleep benefits of our exercise routines.
If you have these fundamentals of sleep hygiene in place, and you’re not sleeping well—particularly if you’re having trouble falling asleep, and your sleep routine is irregular, it may make sense to have melatonin levels tested.
What about when you’re having symptoms of insomnia?
The symptoms of insomnia—trouble falling asleep, difficulty staying asleep during the night, waking early, feeling unrefreshed by sleep and fatigued during the day—overlap with some of the most common signs of low melatonin. Melatonin deficiency can be a factor in insomnia. But there are other common factors in insomnia that frequently occur both with and without melatonin deficiency, including:
If you’re experiencing chronic insomnia—insomnia symptoms that occur three or more nights a week for more than a month—it may make sense to have melatonin levels tested. This is especially the case if your insomnia symptoms include an inability to maintain a regular sleep routine and/or trouble with sleep onset—that’s difficulty falling asleep at the start of the night. If you’re feeling wired and tired at bedtime, while practicing the sleep hygiene fundamentals I’ve described above and practicing a pre-sleep routine that prioritizes relaxation and minimizes light exposure, consider melatonin testing.
Testing for melatonin deficiency can provide important information about your sleep—but it’s essential to remember that melatonin is one part of the complex physiology of sleep. Always take your concerns about your sleep, and all your sleep-related symptoms, with your physician—and ask for a referral to a sleep specialist.
How to choose a melatonin test
Your doctor can test your melatonin levels, using blood, urine, and saliva tests. Many people are interested in testing melatonin levels on their own, using home tests that are now widely available. At-home tests rely on urine or saliva samples. One advantage of home testing is that it’s easy to get multiple readings of melatonin levels of the course of a 24-hour day. That can be important in getting a full and accurate picture of your daily melatonin rhythm. There are several important factors to consider if you’re planning to test melatonin levels at home. Be sure to choose a test that:
Collects several samples over a single 24-hour period. To accurately gauge a daily melatonin rhythm, tests should collect samples in the morning, afternoon, early evening, and at night.
Tests cortisol as well as melatonin. Cortisol and melatonin are both essential to daily sleep-wake cycles. And these two hormones have opposing daily rhythms. When cortisol levels are high, melatonin levels are low, and vice-versa. Some of the best tests available also test for cortisone, a byproduct of cortisol that’s been metabolized. Testing for cortisol and cortisone can reveal potential issues in the way the body uses cortisol.
Submits results to be analyzed at a certified laboratory. You’ll collect your samples at home, and send them to a pathology lab for analysis. (It’s important to follow precisely all instructions about the timing and collection of samples, in order to protect the accuracy of results.) In selecting a home melatonin test, make sure the results go to a laboratory that is CLIA-certified. This is the US government’s certification for laboratories that test human samples.
Gives clear guidance on how to read your results. Both melatonin and cortisol follow daily circadian rhythms, and levels of these hormones change substantially throughout the day and night. Before you decide on a test, make sure the results you’ll receive provide you specific individual measurements for each sample taken at each point during the testing period. You should be able to identify clearly whether any of your individual samples are within normal range, low or high.
Includes physician review of results. The best at-home melatonin tests will have all results reviewed by a doctor.
Protects your data. Only select a test that protects the privacy of your medical information through encryption, complies with HIPPA, and does not share data with any other party.
What to do if you melatonin levels are low
You take a melatonin test, and your results come back with a reading that falls outside of the normal range. (This could be any one of the multiple readings your test required.) What now?
Take your results to your physician. Melatonin testing is helpful in identifying deficiency or abnormality in your current daily melatonin production. But the test can’t tell you why your melatonin levels are off. And the test can’t diagnose a sleep disorder, or another health condition that’s affecting your sleep and your melatonin levels.
Don’t just start taking melatonin without talking to your doctor. You may need a melatonin supplement—here’s what to know about how to use melatonin, and common mistakes to avoid when using a melatonin supplement. But don’t start taking melatonin before you discuss your results with your doctor, have any follow up tests or screenings they recommend, and have your physician recommend an appropriate dose.
What if your melatonin levels come back normal, and you’re experiencing trouble with your sleep? You guessed it—talk to your doc. I can’t emphasize this enough. If you’re not experiencing a melatonin deficiency, that’s good news. But any problems with sleep and daytime functioning warrant follow up with your doctor, to get to the root cause and determine the right treatment.
Sweet Dreams,
Michael J. Breus, PhD, DABSM
The Sleep Doctor™