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  4. Chris talks about how different people have different chronotypes, which would influence whether they had a tendency to stay up later or go to bed earlier. Is this something that shows up on a 23andMe test, and which gene would we be looking for? Do you think this would slightly influence cortisol production, making it slightly higher in the evening? I see you say really high cortisol is pathologic regardless of chronotype.

Chris talks about how different people have different chronotypes, which would influence whether they had a tendency to stay up later or go to bed earlier. Is this something that shows up on a 23andMe test, and which gene would we be looking for? Do you think this would slightly influence cortisol production, making it slightly higher in the evening? I see you say really high cortisol is pathologic regardless of chronotype.

Dr. Amy Nett:  Yes, absolutely. So, I think you hit on a few key points there. Chronotypes, as far as we know, there is actually not a genetic predisposition that I’m aware of that’s been identified, so no genes that I know of that you can look for in 23andMe, but where you’re going to tease this out is the clinical history. This is going to be the patient who is going to tell you, “I’m a night owl. I sort of have always been this way. I’ve always gone to sleep late. I’ve never been able to start in the morning.” A lot of us say, yeah, I used to have kind of a normal rhythm, but now I don’t know. I get a second wind in the evening. I crash in the afternoon. My daily rhythm has changed. There is a change to it. That’s where most of us are going to recognize our HPA axis dysregulation. In this case, and in the case of a chronotype, yeah, you probably would see some difference in the normal cortisol rhythm, and you’re right. You would probably see slightly higher cortisol in the evening, but you would still see a preserved rhythm. Remember, when patients are taking these tests, they’re taking them relative to their waking and sleeping time, so the times are going to be shifted, but the curve should still be the same, and the curve should still be within the reference ranges, so you’re correct in saying high cortisol is still going to be pathologic. It’s just the timing of the curve, so unfortunately, no—no way to test chronotype, but it’s really probably history where you’re going to get that.

 

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