DUTCH Cortisol Awakening Response (CAR) includes graphical representation of the cortisol awakening response from 5 x free cortisol and 5 x free cortisone samples. The CAR provides an excellent snapshot of HPA axis function and can be used as a ‘mini stress test.’
Thirty minutes after waking cortisol levels will increase by an average of 50%. By 60 minutes they will have peaked and started to decline. The rise and fall of the CAR can be measured using salivary swabs upon waking and at 30 and 60 minutes after waking. A low CAR can be a result of an underactive HPA axis, psychological burnout, seasonal affective disorder (SAD), sleep issues, PTSD, chronic fatigue, chronic pain, hypertension, gastrointestinal issues, post-natal depression and autoimmune disease. An elevated CAR can be the result of an overactive HPA axis, anticipatory stress, glycaemic dysregulation, pain and depression.
Salivary cortisol sampling is done with Salivette™ collection, these are specifically made for testing cortisol when timing needs to be precise. The small synthetic cotton swab can be quickly and easily saturated with saliva making collection fast and easy. The analysis is done by LC-MS/ MS.
When should I use
Assessing the CAR is useful where underactive or overactive HPA Axis function is suspected, for example:
• excessive psychological burnout
• seasonal affective disorder
• sleep apnea
• poor sleep in general
• chronic fatigue
• chronic pain
• autoimmune diseases
• glycemic dysregulation
• pain (i.e. waking with painful joints or a migraine)
What is the Cortisol Awakening Response and how is it tested?
When we open our eyes upon waking, cortisol levels naturally begin to rise by an average of 50%. 30 minutes after waking, cortisol levels will still show this sharp increase. By 60 minutes after waking, cortisol levels have peaked and begin to decline. Measuring this rise and fall of cortisol levels at waking can be used as a “mini stress test”. Research shows that the size of this increase correlates with HPA Axis function, even if the sample measurements are all within range. A quick saturation of saliva swabs upon waking, and at 30 and 60 minutes after waking, provide what is required to assess a patient’s Cortisol Awakening Response.
A low or blunted Cortisol Awakening Response
This can be a result of an underactive HPA Axis, excessive psychological burnout, seasonal affective disorder
(SAD), sleep apnea or poor sleep in general, PTSD, chronic fatigue, and/or chronic pain. A decreased CAR has also been associated with systemic hypertension, functional GI diseases, postpartum depression, and autoimmune diseases.
An elevated Cortisol Awakening Response
This can be a result of an over-reactive HPA Axis, ongoing job-related stress (anticipatory stress for the day), glycemic dysregulation, pain (i.e. waking with painful joints or a migraine), and general depression (not SAD). A recent study showed that neither the waking nor post-waking cortisol results correlated to Major Depressive Disorder, but the CAR calculation (the change between the first two samples) did. This measurement of the response to waking has independent clinical value showing dysfunction that may be hidden by current testing options.