Cortisol Awakening Response (CAR)
Doctor's Data
Sample type: Saliva
Requires fasting: No
At home test
Details
The cortisol awakening response is the natural rise in cortisol that is seen 30 to 40 minutes after awakening followed by a noticeable drop by 60 minutes. CAR can be utilized as a biomarker for assessment of the HPA axis function in routine clinical practice. CAR is influenced by overall HPA reactivity, as well as a person’s anticipation of stress.
The CAR involves a measure of the percent rise in cortisol from awakening to 30 minutes post-awakening and the expected decline in cortisol seen at 60 minutes. The Diurnal Cortisol Profile involves 4 cortisol samples taken at 30 minutes post-awakening, noon, dinner time, and bedtime. While the CAR can provide the best information on HPA axis reactivity and function, the Diurnal Cortisol Profile can identify dysregulation in the natural cortisol circadian rhythm.
- Cortisol Morning - AM60
- Cortisol Morning - AM30
- Cortisol Waking
Estimated days for results: Results should arrive 3 to 5 days after the lab receives samples.
• A high amount of psychosocial burnout
• Chronic fatigue
• PTSD
• Seasonal affective disorder (during winter)
• Nightshift work schedules
• Sleep apnea
• Short sleep cycles
• Chronic inflammation
• Adrenal insufficiency
• Lack of morning sunlight exposure
• Hippocampal damage or atrophy
• Amnesia (due to temporal lobe damage)
Factors associated with an elevated CAR include:
• Ongoing job-related and perceived stress (CAR is significantly higher on work days)
• Immediate access to light upon awakening
• Depression
• Ovulation phase of the menstrual cycle
• Sleep issues
• Older age
Cortisol levels should be at their highest level 30 minutes after waking up in the morning, decreasing gradually over the course of the day, reaching their lowest point at bedtime. The resulting diurnal curve or pattern allows health care providers to pinpoint issues with adrenal gland function. Alterations in this pattern can results in symptoms related to stress, fatigue and insomnia.
- Feeling stressed
- Fatigue
- Insomnia
- Nervousness/Irritability
- Salt/Sugar cravings
- Dizzy spells
- Headaches
- Decreased stamina
- Burn out
- Chronic disease
- Anxiety/Depression
3–5 business days
- Add-on: DHEA
- Add-on: Estradiol
- Add-on: Estriole
- Add-on: Estrone
- Add-on: Progesterone
- Add-on: Secretory IgA
- Add-on: Testoterone
- Please read the test collection instructions carefully.
- If you are a menstruating woman, collect one day during days 19-23 of your menstrual cycle (assuming a 28-day cycle). Day 1 of your cycle is the first day of your period.
- If you are a man or a non-menstruating woman, collect on any day.
- Place the YELLOW TUBE next to your bed the night before collection so you can collect saliva immediately upon waking. Set an alarm or timer as needed.
Hormone Use Instructions
- DO NOT discontinue any prescription medications without first consulting your healthcare provider.
- Topical hormones:
- Your last dose before sample collection should be 12-24 hours before collecting your first sample.
- DO NOT use on the day of saliva collection.
- Sublingual hormones or troches:
- Your last dose before sample collection should be 24-36 hours before collecting your first sample.
- Drink 2 full glasses of water (about 16 oz) after taking your last dose to clean the tissues.
- DO NOT take on the day of saliva collection.
- Hormone injections, subcutaneous pellets, or transdermal patches:
- Collect your samples at the halfway point between doses.
- Oral hormones (pills):
- Use as prescribed on the day of collection.
Cortisol or Cortisol-Containing Products
- If you are taking a cortisol supplement, glucocorticoid, or cortisol-containing medication, consult with your healthcare provider before collecting your samples.
- It is recommended to stop using these products 5 days before sample collection.
Day of Collection
- Avoid supplements and non-essential medications. DO NOT discontinue any prescription medications without first consulting your healthcare provider.
- Avoid caffeine-containing foods and beverages.
- Avoid anti-aging creams.
- Do not eat or drink anything (except water) until all samples are collected.
- Avoid the following for 30 minutes before collecting each sample:
- Brushing your teeth
- Flossing your teeth
- Having dental work done
- 10 minutes before each saliva collection, rinse your mouth with water.
Collection Schedule
- Sample 1: IMMEDIATELY upon awakening (within 5 minutes)
- Sample 2: 30 minutes after waking
- Sample 3: 60 minutes after waking
State restrictions:
Patient can't order this test if they are located in Hawaii, Puerto Rico, New Jersey, New York, or Rhode Island
