DUTCH Cortisol Awakening Response (CAR)

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Category:

Turnaround Time: 8-10 days
Test Type: Kit Based

Overview:

A low or blunted Cortisol Awakening Response 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 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 study1 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.

What is the Cortisol Awakening Response and how do we test for it? 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.

How to Collect Saliva

  1. Begin collecting right when you wake up, before getting out of bed. Remove the blue cap, and place the cotton swab from the collection device in mouth.
  2. Leave in mouth until fully saturated but not longer than 5 minutes. Lightly chewing on the swab may help stimulate saliva flow.
  3. Once done, place swab back in the same tube, just as you found it. Do not remove the inner tube. You do not need to spit into the tube. Touch the swab as little as possible with your hands. Label each device completely.
  4. Freeze all saliva samples until they are ready to ship.

Important Note: For the waking sample, set the saliva collection device, the requisition form, and a pen next to your bed. It is helpful to have a timer nearby to set for 30 and 60 minutes after you have begun your first collection. After collecting the first sample, it is best for you to be in a well-lit place.

How to Return

Upon Completion

  1. After freezing the saliva samples, place them back inside the test kit box.
  2. Be sure to check that each sample is clearly labeled. Include the completed requisition form.

Shipping Information

Place the entire test kit box inside the return envelope. Affix the prepaid label or postage if applicable. Return using the appropriate carrier. International patients: please check with your practitioner on where to return the kit if there is not a return envelope/label included (avoid leaving out in warm weather).

 

*Not available in NY, NJ , and RI*

Collection Details:

Patient Preparation:

If you or anyone in your household is using hydrocortisone cream, discontinue the day before and wash your hands thoroughly before handling any part of the test kit.

Collection Instructions:

How to Collect Saliva

  1. Begin collecting right when you wake up, before getting out of bed. Remove the blue cap, and place the cotton swab from the collection device in mouth.
  2. Leave in mouth until fully saturated but not longer than 5 minutes. Lightly chewing on the swab may help stimulate saliva flow.
  3. Once done, place swab back in the same tube, just as you found it. Do not remove the inner tube. You do not need to spit into the tube. Touch the swab as little as possible with your hands. Label each device completely.
  4. Freeze all saliva samples until they are ready to ship.

Important Note: For the waking sample, set the saliva collection device, the requisition form, and a pen next to your bed. It is helpful to have a timer nearby to set for 30 and 60 minutes after you have begun your first collection. After collecting the first sample, it is best for you to be in a well-lit place.

How to Return

Upon Completion

  1. After freezing the saliva samples, place them back inside the test kit box.
  2. Be sure to check that each sample is clearly labeled. Include the completed requisition form.

Shipping Information

Place the entire test kit box inside the return envelope. Affix the prepaid label or postage if applicable. Return using the appropriate carrier. International patients: please check with your practitioner on where to return the kit if there is not a return envelope/label included (avoid leaving out in warm weather).