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A salivary measure of your body's active stress hormone 30 minutes after waking, capturing the peak of the morning surge that signals your stress system's ability to mobilize for the day.
This sample captures cortisol at the point when it should reach its highest level of the day: roughly 30 minutes after waking. The rise from your waking value (S1) to this peak (S2) is called the cortisol awakening response, or CAR.
The CAR is not simply a measure of how much cortisol you have. It may be viewed as an HPA axis resilience marker, an anticipatory marker of upcoming daily events, and a surrogate for your stress system's plasticity and reactivity. It is influenced by gender, health status, and stress perception. The CAR is relatively distinct from later cortisol secretion throughout the day and is not secreted in response to stress.
A blunted rise from S1 to S2 indicates a low CAR. A low CAR has been associated with type 2 diabetes, chronic fatigue syndrome, hypertension, functional gastrointestinal disorders such as irritable bowel syndrome, chronic stress or burnout, cardiovascular and autoimmune conditions, postpartum depression, major depression, seasonal affective disorder, PTSD, jet lag insomnia, sleep apnea, and poor sleep quality. It may also result from awakening in darkness rather than light, or from medications that suppress HPA axis activity.
An exaggerated rise indicates an elevated CAR. An elevated CAR has been associated with job-related stress, anticipatory stress, relapsing-remitting multiple sclerosis, visceral adiposity, metabolic syndrome in females, inflammation, and white light exposure. A low S1 combined with a normal or high S2 may simply reflect a robust anticipatory response to the day's demands.
An absent CAR, where there is no increase at all from S1 to S2, is seen in people with hippocampal damage (especially those with memory loss), high adverse childhood events scores, obstructive sleep apnea, and chronic low-level noise exposure during sleep. An absent CAR is normal in about 15% of healthy adults.
For a low or absent CAR, support may include foundational HPA axis support, sleep hygiene improvement, light exposure upon waking, aerobic exercise, a multivitamin to address possible nutrient deficiencies, cognitive behavioral therapy (CBT), CPAP for obstructive sleep apnea, improving the sleep sound environment (such as ear plugs for noise exposure), and stress reduction through parasympathetic nervous system support, calming herbs, or GABA support.
For an elevated CAR, the key is addressing the underlying source of anticipatory stress. Additional support may include adaptogenic herbs, parasympathetic nervous system support, herbal calming support, GABA support, sleep hygiene, journaling, CBT, CBT for insomnia (CBTI), Rhodiola rosea, and SSRIs when clinically appropriate.