Cortisone (S0) - Mid-Sleep

Cortisone is the inactive form of cortisol. Your body makes it directly from cortisol using an enzyme called 11b-HSD2, which operates locally in the kidneys, colon, and salivary glands. When cortisone shows up in your saliva, it reflects cortisol that was recently active in your bloodstream and was then deactivated as it passed through the salivary glands. This makes salivary cortisone a secondary marker for what cortisol is doing in circulation.

Studies have found that salivary cortisone correlates with blood (serum) free cortisol better than salivary cortisol itself does. This makes the cortisone reading especially valuable when it diverges from the cortisol reading at the same time point.

How to Read This Alongside Mid-Sleep Cortisol

When mid-sleep cortisol and cortisone both match (both elevated, both low, or both within range), cortisone confirms the cortisol picture. When they diverge, cortisone may be more telling. If your mid-sleep cortisol appears normal but cortisone is elevated, your true circulating cortisol may be higher than the cortisol reading alone suggests. The 11b-HSD2 enzyme in the salivary glands may be actively converting cortisol to cortisone, making cortisol appear lower while cortisone captures what cortisol was doing before that conversion.

The root causes of elevated nighttime cortisone mirror those of elevated nighttime cortisol: psychological stress, blood sugar dysregulation, pain, caffeine or alcohol consumption, and thyroid issues. The key difference is that cortisone gives you a second, potentially more accurate lens on the same underlying process.

Questions This Biomarker Can Answer

• Does my cortisone reading confirm or challenge what my mid-sleep cortisol shows?
• Could my true overnight cortisol exposure be higher than the cortisol value alone suggests?
• Is my stress system active during the night even if my cortisol reading looks normal?