The cortisol awakening response – Applications and implications for sleep medicine

Summary The stress hormone cortisol is the end product of the hypothalamic–pituitary–adrenal (HPA) axis, and the cortisol awakening response (CAR) refers to the rapid rise in cortisol levels observed immediately following awakening. During the CAR period, cortisol levels typically increase by 38%–75...

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Bibliographic Details
Published in:Sleep medicine reviews 2014-06, Vol.18 (3), p.215-224
Main Authors: Elder, Greg J, Wetherell, Mark A, Barclay, Nicola L, Ellis, Jason G
Format: Article
Language:English
Subjects:
Arousal - physiology
Circadian Rhythm - physiology
Cortisol awakening response
Depressive Disorder, Major - physiopathology
Humans
Hydrocortisone - blood
Hypothalamic–pituitary–adrenal axis
Hypothalamo-Hypophyseal System - physiopathology
Insomnia
Motivation - physiology
Neurology
Paraventricular Hypothalamic Nucleus - physiopathology
Pituitary-Adrenal System - physiopathology
Polysomnography
Sleep - physiology
Sleep Deprivation - physiopathology
Sleep Initiation and Maintenance Disorders - physiopathology
Sleep Medicine
Stress
Suprachiasmatic Nucleus - physiopathology
Wakefulness - physiology
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Summary:Summary The stress hormone cortisol is the end product of the hypothalamic–pituitary–adrenal (HPA) axis, and the cortisol awakening response (CAR) refers to the rapid rise in cortisol levels observed immediately following awakening. During the CAR period, cortisol levels typically increase by 38%–75%, peaking approximately 30 min after awakening. Evidence suggests the function of the CAR may be related to arousal, energy boost and/or anticipation, although its precise function is still unknown. The CAR has been investigated in a range of clinical populations including the assessment of daytime dysfunction in insomnia; however little research, if any, has specifically examined its relation to sleep architecture, or night-time difficulties associated with insomnia. The aim of this review is to provide an overview of the CAR, a description of the factors which can affect it, and to outline the CAR in relation to the ‘3P’ model of insomnia. This review concludes with a description of a standard protocol for measurement of the CAR, which can be adapted and applied within sleep medicine.
ISSN:1087-0792
1532-2955
DOI:10.1016/j.smrv.2013.05.001