Cortisol awakening response

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The cortisol awakening reaction (short: CAR = cortisol awakening response ) takes place immediately after waking up in the early morning and increases the concentration of the hormone cortisol in the blood and saliva in healthy people by around 50 - 156%. The significance of the cortisol wake-up reaction has not yet been clearly scientifically clarified, but it is assumed that cortisol mobilizes the energy reserves in the body in order to prepare the metabolism for the day ahead and possible stress .

Immediately after waking up, the hormone cortisol begins to be released, which lasts 30–45 min. reached its peak.

definition

Shortly after waking up, the concentration of cortisol increases by around 50-156% in the blood and saliva. This occurs in everyone regardless of their age, and the amount of increase may vary. The hypothalamus receives a stimulus that causes it to release CRF ( Corticotropin Releasing Factor ). This signals the pituitary gland to release the messenger substance ACTH ( adrenocorticotropin ) and to stimulate the adrenal cortex to release cortisol. The cortisol awakening response peaks 30 to 45 minutes after awakening.

The highest cortisol release occurs in the second part of the night, which in turn occurs in the early morning. After that, the cortisol level drops during the day to the lowest value during the first half of the night. The cortisol awakening response is subject to a circadian rhythm . However, a cortisol reaction can also be triggered by other factors or diseases and u. May require medical treatment. This can be influenced by several factors, in particular by stress , trauma, pregnancy, obesity, states of shock and various illnesses.

Influences on the cortisol awakening reaction

sleep

The sleep factor plays an important role in the cortisol wake-up reaction: If the duration of sleep is too short or if sleep is not restful, this has negative effects on the release of cortisol and the cortisol wake-up reaction. There are also other factors whose influence on the cortisol wake-up reaction has been proven:

  • Shift work: Nurses who worked early morning shifts (between 4:00 a.m. and 5:30 a.m.) had a larger and prolonged cortisol wake-up response than those who worked the late day shift (between 6:00 a.m. and 9:00 a.m.) O'clock) or the night shift (between 11:00 a.m. and 2:00 a.m.). Another study found, however, that this greater release of cortisol was due to increased stress and impaired sleep quality before shift change ("If these factors were taken into account, the difference in the cortisol awakening response in relation to the experimental state was no longer significant". , from: Kudielka & Kirschbaum (2017)).
  • Napping: Students who took naps in the early evening hours (between 6:45 p.m. and 8:30 p.m.) did not have a cortisol wake-up reaction, suggesting the reaction may not appear until after they have slept at night.
  • Waking up to light: cortisol wake-up response is greater when people wake up to light instead of dark.
  • Noise: The cortisol wake-up reaction is significantly reduced after nocturnal exposure to traffic noise or low-frequency noise (approx. 40 dB L (A) eq. ).
  • Waking up by an alarm clock or spontaneous awakening: There is no difference between days on which a person wakes up spontaneously or was woken up by an alarm clock.
  • Painkillers, hormone preparations: some drugs suppress the secretion of cortisol by having a negative influence on the ACTH secretion of the pituitary gland.

Psychological factors

  • Early risers show a greater cortisol wake-up response than late risers.
  • Exhaustion: inhibits the nocturnal release of cortisol and the cortisol wake-up reaction is lower.
  • Pain: the stronger the pain, the lower the nocturnal release of cortisol and the cortisol wake-up reaction.
  • Socio-economic factors, social status and material standard of living: the worse these conditions are, the lower the cortisol wake-up reaction.

stress

The cortisol wake-up response is greater for those who:

  • wake up on a normal work day instead of a vacation day
  • get up earlier.
  • suffer from acute stress, e.g. B. Exams at school or university.
  • suffer from heavy workload or excessive demands.
  • Burn-out syndrome : Teachers who suffered from high stress levels or burn-out symptoms showed a high rise in cortisol.

Various everyday situations are associated with stress: the more stressful the stress, the higher the cortisol release. If no solution can be found for the stress factor, the probability is high that the constant release of cortisol can impair health and damage e.g. B. by a heart attack.

Individual evidence

  1. ↑ a b c Tobias Stalder, Clemens Kirschbaum, Brigitte M. Kudielka, Emma K. Adam, Jens C. Pruessner: Assessment of the cortisol awakening response: Expert consensus guidelines . In: Psychoneuroendocrinology . tape 63 , p. 414-432 , doi : 10.1016 / j.psyneuen.2015.10.010 ( elsevier.com [accessed August 25, 2017]).
  2. ↑ Bernhard Kleine, Winfried Rossmanith: Hormone and hormone system - textbook of endocrinology. Springer Spectrum; Heidelberg - Berlin 2013, ISBN 978-3-642-37091-5 .
  3. ↑ a b Stefan Wüst, Jutta Wolf, Dirk H. Hellhammer, Ilona Federenko, Nicole Schommer: The cortisol awakening response - normal values ​​and confounds . In: Noise & Health . tape 2 , no. 7 , 2000, ISSN  1463-1741 , p. 79-88 , PMID 12689474 .
  4. ↑ A. Steptoe, B. Serwinski: Chapter 34 - Cortisol Awakening Response. Stress: Concepts, Cognition, Emotion, and Behavior. Handbook of Stress, Series Volume 1, Academic Press, London - Oxford - Boston - New York - San Diego 2016, Pages 277–283, ISBN 978-0-12-801137-9 .
  5. ^ Günther K. Stalla: Cortisol. Regulation and substitution. German Society for Endocrinology eV Hormones & Metabolism. (PDF 1.2 MB).
  6. ↑ Expertise method: Cortisol Awakening Response (CAR). daacro Contract Research, Trier, accessed on August 21, 2017 (archive).
  7. ^ J. Hellhammer, E. Fries, OW Schweisthal, W. Schlotz, AA Stone, D. Hagemann: Several daily measurements are necessary to reliably assess the cortisol rise after awakening: State and trait components . Psychoneuroendocrinology 2007 (32): p. 80-86, doi: 10.1016 / j.psyneuen.2006.10.005.
  8. ^ Yoichi Chida, Andrew Steptoe: Cortisol awakening response and psychosocial factors: A systematic review and meta-analysis. Review. Biological Psychology Volume 80, Issue 3, March 2009, Pages 265-278, doi: 10.1016 / j.biopsycho.2008.10.004.
  9. ↑ Angela Clowa, Frank Hucklebridge, Tobias Stalder, Phil Evans, Lisa Thorna: The cortisol awakening response: More than a measure of HPA axis function. Review. Neuroscience & Biobehavioral Reviews, Volume 35, Issue 1, September 2010, Pages 97–103, doi: 10.1016 / j.neubiorev.2009.12.011.
  10. ^ DocCheck Flexikon: Cortisol. ( Archive ).
  11. ↑ Jörg Braun, Dirk Müller-Wieland: Basic textbook internal medicine. Urban & Fischer Verlag / Elsevier GmbH, Munich - Jena 2017, ISBN 978-3-437-41115-1 .
  12. ^ Dunja Voos: Cortisol: The stress hormone. Cortisol is an endogenous hormone that is involved in many metabolic processes and is increasingly released during stress. Apotheken-Umschau , March 30, 2017 ( archive ).
  13. ^ Bessel A. van der Kolk : Psychological consequences of traumatic experiences: Psychological, biological and social aspects of PTSD. Institute for Trauma Therapy. ( Archive )
  14. ↑ Ellen R. Klaassens, Erik J. Giltay, Pim Cuijpers, Tineke van Veen, Frans G. Zitman: Adulthood trauma and HPA-axis functioning in healthy subjects and PTSD patients: A meta-analysis. Review. Psychoneuroendocrinology Volume 37, Issue 3, March 2012, Pages 317–331, doi: 10.1016 / j.psyneuen.2011.07.003 .
  15. ↑ Michèle Wessa, Nicolas Rohleder, Clemens Kirschbaum, Herta Flora: Altered cortisol awakening response in posttraumatic stress disorder. Psychoneuroendocrinology, Volume 31, Issue 2, February 2006, Pages 209–215, doi: 10.1016 / j.psyneuen.2005.06.010.
  16. ↑ Saskia van Liempt, Johan Arends, Pierre JM Cluitmans, Herman GM Westenberg, René S. Kahn, Eric Vermetten: Sympathetic activity and hypothalamo-pituitary-adrenal axis activity during sleep in post-traumatic stress disorder: A study assessing polysomnography with simultaneous blood sampling. Psychoneuroendocrinology, Volume 38, Issue 1, January 2013, Pages 155–165, doi: 10.1016 / j.psyneuen.2012.05.015.
  17. ↑ BM Kudielka, C. Kirschbaum: Awakening cortisol responses are influenced by health status and awakening time but not by menstrual cycle phase . In: Psychoneuroendocrinology . tape 28 , no. 1 , p. 35-47 , doi : 10.1016 / s0306-4530 (02) 00008-2 ( elsevier.com [accessed August 25, 2017]).
  18. ^ I. Federenko, S. Wüst, DH Hellhammer, R. Dechoux, R. Kumsta, C. Kirschbaum: Free cortisol awakening responses are influenced by awakening time . In: Psychoneuroendocrinology . tape 29 , no. 2 , p. 174-184 , doi : 10.1016 / s0306-4530 (03) 00021-0 ( elsevier.com [accessed August 25, 2017]).
  19. ^ Frank A. Scheer, Ruud M. Buijs: Light Affects Morning Salivary Cortisol in Humans . In: The Journal of Clinical Endocrinology & Metabolism . tape 84 , no. 9 , September 1, 1999, ISSN  0021-972X , p. 3395–3398 , doi : 10.1210 / jcem.84.9.6102 ( oup.com [accessed August 25, 2017]).
  20. ↑ L. Thorn, F. Hucklebridge, A. Esgate, P. Evans, A. Clow: The effect of dawn simulation on the cortisol response to awakening in healthy participants . In: Psychoneuroendocrinology . tape 29 , no. 7 , p. 925–930 , doi : 10.1016 / j.psyneuen.2003.08.005 ( elsevier.com [accessed August 25, 2017]).
  21. ↑ dB L (A) eq = energy-equivalent A-weighted continuous sound level in dB . The immission limit value according to DIN 18005 " Noise protection in urban development" is 40 dB L (A) eq for urban residential areas .
  22. ↑ Gerhard Müller, Michael Möser: Acoustic measurement technology (specialist knowledge of technical acoustics). Springer Vieweg, 2017, ISBN 978-3-662-55370-1 .
  23. ↑ Noise relevance and EU requirements: Requirements, delimitation and adaptation processes for noise protection (2007). Federal Ministry for Transport, Building and Urban Development (BMVBS) and the Federal Office for Building and Regional Planning (BBR).
  24. ↑ Kerstin Persson Waye, Angela Clow, Sue Edwards, Frank Hucklebridge, Ragnar Rylander: Effects of nighttime low frequency noise on the cortisol response to awakening and subjective sleep quality . In: Life Sciences . tape 72 , no. 8 , p. 863-875 , doi : 10.1016 / s0024-3205 (02) 02336-6 ( elsevier.com [accessed August 25, 2017]).
  25. ↑ Stuart Watson, Kate Horton, Samantha Bulmer, Jane Carlile, Ciaran Corcoran: Effect of aspirin on hypothalamic – pituitary – adrenal function and on neuropsychological performance in healthy adults: a pilot study . In: Psychopharmacology . tape 205 , no. 1 , July 1, 2009, ISSN  0033-3158 , p. 151 , doi : 10.1007 / s00213-009-1525-4 ( springer.com [accessed August 25, 2017]).
  26. ^ A b Brigitte M. Kudielka, Ilona S. Federenko, Dirk H. Hellhammer, Stefan Wüst: Morningness and eveningness: The free cortisol rise after awakening in “early birds” and “night owls” . In: Biological Psychology . tape 72 , no. 2 , p. 141–146 , doi : 10.1016 / j.biopsycho.2005.08.003 ( elsevier.com [accessed August 25, 2017]).
  27. ↑ Meena Kumari, Ellena Badrick, Tarani Chandola, Emma K. Adam, Mai Stafford: Cortisol secretion and fatigue: Associations in a community based cohort . In: Psychoneuroendocrinology . tape 34 , no. 10 , p. 1476–1485 , doi : 10.1016 / j.psyneuen.2009.05.001 ( elsevier.com [accessed August 25, 2017]).
  28. ↑ LA Fabian, L. McGuire, GG Page, BR Goodin, RR Edwards: The association of the cortisol awakening response with experimental pain ratings . In: Psychoneuroendocrinology . tape 34 , no. 8 , p. 1247–1251 , doi : 10.1016 / j.psyneuen.2009.03.008 ( elsevier.com [accessed August 25, 2017]).
  29. ^ Caroline E. Wright, Andrew Steptoe: Subjective socioeconomic position, gender and cortisol responses to waking in an elderly population . In: Psychoneuroendocrinology . tape 30 , no. 6 , p. 582-590 , doi : 10.1016 / j.psyneuen.2005.01.007 ( elsevier.com [accessed August 25, 2017]).
  30. ^ Nalini Ranjit, Elizabeth A. Young, George A. Kaplan: Material hardship alters the diurnal rhythm of salivary cortisol . In: International Journal of Epidemiology . tape 34 , no. 5 , October 1, 2005, ISSN  0300-5771 , p. 1138–1143 , doi : 10.1093 / ije / dyi120 ( oup.com [accessed August 25, 2017]).
  31. ↑ Wolff Schlotz, Juliane Hellhammer, Peter Schulz, Arthur A. Stone: Perceived work overload and chronic worrying predict weekend-weekday differences in the cortisol awakening response . In: Psychosomatic Medicine . tape 66 , no. 2 , March 2004, ISSN  1534-7796 , p. 207-214 , PMID 15039505 .
  32. ^ A. Steptoe, M. Cropley, J. Griffith, C. Kirschbaum: Job strain and anger expression predict early morning elevations in salivary cortisol . In: Psychosomatic Medicine . tape 62 , no. 2 , March 2000, ISSN  0033-3174 , p. 286-292 , PMID 10772410 .
  33. ↑ JC Pruessner, DH Hellhammer, C. Kirschbaum: Burnout, perceived stress, and cortisol responses to awakening . In: Psychosomatic Medicine . tape 61 , no. 2 , March 1999, ISSN  0033-3174 , p. 197-204 , PMID 10204973 .
  34. ↑ Martina Melzer: How stress damages the heart. In: Apotheken Umschau from: November 7, 2016. ( apotheken-umschau.de [accessed on August 23, 2017], archive ).