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The Awakening Cortisol Response: Methodological Issues and Significance
Abstract
The awakening cortisol response (ACR) is a discrete and distinctive part of the cortisol circadian cycle. In healthy adults salivary free cortisol concentrations increase by between 50 and 160% in the first 30 min immediately post-awakening (approximate average increase of 9 nmol/l, range 4-15 nmol/l, estimated to be equivalent to about three secretory episodes). However there are no agreed norms for the absolute concentrations of free cortisol in saliva either immediately post-awakening (range of 4.7-18.5 nmol/l) or 30 min post-awakening (range of 8.6-21.9 nmol/l). This review explores reasons for these discrepancies in normative data including confounding factors such as gender, age, awakening time, light and participant adherence. Although the physiological role of the ACR has not been clearly defined evidence is discussed that suggests it is under a distinct regulatory influence, different from the rest of the diurnal cortisol secretory cycle. Despite the difficulties associated with its measurement a range of studies have demonstrated an association between the ACR and psychosocial variables, stress and health. However it remains unclear whether positive affect and good health are consistently associated with larger or smaller awakening responses. It is early days in the search for the role and significance of the ACR. Its putative role in the regulation of physiological function across the day (e.g. the immune system) and its sensitivity to psychosocial variables make it a prime candidate as an intermediary linking mind and health.
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“CAR increases are large (on average 50-60% above waking levels) and highly variable across individuals; as a result, individual differences in the size of this indicator can be easily detected and modeled statistically, and are of a magnitude that is likely to be physiologically meaningful (Adam et al., 2006; Clow et al., 2004).”
From Prospective prediction of major depressive disorder from cortisol awakening responses in adolescence (2010) · cites this paper as Clow et al., 2004
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Kadooka, S., 平田, 勝., & Sugo, T. (2013) · 体力科學 · doi:10.7600/jspfsm.62.171 · Cited by 2
Aggarwal, K., & Hildebrand, G. D. (2017) · JAMA Neurology · doi:10.1001/jamaneurol.2016.5981 · Cited by 2
Linnemann, P., Friedrich, N., Nauck, M. A., Teismann, H., & Berger, K. (2022) · The World Journal of Biological Psychiatry · doi:10.1080/15622975.2022.2129445 · Cited by 2
Perceived happiness and cortisol awakening response on workdays and weekends
Okamura, H., Tsuda, A., & Matsuishi, T. (2010) · The Japanese Journal of Health Psychology · doi:10.11560/jahp.23.2_11 · Cited by 2
Metadata
- Authors
- Clow, A., Thorn, L., Evans, P., & Hucklebridge, F.
- Affiliations
- University of Westminster (GB)
- Venue
- Stress
- Publisher
- Informa UK Limited
- Published
- 2004-03
- Volume
- 7
- Issue
- 1
- Pages
- 29-37
- ISSN
- 1025-3890 (ISSN-L)
- 1607-8888
- OpenAlex
- W1973501977
- Cited by
- 856
- References
- 55
- Citations by year
- 2026: 10 · 2025: 19 · 2024: 14 · 2023: 21 · 2022: 32 · 2021: 34 · 2020: 43 · 2019: 47 · 2018: 31 · 2017: 47 · 2016: 54 · 2015: 51 · 2014: 55 · 2013: 47 · 2012: 47
- FWCI
- 2.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stress (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- cortisol awakening response, diurnal cortisol rhythm, cortisol secretion, reference values, gender differences, age effects, light exposure, participant adherence, positive affect, immune regulation, mind-body problem
- MeSH terms
- Adrenal Cortex, Arousal, Circadian Rhythm, Humans, Hydrocortisone
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