How Do You Feel On Waking: Understanding The CAR

It Takes Me Two Hours and Two Cups of Coffee to Feel Human

When you wake up in the morning, how long does it take you to go from conscious to alert?

Ideally, you answered 30 to 45 minutes.

This is a biological process known as the cortisol awakening response (CAR). It's a natural rise in cortisol that occurs after waking to help you become alert, energized, and ready for the day.

Researchers think this response developed as a survival mechanism. Thousands of years ago, when our ancestors woke up, they had no idea what the day would bring. Would there be food? Would there be danger? Would they have to run, hunt, or defend themselves? A healthy cortisol awakening response prepared the body for whatever came next.

Today, we often use CAR as a marker of how your brain and body are anticipating the day ahead.

If you found yourself thinking,

"It takes me two hours and two cups of coffee before I feel awake."

or

"I wake up at a level 10 with anxiety."

then I immediately start thinking about your cortisol awakening response.

One of my favorite clues as a clinician is when someone starts a sentence with:

"When I wake up..."

• When I wake up, I'm exhausted.

• When I wake up, I hit snooze three times.

• When I wake up, I'm in so much pain.

• When I wake up, I immediately feel panic.

• When I wake up, my autoimmune symptoms flare.

• When I wake up, I'm already stressed.

• When I wake up, my blood sugar is higher than I expected, even though I ate well yesterday.

Now, is the cortisol awakening response the only explanation for these symptoms?

Of course not.

But it can absolutely be one piece of the puzzle.

So what actually happens?

As your usual wake-up time approaches (and most of us are surprisingly predictable creatures), your brain begins signaling your adrenal glands to produce cortisol. Levels gradually rise before you even open your eyes. Then, within about 30 to 45 minutes after waking, cortisol increases even further. This surge is your cortisol awakening response.

For some people, hearing that cortisol rises first thing in the morning sounds alarming because they've been taught that cortisol is the "bad" stress hormone.

It's not.

Cortisol is made in response to stress because stress requires energy. If you need to escape danger, fight an infection, regulate inflammation, maintain blood pressure, or even keep your blood sugar stable between meals, cortisol is one of the hormones helping make that happen.

The truth is, you would not survive without cortisol.

It's also an important part of your circadian rhythm. You want a healthy rise in the morning because cortisol supports alertness, energy, glucose regulation, immune function, inflammation, and helps your brain transition from sleeping to being awake.

Once cortisol reaches its morning peak, it should gradually decline throughout the rest of the day before reaching its lowest point around bedtime so you can sleep.

In other words, cortisol and melatonin are almost opposite dance partners.

Cortisol should be highest in the morning and lowest at night.

Melatonin should be lowest in the morning and highest at night.

When that rhythm starts to shift, it's not unusual for people to notice changes in their energy, sleep, mood, pain, or even blood sugar.

Can you test your cortisol awakening response?

Yes.

One of the easiest ways is through a saliva test.

To measure the cortisol awakening response correctly, saliva is collected:

• Immediately upon waking

• 30 minutes after waking

• 60 minutes after waking

When graphed, you're hoping to see a nice mountain. Cortisol should rise after waking, peak, and then begin its gradual decline.

For example, if your practitioner runs the DUTCH Plus test, it includes the cortisol awakening response along with a comprehensive assessment of your hormones and cortisol rhythm throughout the day.

Sometimes, however, the mountain doesn't look like a mountain at all.

Maybe it shoots straight up and becomes much higher than expected.

Maybe it barely rises.

Maybe it actually drops instead of rising.

Each pattern can be associated with different symptoms and may point us in different clinical directions.

The research on CAR can be a little mixed because it's a dynamic response. Sleep quality, pain, illness, work stress, travel, anticipation, and even what happened the day before can all influence your results. That means your cortisol awakening response isn't necessarily identical every single morning.

That said, after years of using CAR in clinical practice and teaching practitioners how to interpret it, I often see patterns that make sense when combined with someone's history, symptoms, and the rest of their laboratory findings.

Like most things in medicine, a lab result is far more useful when it tells the same story your patient is already telling.

If your cortisol awakening response is too high...

The first question I ask isn't, "How do we lower cortisol?"

It's...

Why is your brain asking for so much cortisol first thing in the morning?

• How did you sleep?

• Are you in pain?

• Did something stressful happen yesterday?

• Are you waking repeatedly during the night?

• Are you anxious about work before your feet even hit the floor?

• Do you have blood sugar swings overnight?

Those answers help determine where we start.

If someone is waking already feeling stressed, panicked, anxious, or "on," there are calming nutrients and herbs that may be helpful after discussing them with their healthcare provider.

Depending on the individual, I might consider nutrients or herbs such as magnesium, inositol, ashwagandha, holy basil, milky oats, lavender, L-theanine, or others that help support a calmer nervous system.

But notice the order.

I don't start with the supplement.

I start by asking why the body feels it needs to mount such a large stress response before breakfast.

If your cortisol awakening response is too low...

A blunted cortisol awakening response can feel very different.

These are the people who often tell me,

• "I don't feel human until 10 a.m."

• "It takes forever for my brain to turn on."

• "Coffee is doing all the heavy lifting."

Again, I still want to know about sleep, pain, stress, illness, medications, and anything else that may be influencing the pattern.

Then I almost always start talking about circadian rhythm.

One of my favorite clinical tools for supporting a healthy cortisol awakening response isn't found in a supplement bottle.

It's sunlight!

Or, at least, bright full spectrum light (not your phone screen).

In my experience, CAR responds incredibly well to full-spectrum light exposure first thing in the morning.

• Open the curtains.

• Step outside.

• Take your coffee onto the porch.

• Stand on your balcony.

• Walk the dog.

Even five to fifteen minutes of natural morning light can help reinforce your circadian rhythm and encourage a healthier morning cortisol rise.

If natural light isn't available, a quality full-spectrum light box can be a helpful alternative. They are quite affordable now and can sit right on your counter.

Having said this, remember to do the exact opposite at night.

Your brain needs the message that the day is ending.

• Reduce bright light exposure.

• Dim the lights in your house.

• Be mindful of doom-scrolling in bed or watching shows on a tablet with the brightness turned all the way up.

And yes...sleep in a dark room whenever possible.

Timing matters

If you're taking supplements intended to support daytime energy, consider when you're taking them.

• Vitamin C.

• Rhodiola.

• Panax ginseng.

These are often more helpful when taken during the first 30 to 45 minutes after waking rather than several hours later after you've finally remembered.

Movement helps too.

You don't need a 60-minute workout before breakfast.

Five or ten minutes is enough.

• Stretch.

• Reach your arms overhead.

• Touch your toes.

• Rotate your spine.

• Take a short walk.

• Bounce gently on your toes.

Wake up your muscles, your circulation, and your lymphatic system.

Small habits, repeated consistently, often have a bigger impact than one giant intervention done occasionally.

If, on the other hand, your cortisol awakening response is already too high, this is a wonderful time to practice diaphragmatic breathing (expand the ribs, not the belly), meditation, or any other calming practice that helps communicate safety to your nervous system. If your healthcare provider has recommended calming supplements or medications, taking them shortly after waking may also be appropriate.

The bottom line

The cortisol awakening response is one of my favorite examples of how beautifully designed the human body really is.

Every morning, before you've answered an email, poured a cup of coffee, or looked at your phone, your brain and adrenal glands are already working together to prepare you for the day ahead.

Sometimes that response becomes exaggerated.

Sometimes it becomes blunted.

Neither automatically means your adrenal glands are "burned out," and neither means cortisol is your enemy.

Cortisol isn't trying to sabotage you. It's responding to the information your brain and body are giving it.

That's why I never look at cortisol in isolation. I want to understand why it's behaving the way it is.

• How are you sleeping?

• How's your circadian rhythm?

• What's your stress load like?

• Are you in pain?

• Are you eating enough?

• How's your light exposure?

Those questions almost always tell me more than a cortisol value by itself.

When you support the systems that regulate cortisol rather than simply trying to suppress it, you're working with your biology instead of fighting against it.

And that's almost always where the best results begin.