DIRTM™ (Diurnal Intracytoplasmic Reflux Time)

DUTCH CAR™ (Cortisol Awakening Response) measures free cortisol levels in saliva, collected upon waking, 30 minutes after waking, 60 minutes after waking, and then throughout the day. This targeted collection schedule captures the characteristic rise and fall of cortisol that occurs in the first hour after waking, as well as the broader cortisol profile throughout the entire day.

These markers are included to assess how the stress response system reacts upon waking, providing additional information beyond simply measuring total daily cortisol levels. The amplitude and timing of the cortisol rise after waking can highlight patterns of increased or decreased stress reactivity, which are not always visible in standard diurnal cortisol rhythm tests.

Typically, specialists analyze CAR results alongside the person's symptomatology, sleep quality, perceived stress levels, daily routine, and other relevant laboratory results. The results are interpreted in context to understand how the body's stress response upon waking correlates with each patient's overall experience and condition.

Recommended for: 

• Stress response regulation: patterns of HPA (hypothalamic-pituitary-adrenal) axis hyperreactivity.
• Occupational stress: persistent work-related stress or anticipatory stress associated with work.
• Mood disorders: depression not associated with seasonal variations.
• Pain patterns: waking up with pain, including migraines or joint discomfort.
• Metabolic regulation: dysregulation of glycemic control (unstable or altered blood sugar).
• Stress reactivity: difficulties in managing daily stressors despite normal baseline cortisol levels.
• Sleep-related symptoms: unrefreshing sleep or difficulty waking up feeling refreshed.
• Energy patterns: marked fluctuations in energy levels during the morning.