Is Cortisol causing your patient to struggle with sleep in the middle of the night?

by Carrie Jones, ND, MPH

The DUTCH Plus now has the answer!

When patients suffer from insomnia, the 5 salivary cortisol measurements on
the DUTCH Plus may notbe enough to assess cortisol’s potential role in the sleep disturbances. Salivary measurements typically begin when the patient wakes and rises in the morning. It would be very helpful to also provide cortisol levels in the middle of the night when the patient is struggling to sleep. Determining cortisol’s potential role will help the provider treat the patient’s insomnia with precision. The DUTCH Plus now offers insight into this question.

Beginning January 2, 2019 DUTCH Plus kits will feature an optional 6 ^th salivary sample we have dubbed the “Insomnia Sample.” For an extra charge of $25, patients can collect this sample if they are struggling to sleep in the middle of the night. Because we are using the convenient swab collection, this can easily be done without further disturbing the patient’s sleep.

Why DUTCH Plus?

The DUTCH Plus offers an evaluation of the Cortisol Awakening Response (CAR) by measuring salivary cortisol upon waking and then again 30 and 60 minutes later (additional measurements are made around dinner and bedtime). Research has shown that this post-waking increase in cortisol (the CAR) is the best way to assess an individual’s stress response and HPA-axis function.  It has been independently correlated to symptoms related to cortisol, like depression, fatigue, etc. The DUTCH Plus combines this information with metabolites of reproductive and adrenal hormones as well as markers of vitamin deficiency, neurotransmitter metabolites and melatonin. This test is the most comprehensive, cost-effective hormone test available.

What insight does DUTCH Plus offer an insomnia case?

• Free cortisol values throughout the day, including at bedtime
• • A high bedtime sample may hinder sleep.
• Overnight melatonin production
• • Low melatonin production may contribute to insomnia
• Progesterone levels
• • Particularly in perimenopausal, low progesterone may be associated with poor sleep
• VMA
• • As the primary metabolite of norepinephrine and epinephrine, high levels may be found in patients in sympathetic overdrive, which may lead to insomnia if persistent at night.
• The new Insomniac Cortisol measurement
• • This new measurement offers valuable additional information about cortisol’s potential causal role in sleep disturbances.
  • Note: while the above markers are included in the DUTCH Plus, the Insomniac Cortisol measurement is optional and included at an additional charge of $25.