RHR: How to Use Tech to Improve Your Sleep, with Harpreet Rai

In this episode, we discuss:

• What the Oura Ring can do
• The importance of sleep
• Why your brain needs downtime
• Using technology to improve your health
• How to measure your stress levels
• How your sleep reflects the way you spent your day
• What’s next for the Oura Ring
• How you can get $50 off your Oura Ring purchase

Show notes:

• Oura Ring
• “Sleep Quality and Adolescent Default Mode Network Connectivity.”
• Learning How to Learn from Coursera
• The Moment app
• The Center for Humane Technology from Tristan Harris

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Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week I’m excited to welcome Harpreet Rai as my guest. He is the CEO of Oura Ring.

The Oura Ring is, I think, the most effective device on the market today for tracking things like heart rate variability, sleep, and physical activity. I have one myself and we use it extensively with our patients in the clinic. So I wanted to talk with Harpreet about heart rate variability, what it can tell us, how we can use it to improve our health, the sleep tracking technology in the Oura Ring and why that’s important, and just what the general value is of increasing our awareness about the various behaviors and interventions that we do on a daily basis and how they impact our sleep and our stress as measured by heart rate variability and our overall health. All right, let’s dive in.

Chris Kresser:  Harpreet, such a pleasure to finally have you on the show. I’ve been looking forward to this for a long time.

Harpreet Rai:  Likewise, Chris. Yeah, it was awesome to connect early in the year at Paleo f(x), and glad we finally got to reconnect now.

Chris Kresser:  Cool, so I'm looking at my Oura Ring right now on my finger. It's funny, I've been in the clinic, I've had at least five or six patients say, “Oh, you’ve got your ring. How did you get yours already in the new version?” And I’ve sensed some Oura Ring envy among my people. But I know that the new version is shipping out now. Because I preordered one, so now I have two. So if anyone needs a size 10 … Oh, actually I’m just noticing that my other one is a different color.

Harpreet Rai:  Okay, nice.

Chris Kresser:  So maybe I can fashionably go back and forth between two different rings here. So yeah, the reason I wanted to have you on is not to create more ring envy, but to talk about the really cool technology behind this ring. And just even step back further and discuss why someone like me would wear a ring like this.

Harpreet Rai:  Sure.

Chris Kresser:  What it can do for us and why you’ve made some of, at Oura, made some of the decisions that you made. Because the tracking industry is pretty big now. There's so many different devices and things you can choose from, Apple watch, Fitbit, Garmin, etc. And in a way you could look at it like, “Why did we need another one?”

Harpreet Rai:  Right.

What the Oura Ring Can Do

Chris Kresser:  But I think there are some really clear and interesting answers to that question. You at Oura have chosen to focus on sleep, which is interesting in itself, because so many others focus on things like steps and activity. And even some on, like Apple watch is really kind of promoting health protection. Like you fall down, or if you're having a heart attack or something like that, which is great. But why sleep?

Harpreet Rai:  Yeah. Look, thanks for the question, and maybe just to make sure we don’t create more anger, potential Oura envy here, just to let everyone know we put this on our blog as well. We've now shipped over 10,000 gen two Oura Rings. We’re shipping, we’ve sent thousands per week. So people, they are coming soon. Frankly, we got more demand than we expected, and we’re a small company, and we’re trying to grow as fast as we can, but we do apologize, and our team is working around the clock, literally, to get them out as fast as we can.

Chris Kresser:  Let me just give full disclosure. I was provided an Oura Ring to evaluate and I also bought one. So you can take my recommendations with that in mind. I paid money for one, and I’m very happy that I did. And I was also generously provided one for evaluation by Harpreet. So always important for me to get that out there.

The Importance of Sleep

Harpreet Rai:  Appreciate that. But yeah, look, I think you’re right, the wearable market, they’ve been around for quite some time now. I think Fitbit was started even a little bit around 10 years ago. But our view was, as you mentioned, like, we wanted to focus on sleep. I think there's a couple reasons as to why we wanted to focus on it, but literally from the health aspect—and I think this is more longer term—but still there is a clear link between lack of sleep and all types of chronic disease like cardiovascular disease, cancer, longevity, just length of life, diabetes, and also Alzheimer's.

But if you look a little bit shorter term, we also think about it as it's literally the best performance-enhancing drug out there. I think Matt Walker said this, and he's absolutely right. If I told you or any of your patients or people that hey, or any of my friends, that you can take a drug that will increase your testosterone, literally improve your memory recall the next day, right? Will help you cognitively and emotionally, will help keep your insulin levels in check and prevent cardiovascular disease and help create more killer T cells that help fight off cancer, I feel like everyone would take that pill.

Chris Kresser:  That’d be a trillion-dollar pill.

Harpreet Rai:  It would probably be the biggest and most successful drug ever.

Chris Kresser:  Yeah, and I tell this to my patients, and I know Pete Attia says this too, if you had to choose between letting your diet slip or letting your sleep slip, what would you choose? And a lot of people say diet over sleep. They’ll protect their diet over their sleep. But really, if you have to make that choice, which hopefully you don’t, diet is the obvious answer because if your sleep slips, you’re going to suffer far more and more quickly than if your diet slips.

Harpreet Rai:  Exactly, yeah. So that's one of reasons we really focused on it. I think the other concept that’s starting to change, I think, a little bit now and we’re seeing in sort of the professional sports world, but also frankly, from a Functional Medicine world, thanks to people like you, is that if you want to feel better tomorrow, if you want to perform better tomorrow, you’ve got to start getting ready today before, and that starts with your sleep. So this idea of sleeping is sort of the leading indicator for how you can perform better tomorrow. Something that’s actionable.

Chris Kresser:  Yeah.

Harpreet Rai:  I think the last thing really is we’re really more distracted than ever. The average person is touching their cell phone about 10 times an hour. We have people who are watching more Netflix than ever, YouTube than ever, spending more time on emails. Frankly, eating later, food-ondemand restaurants open later, and all those things are taking away from our sleep. And so if we just look as a society on average, a third of the population is getting less than six hours.

I think overall, over the last 30 to 40 years, the amount of sleep as a society has fallen by one hour. And so it's also just causing people to be tired the next day, to have brain fog, and frankly, not to be as introspective. So I think it's this idea of being a little bit more conscious and being present. I think sleep is starting to, the lack of sleep is hurting our society as a whole on that.

Why Your Brain Needs Downtime

Chris Kresser:  Yeah. I think you know about the default mode network, and in today's technology-addicted world, one of the consequences that we suffer from that is our brains don't enter this default mode network, which is really like, the easiest way to think of it is just downtime for the brain. We used to think that when we’re not, the brain wasn’t active, it was just at rest and nothing was happening. But now we know that's totally false and that when the brain is “at rest,” I’m doing air quotes, “at rest,” if we’re just kind of zoning out, looking out the window, daydreaming, the brain is incredibly active. And that activity is what generates creativity and innovation and new ways of thinking about things. And it’s restorative and rejuvenative.

And I've seen studies, I'm looking at one right now, actually, it's called “Sleep Quality and Adolescent Default Mode Network Connectivity.” And this study basically found that sleep deprivation, which is really common in adolescents and of course in adults too, led to reduced connectivity in the default mode network. So that would be expected to lead to lower creativity, less capacity to think out-of-the-box and in adolescents, actually, in this study they’re speculating that it interferes with brain development. So this is pretty serious stuff.

Harpreet Rai:  Yeah, I think that's without a doubt. It's funny, right? I think there's two aspects where I looked into that on that thread is just think about sleep and when we go into REM sleep. So when you go into REM sleep, your frontal cortex, the sergeant of your brain, shuts off, and so your brain actually literally explores. And it's in this phase that most of our memory consolidation happens. Your brain starts playing those memories of what happened during the day, three times at 3X speed. So it's, like, fast-forwarding everything and it’s literally repetition, repetition, and that helps memory consolidation.

But the other thing on that thread of, like, when your brain is allowed to wander, like you said, during the day, there's a great course on this on Coursera and it’s called Learning How to Learn. And I think it’s created by two professors out at University … UCSD in San Diego, and then also McMaster. And what they talk about is exactly what you're saying that study cited, is that actually this downtime is when diffuse learning happens. It's when that mental conductivity happens. And from digital devices today, if you're literally checking your phone once every 10 minutes, your brain isn’t allowed to wander.

It's coming back, it's checking in, it's actually probably getting back to that addiction type mentality that so many of us have from other things like trading stocks or bitcoin, and frankly, that is without a doubt hurting productivity and just your mental ability as a whole.

Chris Kresser:  It’s activating the dopamine reward system over and over again, and that's a certain kind of goal-driven mental state to be in that can be highly productive and useful, but not … that's not a state that we’re supposed to be in 24/7. And if we are, then as you said, we miss out on all of the deeper kinds of learning and growth and evolution that can happen in our brain. And I think it's a … I did a two-hour presentation on technology addiction and its effects on the health and the brain for the Health Coach Training Program.

And in the course of researching for that, I became quite alarmed, to be honest. I mean, this is something I've been aware of for a long time, so it wasn't a surprise, but doing the actual research and pulling it all together, it was like, this is a serious threat to humanity. I mean, I don't think most people actually realize how significant this can be.

Harpreet Rai:  I think Tristan Harris, he’s—

Chris Kresser:  Former Google.

Harpreet Rai:  Exactly. Like, I forget his exact title though. The chief ethical officer? I’m not entirely sure.

Chris Kresser:  Yeah, yeah.

Harpreet Rai:  But yeah, these things are getting more and more addicting. I use, I think over a billion people use Chrome, the web browser.

Chris Kresser:  Right, yes.

Harpreet Rai:  And there is this new thing in Chrome on mobile where, I don’t know how they decided to roll this out, but when you open a new tab now, at least for me and I know many others who I’ve checked with on this, is that you’ll have the Google search box and then underneath you’ll see like six or eight stories. And literally they’re all news articles about things that you’ve been searching recently. And what is that designed to do? I mean, let’s get real. It’s designed to keep you clicking more, spend more time in Chrome. Why? If you spend more time in Chrome, you’re looking at more ads.

Chris Kresser:  You’re worth more to advertisers.

Harpreet Rai:  Yeah, you’re worth more to advertisers. More time spent, right? You’re driving those impressions up, and so it’s amazing. I saw that in myself. Well, okay, I went from having 10 Chrome windows open, or tabs open, to all of a sudden 20 or 30. And I had to find out how to look up, how to remove that from my phone. But what if we started checking with ourselves as often as we check in with our phones? I know there’s been, like, sayings like that before out there on Instagram. But I think it's really true, and sleep is a form of checking in, and I think we’re going to talk about heart rate variability.

But look, we see this from our users. So many users will post stories, will send us screenshots of their data, and they say, “Hey, when I went camping for two weeks” or “I went on vacation or even camping for two nights,” all of a sudden you'll see deep sleep improved, you'll see your heart rate variability improve, not as much disturbances. And we sort of ask ourselves as a company, we’re like, oh, wow, that’s awesome. Why is that happening? Well, there could be a ton of things. It could be happening because actually you’re sleeping outside, the ground is colder, and so as a result, we know that a cool temperature at night helps improve deep sleep. Okay, that could be something. The other reason is the light goes down, right?

So the sun goes down at six, seven o’clock, depending on the time of the year and where you are. Okay, so actually melatonin is being released at the right time. And probably the third reason if I had to guess is, or fourth reason, you’re out in nature, you’re in the trees. We know there’s some positive effects there. But you're probably not looking at your phone as much.

Chris Kresser:  Absolutely, 100 percent.

Using Technology to Improve Your Health

Harpreet Rai:  Yeah, you’re there in the present, you’re with friends, your mind is being stimulated in nature just walking. And so I think us as a company, I think we’ve thought about using technology for improving our health, using technology to improve our consciousness, and I think that's another reason why we focus more on sleep. Because when some of these things don't happen, you do see that data reflected in your sleep. Or perhaps in your heart rate variability. And so those are a couple reasons as to why we focused on sleep.

Chris Kresser:  Yeah. I’m glad you did because people need help. We all need help. Everyone’s susceptible in this society that we live in now. Sleep is not something that's valued. There's all kinds of sayings that reflect that. Like, “I’ll sleep when I’m dead,” is one of the most interesting ones to me because it’s like, well, yeah, you’ll be dead a lot sooner if you don’t sleep. So I guess you’ll get more that way. But it’s just, we live in a culture that is, you’re kind of fighting an uphill battle if you’re trying to get sleep because there's so many influences that interfere with it. From the blue light that devices emit to Netflix’s autoplay feature—now, if you watch something on Netflix, before you can even lean over and turn it off, it’s already going on to the next one. And it’s just another way that our attention is kind of hijacked. So having, to me, that’s when the biggest benefits of a device like this is it’s basically an awareness enhancer. It’s something that can remind us to pay attention.

Harpreet Rai:  Yeah.

Chris Kresser:  When we bring our attention to something, that’s what enables us to change it. I had a, one of my then-teachers in the past liked to say, “The focus of your attention determines the quality of your experience.” Which really is a powerful saying if you think about it. It's only what we are attending to that is going to drive our quality of life and our experience, and we only experience and remember what we pay attention to.

So the most powerful thing for me around this is thinking about myself, like, I call it the rocking chair test, where I’m 100 years old and I’m looking back, am I going to want to look back on a life where I spent a large part of my day, like, staring at my phone? Or am I going to want to look back on a life that was richer and more fully lived? And I know what the answer to that question is, and that’s what drives a lot of my choices. But like anyone else, I need reminders and help. And that’s where something like this can be really useful because it’s just a non-intrusive guide that I’ll just occasionally … I don’t do it every day because I’m pretty tuned in to my rhythms at this point. But if I make some kind of change or intervention, then I have a way of getting immediate feedback on what the results of that were in terms of my sleep and heart rate variability, which is pretty cool.

That’s something that took longer in the past. More experimentation and trying to figure those things out, but let’s say I’m like, “Okay, I want to check and see what happens if I eat a snack before bed. How does that affect my sleep?” I can immediately get that feedback in a way that I couldn’t get before, which is pretty cool.

Harpreet Rai:  I mean, frankly, your example of a snack before bed, I have no problem putting this out there. I love ice cream. I think a lot of Americans do.

Chris Kresser:  What’s not to like?

Harpreet Rai:  What’s not to like? I think it’s something like, guess how many pounds of ice cream the average American eats in a year.

Chris Kresser:  Oh, it’s probably …

Harpreet Rai:  Take a guess.

Chris Kresser:  Jeez, I don’t know. Let’s see, 100?

Harpreet Rai:  Oh, no, it’s not that bad.

Chris Kresser:  I think it would be. If you think about, like, if they’re only eating, if that was the only source of sugar, it probably would.

Harpreet Rai:  Sure, oh, of course, yeah. I think it’s something like 23 pounds.

Chris Kresser:  Yeah.

Harpreet Rai:  So or …

Chris Kresser:  Twenty pounds is an enormous amount of ice cream, though.

Harpreet Rai:  It’s actually, so it’s surprising. It’s actually … it is an … it’s not. It’s, “a pint’s a pound the whole way around,” I think is the saying. So a pint, 16 ounces, what’s in that standard Ben & Jerry’s little thing that people love to eat including myself, that’s a pint. And when I first got an Oura Ring a few years ago when we were working on this and the Kickstarter just launched, I remember like, yeah, every once in awhile, I’m not going to lie, I’d be, “Oh, it would be a cheat day.” Or I’d been keto for about 30 days in a row, I want to start to disrupt the cycle and I reach for something that’s absolutely terrible for me. And normally you’re having a dessert close to your bedtime.

Chris Kresser:  Yeah.

Harpreet Rai:  And normally I'd eat half a pint, or I’m sure Ben & Jerry's has thought about magically how to fit that pint and add the right ingredients to make sure you finish the whole thing in one night. But let’s say I ate a pint of ice cream and I ate it an hour or two before bed, right when you’re watching Netflix after you’ve finished some work for the day and finished your dinner. And so you’re distracted, you’re watching TV, and the next thing you know, the pint of ice cream is gone. It just was incredible to see my data the next day, literally, the next day on how bad I slept.

I would normally get 45 minutes to an hour of deep sleep, it would be 15 minutes. My resting heart rate, typically, let’s say if I’m working out a little bit more, should be probably in the mid to high 40s, right? But all of a sudden now it’s spiked to like mid-50s. And then looking my heart rate variability, something that we know is linked to fasting glucose levels or glucose levels, and also just an overall signal of parasympathetic stress. Alessandro Ferretti, I think, has done a lot of great work out there on sort of triangulating heart rate variability and changes in HRV related to fasting glucose levels.

And so I’d look at my HRV data the next day, and I’m like, “Wow, down by a third.” And so to me it was, like, immediate feedback. It was like, “Whoa, dummy, don’t do this anymore.” Like, yeah, I feel a little bit slow the next day. After I ate a pint of ice cream, I sort of would feel that in my gut, and I knew I shouldn’t have done it. And I’ll feel like I have to go to the gym and work it off, but just being able to see that data the next day, it’s like, yeah, I got this personal assistant, to your point. I got someone in my corner who’s looking out for me. I got—what’s that character in James Bond?—Moneypenny.

Chris Kresser:  Right.

Harpreet Rai:  It’s like I’ll check in with Moneypenny in the morning and, “Oh, man, yeah, look, Bond,” I’m no Bond, but like, “Hey, Harpreet, something is dramatically wrong here. Did you eat a late meal last night?” It’s one of our more popular messages in the Oura app from the data we see amongst our users.

Chris Kresser:  Yeah.

Harpreet Rai:  And it’s just amazing to see the feedback, and then you’re like, “Oh, wow, that really did have a big impact.” And you then, the next time you have that craving, like, I start thinking about how much worse I’m going to be the next day. How much worse my data is going to be and how much worse I’m going to feel. And frankly, I think my consumption—thank God—of Ben & Jerry’s has gone down tremendously.

Chris Kresser:  Yeah, well, I mean, that’s a really valuable insight to get. And it’s interesting for me. I’ve done a lot of experiments. One is with the infrared, we have a near infrared sauna, a SaunaSpace. I just actually had Brian on from SaunaSpace to talk about infrared sauna as a lever for health and life extension and wellness. And so I've been experimenting with different timing of using the sauna. Do I sleep better if I do it right before bed? Or do I sleep better if I do it in the afternoon?

And that's been really interesting and also even with like meditation practice, and sometimes if I—and I've known this, actually, just for years—but there's certain things that I've kind of known for a while intuitively that I’ve wanted to like see what the data say about it. And if I meditate too close to sleep, I actually sleep worse because it gets me into a different brainwave state that is not necessarily conducive to sleep. So, yeah, really useful for that.

How to Measure Your Stress Levels

And I want to kind of segue into stress, since that's really a big part of the sleep discussion, why people aren't sleeping. Either being so kind of overwhelmed and just not having as much time to spend in bed or once they get in bed, not being able to sleep because of the level of stress.

And one of the best objective ways of measuring stress response is heart rate variability, which is something that I think people, more people have heard of now. But still I notice when I'm talking to my patients that I would say about 50, 60 percent of people have not heard of heart rate variability, or if they have, they haven't really heard about it. They’ve heard about it more in the context of assessing performance readiness in athletics, but not as much in terms of stress. So why don’t we shift gears and talk a little bit about HRV and how Oura is measuring it and what we can do with that data.

Harpreet Rai:  Sure. Yeah, I mean, so HRV, literally, what does it mean? I guess heart rate variability, so it’s the variation of your heart beat. So you and I are on this podcast. Maybe I had more coffee than you today, for example. So let’s say my heart rate’s 70 beats per minute and your resting heart rate, let’s say, is sub 60. That's beats per minute, right? It turns out that every single beat is actually slightly different over the course of that minute.

One may be at, let’s say for me, is 69. The next beat might be at 71 beats per minute. The next one might be at 60.5 beats per minute. So the individual variation between each beat or the interbeat interval, that’s actually, that variation turns out as a great signal for us in stress in the human body, in mind and stress. So there’s been a lot of great research showing the interpretation of sort of your nervous system being in a parasympathetic mode or higher stressed out, or sorry, a sympathetic mode, which is indicating more stress. Or parasympathetic mode, which is less stress.

And so all the research that’s been done is they’re showing that low HRV is more tied to chronic disease, more tied to probably bad insulin resistance and higher fasting and postprandial glucose levels. They’re also doing a lot of work sort of showing that’s a leading indicator for stroke and heart attack. So I think it’s also a great indicator for short-term stress.

Chris Kresser:  Yeah.

Harpreet Rai:  One of the things we know about meditation is doing meditation can actually just in a short session no longer than 20 minutes, I think that some of the research out there, 10 to 20 minutes, increase heart rate variability and put you more into that parasympathetic stress.

Chris Kresser:  That’s fun. I’ve been able to track that, and that’s really fun to see that response.

Harpreet Rai:  Yeah, that’s something we’re going to be introducing in the Oura Ring, as well, during a session.

Chris Kresser:  Cool. Yeah, I’ve used other devices to do that, but where you can actually see the real-time feedback, but I think that’s really powerful to give people an experience of being able to influence an objective marker of their stress response. There’s something to that, I think. Something to being able to see, like, a readout on a screen that your, whatever you’re doing, whether it’s meditation or something else, is having a real and measurable impact on such an important variable of your health I think is a very, is a powerful experience to give people.

Harpreet Rai:  Yeah. Look, I think it comes back to that ice cream example. It’s actionable.

Chris Kresser:  Right.

Harpreet Rai:  If you start to see your heart rate variability improve when you meditate, you’re probably going to want to meditate more. It gives you more conviction or confidence that, hey, this is actually helping me. I think it’s just like a continuous glucose monitor. If you start to wear one of those, and let’s say you’re Paleo and still eat certain types of fruit, like I do. Like, I realized I have a huge glucose response to certain types of fruit. And so it was really instrumental in me starting to cut out things that weren’t working for me.

Chris Kresser:  Yeah, I bet that helped with the ice cream too.

Harpreet Rai:  Yeah. Yes.

Chris Kresser:  The combination of the CGM and the Oura Ring.

Harpreet Rai:  Exactly.

Chris Kresser:  It makes you think two or three times about the ice cream.

Harpreet Rai:  Totally. Yeah, look, the way we collect heart rate variability today is we actually, we sample your heart rate variability all throughout the night. So maybe just a little bit how we do that easier and better than some of the other devices out there. We created a ring, not just because of fashion, but actually because of accuracy and access to a really, an easy way to get a very, very good heart rate.

So if you think about a hospital and you know this, you’re the doctor. So why does every hospital in the ICU, they’re measuring your SpO₂ and your heart rate from your finger? It turns out that those arteries on the inside of your wrist are going into your hand, in the skin on your hand, and the nerve density, the skin is extremely thin. And so that artery, that arterial pulse in your finger is about 50 times, almost, in some individuals, 100 times stronger, that signal strength of that pulse on that finger than, let's say where your wristwatch sits, which is venous pulse, not an arterial pulse.

Chris Kresser:  Yeah.

Harpreet Rai:  And so we saw that, we knew that. There's companies that make these heart rate sensors in hospitals. We were pretty observant of that. I think the challenge was, how do you put all the same type of technology, optical technology from sort of a bigger wrist-based unit into something that can fit on the finger? And so we did our gen one as a proof of concept showing that it is achievable, and then really, the ring was a little big. That’s obviously some of the feedback and pushback we got.

Chris Kresser:  I’ve got to say, that's what kept me from using it initially.

Harpreet Rai:  This unit? Yeah.

Chris Kresser:  I was pretty happy when I saw the new one. And they are, they’re really, I’m pretty tough. Like, I don’t really like jewelry, I don’t wear much jewelry. I don’t even wear a watch, and I have my wedding band, and that’s it. So I really didn’t want something that was going to be obtrusive and, like, really obvious and people asking me all the time, “What’s that?” I’m kind of a private person. I’m just not steered that way.

Yeah. So this actually is about the same, it’s a little bit, tiny bit wider than my wedding band and maybe a touch thicker. But if you’re looking at it from, if you’re not looking at it up close, most people would just assume almost that it was. I’ve never actually had anyone come up to me and say, “What’s that? Why are you wearing that thing that is very large on your finger?”

Harpreet Rai:  Right, yeah.

Chris Kresser:  They just assume it’s a ring that I’m wearing because I like to wear rings. That works for me.

Harpreet Rai:  We’ve so … yeah, no, thank you. The gen one versus gen two, a lot of people have told us that, who bought a gen two have said, “Yeah, I heard about you guys with gen one, but the improvements in the size …” and also the battery life, we were able to extend the battery life from two nights to six nights now. So on the seventh day you’ll have to charge it. But it charges in about an hour. So there were big improvements on sort of the form factor, decreasing the size, but also extending the battery life. But yeah, so starting off, or getting back on that thread of why the finger, it was really because its pulse signal is really strong.

Chris Kresser:  Yeah.

Harpreet Rai:  And so throughout the night we’re actually measuring your heartbeat and we’re shining infrared light, just like the SaunaSpace, we’re shining a tiny infrared light at 250 hertz, or 250 times a second. Most of the wrist-based wearables are sort of sampling anywhere from somewhere in, actually some of them two hertz, like two times a second. But I would say the average, call it Fitbit or Apple watch, is probably sampling anywhere between sort of 10 and 24, 26 hertz.

And so because we use less power than those devices, because we’re sensing off the finger, we can sample much more often. And that gives us a much more robust heart rate measurement, it allows us to see every single beat. We actually just recently had an abstract published in the medical journal Sleep showing that our HRV overnight compared to an EKG is 98 percent-correlated R². We will be publishing the full paper later this year with an independent researcher validating that on our gen two. So that will be really fun.

Chris Kresser:  That’s a pretty strong correlation.

Harpreet Rai:  Yeah.

Chris Kresser:  For people who are not familiar with data and that kind of measurement, that’s a pretty true fidelity.

Harpreet Rai:  Yeah. And so that’s … we measure HRV, actually, throughout the whole night, every single beat. We are measuring it during the day as well. But we haven’t released the information yet. The reason is, I think, during the day, a lot of people ask us why we haven’t done that, is there’s a lot more noise. It’s sometimes hard to tell.

Traditionally people would do, and you tell me how you did it, but a lot of people would do an HRV test first thing when they wake up in the morning. You put on a chest strap and you would sort of try to lay in bed, calm, but almost like sleeping and get this HRV measurement over five to 10 minutes. But that was sort of a pain in the butt to do. Not a lot of people wanted to do it. And frankly, if you woke up with an alarm, you didn’t wake up with an alarm, if you had a cup of coffee or—

Chris Kresser:  A bad night’s sleep.

Harpreet Rai:  Yeah, a bad night’s sleep or let’s say something else woke you up, like I live in the city in San Francisco with cars honking outside.

Chris Kresser:  Your seven-year-old daughter coming in and pulling you out of bed. Yeah, any number of things.

Harpreet Rai:  Exactly. That’s going to throw off that HRV reading for those 10 minutes. And so during the day, just imagine that if you had two cups of coffee instead of one, if you were in a little bit of a rush to work and you were late for a meeting, or frankly, even if you had to go to the bathroom, that HRV data can be really noisy. So what we have found is just by collecting a lot of data is sort of saying that there happens to be a clearer signal, actually, at looking at HRV data all throughout the night.

And it sort of gets back, actually, to what happens to our brains and our bodies when we sleep. It’s that culmination of stress during the day is sort of reflected during the night. So your night will end up being almost like the mirror of your day, as our chief scientist at our company likes to say. And so we found it’s actually a really easy time to look at a large amount of data, get a really good baseline, and then see how that baseline changes day to day based on your activities.

Whether you pounded that pint of ice cream or you had a late workout or frankly even sometimes a really hard workout, we’ll see people that go and they have a really hard weightlifting session, your HRV will go down that night.

Chris Kresser:  Of course, yeah.

Harpreet Rai:  And it should.

Chris Kresser:  It’s a stressor on the body. That’s how it works.

Harpreet Rai:  Yeah. And it should. And then you can see, it’s cool to see, oh, but two days later or maybe even three days later, depending on what kind of shape you’re in, my HRV is actually higher than it was that first day I worked out.

Chris Kresser:  And that’s traditionally how HRV has been used with athletes to determine how long they need to rest and recover before they work out again.

How Your Sleep Reflects the Way You Spent Your Day

I have to rewind, though, because you said something that’s very important, and I want to call it out. Because it’s similar to something that I said to my patients for years, which is your night will be a mirror image of your day.

And I've said that in a less elegant way to patients often when we talk about sleep, which is, you can't run around like a chicken with your head cut off all day and then expect to just, like, hit the sleep button and sleep peacefully and restfully throughout the whole night. And yet that's exactly what a lot of us do. And that's one of the reason sleeping pills are so one of the most commonly prescribed medications and OTC medications. Because we do that. We do just kind of go around our day in a crazy way, and then it comes time to sleep, and we wonder why we can't sleep and why we’re not sleeping restfully. So I just think that’s such an important concept.

A Feldenkrais practitioner that I did some training with at one point said the same thing. Like, if you want to sleep well, you have to manage your stress levels throughout the day.

Harpreet Rai:  Yeah.

Chris Kresser:  Full stop.

Harpreet Rai:  Yeah. That’s absolutely right. It's this really interesting cycle where, like, your activity during the day is reflected at night. And then what happens at night sort of sets you up for success or potential failure the next day.

Chris Kresser:  Yeah.

Harpreet Rai:  And so I think our view as a company was, well, let's focus on the time to gather more accurate data, frankly, sometimes even more actionable data and easier to understand data, and that happens to be your sleep data. Because you can sort of see the culmination of all those different choices you made during the day between food, maybe stress at work, your activity, which could be good stress, obviously, and see how that’s affecting your sleep.

Chris Kresser:  Absolutely.

Harpreet Rai:  So that’s really why we focus on it. But yeah, I mean, getting back to HRV, I think, look, it's great that it's now becoming a metric that's more and more discussed. I do think, like, we designed our device to capture that data pretty seamlessly. Really, sort of the intersection of comfort and ease of use and accuracy. And that we were pretty conscious, like, we chose infrared light. Most other wearables choose green light. That green light is disturbing when you sleep. We know it's not good for the photoreceptors in your skin. It's literally going to harm your sleep. And so that was a conscious decision we made.

And you know we didn't put any lights in the Oura Ring, like visible lights or LED indicators. Another reason is because we’re already touching our phones once every 10 minutes or more. And so why, why would you want something that's distracting even more? So we made a lot of these kind of conscious decisions to bring people … like, and get them less distracted and bring them into the present, as you mentioned. And heart rate variability, that’s something I think we’re to continue to see more research on, continue to be used more and more. First, sort of leading edge with the Functional Medicine practice, but hopefully eventually we’ll even get the larger medical system looking at it more seriously.

Chris Kresser:  That’s great. I like the ring for that reason too. Again, going back to the tech addiction presentation, so many adults, I think something like 60 or 70 percent, sleep with their phone in their bedroom or even right in their bed or near their pillow or on their bed stand next to them. And I think that with adolescents, that number is like 80 or 85 percent.

Harpreet Rai:  That’s scary.

Chris Kresser:  Which is horrifying, yeah, when you know what having, when you see the research on what having a phone that close to you while you’re sleeping does. Not just because of the light that it emits, but because of the association our brain has with the phone. And if notifications are coming in and we’re thinking about what’s happening, then that’s not going to be conducive to sleep.

So it’s nice that you just can have the ring on and not have to have your phone or even a watch that has all sorts of notifications and things on it nearby. A couple of people I know are really concerned about EMF and Bluetooth and things like that and are reluctant to wear anything on their body like a watch or a ring that has that technology. So what would you say to those folks?

Harpreet Rai:  Yeah, look, we did actually put an airplane mode in our device, and we see a lot of users like that, and they use it quite frequently. So you can turn the ring on an airplane mode and it actually will store data up to six weeks now. So you don't ever have to sync it, you can go a whole month without syncing it. In fact, we’re going to be collecting some data with the university and a professor with some hunter–gatherers in Africa and we’re actually just giving them the chargers and they don’t have cell phones, and we’re just going to collect some data. That’s going to be a lot of fun. But yeah, we’re putting on airplane mode for that.

Chris Kresser:  That’s cool. So you can put it in, I didn’t know that. So you can put it in airplane mode, just wear it for a week, and then sync it and check your data for that last week.

Harpreet Rai:  Exactly. Yeah, and so we’ll make some better instructions in how to show people that it’s there. But if you just, there’s an area in the app where you can click on sort of the battery in the top right, the power setting. And if you click it there, you’ll see a button to turn it.

Chris Kresser:  I see it. Ring, airplane mode. I see it right now.

Harpreet Rai:  Yeah.

Chris Kresser:  Cool.

Harpreet Rai:  And then you just pop it in the charger and it’ll take it out of airplane mode.

Chris Kresser:  Now what’s your take on, just to put this in perspective for people, like what sort of, what amount of EMF is this submitting relative to other types of devices that people are using, like a smartphone?

Harpreet Rai:  Sure, yeah. So I think one way, I am sort of a sciencey and I guess engineering-type mindset, so I do believe in sort of energy can't be created or destroyed, it’s just sort of transferred. So we have a tiny battery inside this ring. We have a, let’s call it a 15-milliamp battery. And so what does that mean? Well, your iWatch has a battery that’s five times bigger than that and your iPhone has a battery that's almost 50 times bigger than that. And then you think about, okay, well, how quickly is that battery consumed? Well my iWatch’s battery lasts about a day. My iPhone’s battery lasts about a day. And so where is the energy going? And my Oura Ring lasts about a week. And so our battery is sort of, think about it from a physics perspective, 150th the size, and it lasts six times longer than your iPhone. And so the amount of EMF is honestly pretty small. I think we do use a lot of energy, but we focus it in infrared light.

Again, one of the things that we found when using certain types of frequency of light to detect your pulse is that everything we know about infrared light is actually healthy for us. So that was a very conscious decision. And so I would say compared to other devices, it's anywhere from sort of 1/10th to 1/100th of the EMF compared to other wearables or your phone.

Chris Kresser:  And then if you don't, I mean, the airplane mode is pretty cool. Because I don't necessarily check my data every morning because I, like I said, I’ve been doing this for a long time and I'm kind of in pretty good tune with what's happening. But I'll usually do it, like, for a period of time when I'm doing an experiment. I might check it for a few days in a row or something like that. But I like the idea that you could easily, you could just put it in airplane mode and then just check it at the end of three days or something when you want to see what's going on, if anyone is worried about that.

Harpreet Rai:  Yep. And look, we also know that, we’ve seen it from our users, those that are pretty focused on EMF or some of them might be more immunocompromised, that they actually use Oura Ring as a way to sort of check if there’s almost too much EMF and things that they can do and see if it has an impact. So we have some people that have gone sort of full, almost the caging around the bed and changing the type of outputs they have, and they’ve seen an improvement in their sleep because of it.

And we’ve seen also people just send us messages like, “Hey, I normally would leave my laptop on in the bedroom, but then I started to turn it off and put it downstairs. And actually saw my heart rate variability improve, my deep sleep improve.” And so that they are getting a consequence of EMF. And it’s definitely not the case for everyone. I think some people are more sensitive to EMF, but we did make that Bluetooth, that airplane mode for people who were concerned about it.

Chris Kresser:  Yeah, I mean, I definitely see it in my patients, and I think probably a lot of people are sensitive to some degree. Not to the extent that you hear about in some cases, and that I've seen with some of my patients. But I think that's probably one factor for when you go camping. Just not being exposed to as much of that or looking at screens as much, for whatever the effects of that are.

Harpreet Rai:  Yeah. I’m curious, actually, just for you, Chris, as a Functional Medicine doctor, how do you explain how important sleep is to your patients? Like, I have a lot of friends ask me now, as they know, like friends I had from college or high school, and they’ll be like, “Well, how much sleep do you get? Or why does that even matter if you get eight hours or six hours or even five?” How do you normally explain it? Because there’s some cool stuff in sort of the metabolic pathways that you know much better than I do, that I love to give examples to. I’m just curious how.

Chris Kresser:  I generally try to keep it pretty simple. I mean, it depends who’s asking, and I try to tailor the answer to what this other person is asking. If it’s someone who’s really data driven, I might give a data-driven answer. If it’s someone who’s less educated about all this stuff, I will try to keep it simple. But I mean, one way to look at it is you can survive for quite a long time without food. Thirty days, more than that. There are people who’ve survived for much longer than that without food. You can survive without water for a lot shorter period of time.

If you’re completely deprived of sleep, meaning you don’t get any at all, you’re not going to survive for very long. And sleep deprivation can absolutely wreak havoc on every system of the body, even if every other aspect of your diet, behavior, and lifestyle is completely optimized. It's the dealbreaker of all dealbreakers, where no matter how well you're doing, everything else—you can have the perfect diet, perfect physical activity routine, perfectly managing stress during the day, perfect relationships, time outdoors, sun exposure, everything that we talk about—and if you're not sleeping enough, all of that is going.

It’s not like those things will be not helpful in some way. Obviously, you’d be a lot worse off if you weren’t doing those things right as well, but it's a dealbreaker. It will torpedo all of your other best efforts. And as far as we know, there are definitely people who can get by on, in the range, from every sleep scientist I’ve talked to, is seven to eight hours for the majority of people. And you have your outliers who can get six for an extended period of time be okay, and people who need nine. But they’re a lot more less common than, and there are a lot more people out there who think they’re an outlier who aren’t.

That’s the biggest problem. Everybody thinks they’re in that outlier category, but given the definition of outlier, that can't be possible.

Harpreet Rai:  Everyone thinks they’re an exceptional and great driver, but they totally can’t be.

Chris Kresser:  Yeah, so that's usually how I describe it, and then it’s, the problem, though, is that it’s, as you know, Harpreet, is it’s a systemic issue. It’s not as simple as changing your diet even, or taking a supplement or a pill. Like, changing your sleep, you often have to examine some pretty deep core beliefs and assumptions that we’re making about who we are.

Take someone who is a workaholic, who might have had a childhood where they grew up in a family that valued that, that achievement. And their self-worth is based on what they accomplish. And that, then they became a workaholic. And so for them, not sleeping is a function of some very deep childhood conditioning. So it's not just a question of like, “Oh, yeah, okay, I'll sleep more.” So I think it's not so much a question of education or information in a lot of cases that is the obstacle to changing the behavior; it's that behavior change is hard and is often dependent on really deeply rooted beliefs that are not amenable, that don't change just by being provided information, I guess, is what I would say about that.

Harpreet Rai:  Yeah, no, I think that’s an awesome way to explain it, and I'll probably borrow a lot of that when people ask me.

Chris Kresser:  Sure.

Harpreet Rai:  I agree, I think it's a really, as far as yeah the benefits or the damages of poor sleep, it is incredible how it affects literally every part of the body and mind. So I always, I guess for the friends that I have that are often keto and working out quite a bit, I sort of say what you said but in a way that, “Hey, did you know actually that half your growth hormone and your testosterone is released at night?” And if you’re compromising that, to your point, yeah, you can be working out great and eating foods that we know are healthful and enhancing muscle growth or setting you up for higher amounts of testosterone. But actually, you’re going to compromise that when you sleep.

Or for the workaholics, I’m a workaholic, and it is a hard thing. It’s something that I’ve, to your point, my dad was a workaholic and sort of thought that, oh, you always had to be up late studying and working hard.

Chris Kresser:  Yeah.

Harpreet Rai:  I think about it like memory recall. Well, if you get less than six hours of sleep, literally, your memory recall goes down almost by 30 or 40 percent for the next day. So yeah, and I think this needs to change in the corporate world, and I think thankfully, there’s people like you that are bringing awareness to this and implementation to this with some of the corporate wellness world. But I literally, it’s like, okay, so Google or Facebook or Goldman Sachs, if you’re paying people to be there until midnight every night, like, they’re going to remember less the next day. They’re going to be, they’re actually going to be, I almost want to say dumber the next day.

Chris Kresser:  For sure, dumber, yeah.

Harpreet Rai:  Yeah. When you start thinking about that as someone who’s, like a lot of your listeners are, like, focused on being more productive and being more effective at work, I think that’s like, it’s really important to understand some of that science. And oftentimes I do feel like, yeah, we keep trying to push ourselves in some shape or form, push ourselves to be better athletes, even just recreational, push ourselves to sort of work harder and push ourselves even socially to be there for others we know and just to hang out and spend time with loved ones and friends.

And so I guess the way I always, that someone said to me that really resonated is, “Well, if you’re not getting enough sleep, you’re not the best version of yourself the next day.” You’re literally doing a disservice to you. Just like you said about being present and being in the moment, you’re really going to value those experiences that you’re present for. It’s the same thing, like, you’re really going to value those days that you’re really present for and that you’re able to perform at your best for. Those are the days that you really get it locked on. And it’s just hard to remember that like you said, when I think so many people from such a young age are being told to push and work as hard as they can. And that comes with a compromise of sleep.

Chris Kresser:  Yeah, and it might seem ironic to use technology to reduce your use of technology or create more balance in your life. But I think technology is just a tool. It's up to us how we employ it, and I am a big fan of using some technologies to create more balance. The Oura Ring is good example.

There’s another good example which is the Moment app, which maybe has been superseded or at least Apple with iOS 12 now has some of their own features for helping people to increase their awareness of how much they're using their phone and to put some sort of guide rails around that and have more control over notifications and the do-not-disturb mode at night, which I think we can be cynical about it, and that's a technology company doing that, but I think it's a good move.

Harpreet Rai:  Without a doubt.

Chris Kresser:  It shows some sign of corporate responsibility for the impact that these devices are having, and so let's use the technology wisely in a way that it can actually support us.

Harpreet Rai:  Yeah, there’s a great … well, we’ll have to link to it in the show notes if it’s still up on the internet. Tristan Harris, I think when he started sort of bringing up this effort and broaching the subject that these things are designed to be addictive, all these apps and all these services like Netflix, he did this study I think. And they took 200,000 people that had iPhones and had all these apps installed on the phone. And they literally looked app by app and they said, “Does this app make you happy? Or does it make you sad or unhappy?” And what they found was the response on whether Netflix makes you happy or not was directly correlated with how much time you actually spent in it.

So something like if you’re spending under, I think, 40 minutes a day in Netflix, people actually were like, “Oh, yeah, I’m pretty happy. I watched something funny, I watched something that’s entertaining, maybe I’m watching a documentary, I’m learning more, or I’m just watching something with friends. I feel pretty happy.” But those who were spending, like, I think, more than 50 minutes, it was a pretty clear indicator that they were unhappy. And so I totally think it’s great that now Apple and, I think, Google announced a similar initiative. I don’t know if it’s launched yet, but about trying to show people that their usage in these apps is putting up those guide rails so you don’t overextend yourself and honestly do damage to your body and your mind.

What's Next for the Oura Ring

Chris Kresser:  Yeah, exactly. So you mentioned that one thing that was coming for Oura, which is HRV tracking during the day. What else are you guys working on? I imagine you have some ideas cooking back there.

Harpreet Rai:  Yeah, I mean, there are some small things. We’ve recently done, we just started actually importing activities and help from HealthKit. So for those who use some of the other devices or apps for tracking their workouts or using Strava or using a bike that’s hooked up to some sort of Garmin connect that’s tracking the output on your bike, now that activity data is flowing into Oura. Even if it’s something small.

The meditation mode, yes, that’ll be a larger effort that we’ll release later this year, being able to track sort of your heart rate and heart rate variability during a meditation session. And then honestly, also go a step further. Start helping people find more correlations. So, hey, those days that you actually meditated, did you get more deep sleep? And so that is probably going to be a good first step for us in this correlation angle on the app and the user experience. So we want users to start finding an easy way to correlate their choices and see if it’s helping or hurting their sleep. So certain days that you did weightlifting, let’s say, versus cardio. Or certain days if you were at the gym once a week versus three times a week, did you have a better week of sleep? So helping people find those correlations, that’ll be something we introduce in the app as well.

There is another effort that we’re undergoing, and I think this will be a fun one for users. We’re going to introduce a concept called Oura Labs. And so the idea of Oura Labs is actually taking, call it a group of willing Oura Ring participants, where we’ll go have them wear blue light blocking glasses for two weeks and then take them off for two weeks and see the change in their data. I think a lot of us, we do that individually and we’re able to see it, but sometimes it can be more powerful and a good reminder when you see that data with others in a larger amount of people. So I think that'll be something else you see us start to do more as a company.

Chris Kresser:  That's cool. Well we’ve got a lot of people in my audience that are doing lots of experiments and I'm sure would love to participate. So if you need any folks for your study, let us know and we’ll help you out.

Harpreet Rai:  Totally.

Chris Kresser:  So yeah, this has been a fascinating conversation. And just so, it’s so great to have these new technologies available to us that we can use to actually support our health and well-being. Because so much of technology is actually, as we’ve talked about during the show, has the opposite effect. So it's cool to be able to use it in a different way that actually leads to us making better choices that support our health. And so thanks for everything that you guys are doing at Oura to make that possible. And I understand you have generously created a coupon for our audience if they want to order a ring and save a little money.

How You Can Get $50 off Your Oura Ring Purchase

Harpreet Rai:  Yeah, that's right. So we are giving a coupon to your audience for $50 off for when you buy the ring if you're a follower of Chris and everything that you and your practice does. Yeah, we wanted to offer that for $50 off. I forget, what was the code that we wanted to go with?

Chris Kresser:  I think it was HIH, did you say?

Harpreet Rai:  No, I think we were going to do just I think KRESSER, right?

Chris Kresser:  All right, KRESSER sounds good. That’s better. I was reading that off an email but it might’ve been from something else. And I just want to let everyone know, I have no financial relationship with Oura other than receiving the ring to test out. I bought my own. I don’t make any money from this. I’m just sharing products with you that I found to be helpful myself and with my patients. So hopefully it’s useful. And Harpreet, thanks so much again for joining us. And I’d love to have you back in a couple years or so, and we’ll see, I’m sure there’ll be a lot of new stuff to talk about by then.

Harpreet Rai:  Totally, yeah. Chris, thanks a ton for having us on. I really appreciate it and frankly, thanks for bringing a lot of awareness just to, about people and their health and improving their health and wellness. And also on sleep. I think as we both agree, people are getting less of it and honestly it's hurting us in our lives. And so I appreciate you also just being an advocate for it in the community.

Chris Kresser:  Absolutely. Okay, everybody, thanks for listening. Continue to send in your questions, ChrisKresser.com/podcastquestion. I know we’ve been doing a lot of interviews. I have done a few Q&A episodes lately and we’ll continue to do them. So please do send them in, and even if I don't answer them directly in the podcast, we sometimes write blog articles and it just kind of informs what I'm doing. It helps me to know what you’re thinking about and want to know about. So please do keep sending those in and we’ll talk to you next time.

Harpreet Rai:  Thanks, Chris. Take care.

Chris Kresser:  Thank you.

Ready to take control of your sleep habits? Choose your Oura Ring and enter the coupon code “KRESSER” at checkout for $50 off your purchase.

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