NBA uses the Oura smart Ring
Sleep, Heart rate variability and data. What the experts think- The Bodyclock Podcast by Owaves
I have personally been using the Oura smart ring for the last 3 years and have found it incredibly useful. With the NBA planning to adopt it in COVID season I thought I would compile conversation from our Owaves Bodyclock podcast on Apple iTunes and Spotify.
The ring has sensors to measure physiological metrics like temperature, respiratory rate, sleep time, and heart rate variability. It uses those measurements to sync with an app to produce a sleep and readiness score.
https://podcasts.apple.com/gb/podcast/the-body-clock-podcast/id1436533977
Dr. Tommy Wood: Therefore I’m going to suck today. So the Oura ring is a fabulous tool. But you really need to know how to use it. And how that data is going to affect you cognitively. So like heart variability, doesn’t tell you anything about how you’re going to perform in the gym that day. It gives you some rough idea of how a given workout or training session is going to affect you. So if you’re heart rate variability is low, you may crush it in the gym, but is going to take you longer to recover from it.
So the problem is that people think that the heart rate variability is going to tell them about performance, but it doesn’t really. It doesn’t correlate with performance well at all, but it can tell you over time if you have signs of overtraining, you’re pushing too hard or you need more time to recover. So, again, it’s just knowing what the data means and how to use it. And what I see currently is that people measure all this stuff, but then it becomes a point of worry, which then you’re a self-fulfilling prophecy and then they end up feeling worse and performing worse.
Dr. Sohaib Imitiaz: Yeah, because you’re like, I’m not hitting that hard, why is my heart rate variability in so low? And it was high last week, but yeah. Then you think, okay, I won’t go for that workout when the workout would probably benefit. Just because you might be stressed which is affected your HIV, but then you need to. So you have to be quite dynamic. Where do you lie on the continuum of kind of optimizing human performance? Performing well today now, and longevity- because a lot of arguments with inflammation, you know, being kind of a hallmark of longevity.
But then sometimes to perform, you need to be, you know, stressing your body in the right ways. You think that the trade-off are most consistently the principles that help you perform better and live longer?
Dr. Tommy Wood: So if you stick to the general principles, they will do both. However, you have to accept that if you want to- so sports performance is a really good example and you can think about most professional athletes. So Tour de France cyclist are nice. Basically, there were these emaciated skeletons that strapped to a bike and they can go uphill super, super fast like- it’s incredible. I probably wouldn’t even make it up the hill. You know, that they’re heading up at it 20 miles an hour.
Dr. Sohaib Imitaz: Which will be good. So I’ll get you to explain that a bit more. But I can kind of see the correlations that OK, my sleep wasn’t geared by the quality from looking at these things and working. And OK, that’s why I have brain fog or like if I know if I’ve slept well normally you can tell yourself as well. And you know, like because I know periods of when I’m sleeping well, I’ll be more creative.
I know. I can be happier and creative and someone who’s into innovation. I need ideas. So I’m always kind of trying to look at broad perspectives of different industries and to be creative and come up with ideas. I’m always missing Royan on Slack or WhatsApp on the days I’ve slept better, I am genuine more creative.
It’s really terrible. It’s quite interesting because days in sleep deprivation, which were my orthopedic rotations about four months ago, I wasn’t having many creative ideas. I was stressed, sleep-deprived, my sleep pattern, circadian rhythm was all over the place due to night shifts. And it’s very interesting. So could you go into the quantified self or what technology is your opinion on Oura Ring, Whoop? What would you recommend?
Dr. Benjamin Smarr: Yeah. Yeah. No. So I mean. So those who don’t know Quantified Self has been around for about 11 years. It’s still run by one of the founders, Gary Wolf, who I’m lucky to know because he’s also in Berkeley, it turns out. Terrific guy. And what he’s helped people do by creating this platform is to figure out ways to tell stories about themselves that are quantitative.
So the story you just told me is a terrific example where you say, “I was measuring my sleep. I was measuring how it changed as a function of doing these different medical rotations. And I was writing down how many creative ideas do I have per day.” Right? “I was writing down how many times do I text Royan in a day.” That’s a great example of a story where you say, you know, in my life, this quantification shows me that these things seem to have a relationship.
Quantified self is not predicated on a particular topic. It’s just the idea that if you start measuring things, you can see where there are patterns or sometimes whether or not patterns that you had imagined that might have been and that it informs your self-awareness, it informs your decision making.
And if you can tell that story to others, you pass along that armature or you allow them to build their own tools for self-discovery help, hopefully. And I mean, I’m actually not just a fan of this. I think this is the future of medical science. I think this is profound. You know, we didn’t used to have the ability to look at lots of people’s sleep by using an Oura Ring like you were talking about, right?
That data just didn’t exist five years ago. It could not have existed five years ago. And so there are no medical textbooks that cover that because how would you have ever known what you were looking at? Medical textbooks and our culture generally tend to treat towards the average. They tend to say somebody should sleep eight hours, right, maybe if you’re lucky. It says if you’re young, it changes for when you’re old.
If you’re male, it changes from when you’re female. But even then, those are these very, very clumsy boxes dropped on top of humanity, which is the most complex thing humanity is aware of, right? And so. The only way forward in my mind, if we run out of classical knowledge, how do we get more knowledge from all these amazing tools? You’re never going to do it by me running a study in a lab on a handful of people.
How am I ever gonna know the differences between you and me and everybody listening? If all I ever do is look at a handful of people, the only way we can do this is by building a community where people get to be part of discovery. You get to learn about your creative ideas. I get to learn about when and I’m a better cook. You know, my fiancé learns about when is she gonna be the best runner. So everybody has their own interests. And a lot of people are interested in disease management, especially as they age. All of that is real.
All of that is experience that ought to be engaged with. And there’s this incredible opportunity right now for people in the medical environment and people like myself on the research side to reach out. And rather than say, “I’m doing this thing and it’s important that you could be a data point,” actually listen. Actually build relationships. Actually say, “What do you care about?” Let’s help you value science.
Let’s help you value somebody with medical perspective, listening to you and thinking about how could we explore this. That’s very challenging from a cultural standpoint, especially in medicine. I hate to say it. Medicine has this culture of being right, right? Patients need somebody who’s authoritative. They need you to say, “Yes, this is the problem.” And we’ve drawn back the curtain now, right?
We can see much more than we used to be able to see. And medicine does an enormous amount of good for an enormous number of people. And this weird anti-vaccine thing is a great reminder that we should not take that for granted. But if we say that’s the end of medical knowledge, we’re depriving ourselves of all of this new learning that’s possible with all of this new tech that we’ve developed. That would be criminal. So I think the only way forward is to change the nature of the institutions, right? Break out of the lab.
Break out of the hospital and break out a patient receiver consumer mindset. Not to get too hippie on you here. And really think about the community. Really think about valuing people sharing rather than tricking them into sharing. Really think about valuing hearing people’s stories rather than tell them, “No, that’s not the standard.” Everybody is different, right? We’re all humans, but we are fairly individual humans. And so capturing that fine-grained difference is the only possible way we’ll ever get to things like personalized medicine or predictive medicine.
It just doesn’t make sense otherwise. So you can tell, I’m sure, I’m very passionate about this. I think people engaging in self-discovery in responsible ways, using state of the art scientific technique, but appropriating it with new tools rather than just say, “Well, I guess that’s for scientists.” I think that has serious transformative power for our human well-being globally. And anything that can help move that forward, I am all about it. Anything that is a barrier to that. I think it’s harmful and it ought to be torn down. So let me stop myself there because I can go on and on.
Dr. Sohaib Imitaz: That’s so good to hear. And I can see you’re so passionate about that. And it’s interesting how doctors get very little teaching on sleep. And then if you present them with metrics like heart rate variability, which I did to a surgeon recently and they hadn’t really heard of it. And exactly.
They just can’t understand the technological advancements, these tools. National directors don’t even know the Oura Ring exists. Surely there’s something going wrong. If the guardians of health, the so-called guardians, aren’t aware of where health is moving and if a patient comes to you with this data, you can’t really interpret it. So getting back to that question, are you an advocate of someone? Do you measure your sleep?
Do you use the Oura Ring? What do you think is useful? And could you tell the listeners about deep sleep versus REM sleep? And is one more important than the other as well as, I’ll throw in something else, genetics? So night owls, morning larks, how much do we vary by? Is it true? Is it false?
Dr. Benjamin Smarr: Yeah, yeah. Yeah. Great questions and all of them are right for the kind of discovery work that I’m talking about. Right. So broad strokes working in reverse order, maybe.
Dr. Sohaib Imitaz: Perfect.
Dr. Benjamin Smarr: Clocks being cellular machines are largely dictated by genetics. Biological clocks, I mean. Circadian clocks. So it definitely seems to be the case that if you’re genetically…You know, the machinery is a little bit sticky and your clock takes longer than 24 hours to run, you’ll try to live a longer day. So you’ll end up staying up later.
You’ll take longer to warm up in the morning and you’ll stay up late into the night. And the opposite is true. And so people like me who have a short clock. You know, I get up between five and six and I hop out of bed and I’m ready to go. And by eight o’clock, I’m pretty much not useful. And I just want to read a book and go to sleep, right? How? I’m like the stereotypical old man. You can find that to a certain extent.
It’s plastic to a certain extent, but it seems to be remarkably resilient to what your genetics is. Meaning, for someone like me to try to stay up late and go to parties and socialize and network is really hard. And similarly, you know, obviously a lot of my students are late types and they’re at a time in life when their clock has been delayed by puberty.
And so if I say, “Well, let’s have a meeting” at you know, what to me is late, right? “Let’s have a meeting at 9:30 or 10:00.” They go, “Ahh, do I have to get into lab by 10:00, God.” So you know, they can do it because I can make them do it. If I’m mean about it, I try not to be, of course, but it’s not good for them. So there is some plasticity, but really it’s a part of who you are. It’s part of your genetic identity.
The same way that we think about race and gender and these sorts of things, right. It really is part of our human diversity. So we should be measuring that. We should be valuing that. How do we do that? So, yes, I wear an Oura Ring. The way that I use the Oura Ring is I just scroll way down to I click on my little sleep button and it gives me a score. I don’t care what score they think my sleep was.
Scroll to the bottom and I look at the continuous heart rate or I look at the temperature deviants across days. Those are real data, right? So if you look at the heart rate, what you want to see is you’ll get a little graph of your heart rate across the night. And what you’ll see is that if you’re healthy, it stays relatively flat, it stays relatively low, and it has ripples. So you’ll have sort of three, four or five humps that describe that night. And those are your sleep cycles. And so that’s very good.
That’s showing that your body is going through a regular cyclic kind of sleep that’s very healthy. What a lot of people might notice is it starts very high and then it sort of precipitously falls down in the first half of the night and then it starts to bump along. That probably means you had a drink or a big meal too late in the day. And your body was still dealing with that when you went to sleep. So that’s the sort of thing you can look for and you can start to say, “What am I doing?” How is it affecting the shape of these data? And how do I learn about what’s good for me, right? What are the right habits?
If I went to sleep earlier or later, did that change the shape of this thing? Separate from that, they try to use the data to back project onto your cortex. So when we talk about sleep cycles and you had asked me about different kinds of sleep, so deep sleep, REM sleep, slow-wave sleep. These are types of sleep that are characterized by the activity on the surface of your brain, your cortex, and basically how many sorts of crackly noise is going on electrically versus how much are these big, long, slow waves coordinate the activity.
And when you’re in sleep, people back in the 70’s discovered that you could see patterns to when you’re in REM sleep or when you’re awake, your cortex is going, “up, up, up, up, up,” and it’s really doing things. When you’re into deep sleep, it’s going, “whoa, whoa.” It’s making these canonical brain waves and helping to get itself back on track. And get coordinated, flush things out. And unfortunately, from my point of view, that has been canonized as sleep.
It’s not sleep. It’s the behavior of the cortex during sleep. And your heart has its own behavior. Your liver has its own behavior. Your temperature is doing different things. And we haven’t done a good job of capturing all of that sleep that is not happening in your cortex. So when you look at your Oura Ring or your Whoop or your Fitbit or your Apple Watch, all of them will say, “Here are your sleep stages, here’s your slow-wave sleep, here’s your deep sleep, here’s your REM sleep.”
None of them are really measuring that, but all of them are measuring something like your pulse rate or your heart rate variability or if it’s an Oura Ring, your body temperature. Big fan of body temperature, which is one of the reasons I like Oura. And they’re saying, given that we can see this thing sort of has these ripples, you know, three, four cycles in a night. How accurately can we guess from that what your cortex was doing? Because that’s what people say sleep is. And so that must be what we’re aiming at. And that’s fine. But I fundamentally disagree.
Will Apple compete?
Dr. Sohaib Imtiaz: It’s the worst for you exactly. I mean all my night shifts I’ve been measuring my heart rate variability recently and it’s a lot worse than my day shift and obviously because my circadian rhythm is completely disrupted and obviously the pager goes off that bleep sound I’m sure-this needs to be studies done with the cortisol release-but yeah it helps me figure out more why I need to adjust in stressful situations. So your heart rate variability being the big one but chest straps I think are the biggest limiting factor. Have you got wearables that you can use to measure from your wrist or-?
Dr. Molly: Yeah I mean I’m experimenting with the Oura Ring and I think the Apple Watch will eventually get there.
I mean they’ve done they’ve done EKGs now so Apple is working strongly to get ahead of the puck in this space.