The Melanie Avalon Podcast Episode #76 - Harpreet Rai (Oura Ring)
Harpreet Singh Rai is the Chief Executive Officer of Oura and a member of its board. His purpose is to be part of a team that is committed to improving population level health and wellbeing. He is responsible for Oura’s vision and strategy and guides decisions that ensure the organization's financial health. Before Oura, Harpreet was a portfolio manager who led the technology, media and telecom portfolio at Eminence Capital for 9 years. He began his career working in Morgan Stanley’s merger and acquisitions group. Harpreet studied electrical engineering at the University of Michigan.
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6:50 - Harpreet's Background
14:00 - The Tech in the Ring
16:10 - Accuracy of the sensors
18:45 - heart rate variability at night
20:10 - inaccuracies with movement
21:00 - what is heart rate variability
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26:40 - Arrhythmia
27:35 - the wearable tech for heart health
29:20 - hRV In Meditation
31:05 - oura in a sauna and in water
32:35 - RMSSD
33:05 - the data in the User interface
33:30 - oura's personalized "readiness"
36:40 - what is the baseline for comparison?
39:30 - Sleep Measurements
39:50 - sleep timing and ideal bedtime
44:30 - LUMEN: The Lumen Breath Analyzer Tells Your Body If You're Burning Carbs Or Fat For Energy! You Can Learn More In Melanie's Episodes With The Founder (The Melanie Avalon Podcast Episode #43 - Daniel Tal, The Melanie Avalon Podcast Episode #63 - Daniel Tal (Lumen)) And Get $50 Off A Lumen Device At MelanieAvalon.com/Lumen With The Code melanieavalon50
46:00 - readiness score vs natural intuition
51:15 - temperature alert
52:45 - COVID research study
55:05 - EMF Exposure
56:00 - Airplane Mode
56:30 - Infrared lEDs
Melanie Avalon: Hi friends, welcome back to the show. I am so incredibly excited about the conversation that I am about to have. It is about a topic, which is honestly a item that pretty much embodies the spirit of this show, when it comes to taking charge of your health, figuring out what's happening in your body, making lifestyle choices to address that. This is the thing for that. I am talking about the Oura ring. Listeners might be surprised because I think when listeners think about me, think about the show, they probably think that the first thing I ever tried was an Oura ring, because it's just that much in line with everything. But I actually did not start using one until a few months ago, and that is because something we can actually talk about in this show. The psychology of wearing something and getting back that feedback all the time, I was wondering if it was going to make me neurotic or crazy, or if it would be hard to interpret. Actually, it has been the complete opposite. I now feel I'm going to have an Oura ring in my life for the rest of my life.
I have learned so much about my body, about my health, about my sleep. I am here with the CEO, Harpreet Rai, to dive deep into the science of Oura, what we can learn from it, why listeners might want to bring an Oura into their life as well. Harpreet, thank you so much for being here.
Harpreet Rai: Melanie, thanks so much for having me on. I really appreciate everything you do and how you share information with your audience, so they can improve their health. I'm delighted to be here.
Melanie Avalon: Well, thank you and I echo it right back at you because this product, the Oura that you've created is, it's a game-changer. It's definitely my favorite biohacking thing that I have brought into my life. I can say that pretty confidently. I'm sure you get this question all the time, but your background, you actually have a background with Morgan Stanley. How did your interest in wearables, like Oura, how did that start?
Harpreet Rai: Yeah, it's a great question. All things great in life, sometimes unexpected. I actually have a little bit of background in wearables. I would say really, my interest in connected health and sensors probably started at a pretty young age. My father was an electrical engineer, my grandfather was an electrical engineer. Obviously, when I went to college, I had to be an electrical engineer. But, no, all kidding aside, I was fascinated with technology and things like computers at a really young age, I still remember the first 386, my dad brought home. The first thing I did after getting MS-DOS working and playing Tank Wars was literally, I think, later that night, I took a screwdriver to the thing and immediately popped off the kit. I think my dad was a little upset the next morning, but we worked it out. I was just young and curious.
I've always loved technology, love how it works, and wanted to understand. I think technology being applied to health came a little bit later for me. I wanted to fit in school, I looked different. I grew up in basically suburban Pennsylvania and New Jersey. I'm Indian, I'm Sikh, I have a turban and a beard. I would say, when I was in high school, it wasn't cool to be a nerd. I think it's getting a lot better out there, which is great, frankly. For me, sports was the equalizer, it's how I could fit in, it's how I could be normal. My sport was soccer, that's what I fell in love with. I felt just at a young age, I had to work twice as hard to be half as good. I remember seeing friends on the soccer team that they could smoke cigarettes, they could eat really crappy food and like a ton of sugar, and be able to run a five-minute mile. I felt if I looked at a thing of Sour Patch Kids, I'd gained 10 pounds, but let alone eating with it. I just was trying to understand the young age, how can I train better? How can I prepare better? When I started to realize, “Man, different people react differently to the same stimulus.”
When I got into college, and I went to University Michigan, study Electrical Engineering, and specifically, Michigan had a MEMS program, which is microelectromechanical systems. For those who are not familiar, it's basically the grandfather technology of sensor design, sensor tech. My senior design project was an accelerometer, motion sensor, and my master's design project was actually a neural probe, how can we insert neural probe into the brain without causing a lot of scar tissue. I always felt the sensors and the applications in health could really help because I had problems understanding my own health and how to optimize it. I think that's where my fascination started.
I ended up getting distracted when I graduated college. I was probably looking for a little bit of the same validation that I look for when I got into sports, trying to fit in, and “be cool.” For me, that manifested itself in, “Hey, I want to go work on Wall Street.” I was graduated in 2006, 2007, it was a financial boom, the ton of friends in the business school, and they're like, “I'm going to go work at Goldman Sachs,” “I'm going to go work at JP Morgan,” or, “Morgan Stanley, and make 100 grand a year.” I thought, “Oh, that's a cool thing to do.” It was a financial boom, I was pretty good at math and spreadsheets and stuff and I was able to read some interview prep guides on investment banking and was able to get a job.
I ended up working in New York and Manhattan, in New York City at Morgan Stanley in M&A Group. A year actually into that, one year in, I gained 50 pounds my first year. I probably gained about a pound of weight per week, and coming in I was 150 pounds. That was a huge amount of weight. I remember, some friends saw me from college, they came to visit because I was living in New York, and they're like, “Hey, man, holy cow, this is really taking a toll on you.” I also remember, it was the first time in my life, where I'd come home from work and not be able to fall asleep. I'd be so wired up, whether there is a late cup of coffee, whether I'm jacked up on adrenaline, just working till 2 AM under fluorescent lights, whatever it may be. It was the first time I started experiencing mild insomnia, which is just crazy to be.
I ended up leaving Morgan Stanley after just about after a year, it was a two-year analyst program, so I left early that was looked down upon, but I went to something called a hedge fund. I went to this fund called Eminence Capital, it's a $7 billion hedge fund, they've been around for 22 years, great place, ended up staying there for eight and a half years, and I was able to go from analysts to senior analyst to portfolio manager. I ended up getting to invest all across the tech sector, including hardware and wearables, and internet companies, and telecom companies. It was there that my fascination of wearables came back. I was looking, spending a lot of time with the components that go into these things, whether they're Apple Watches, or Fitbits, or Oura rings, lot of the same components.
I actually not one of the founders of Oura ring and the CEO, but I happen to meet the cofounders really early on. They’d just announced the Generation 1 Oura ring. I was fascinated with it, knew how important sleep was after repairing my own sleep. It was first wearable that I got on the Kickstarter at the end of 2015, early 2016, that I never took off. I realized, “Man, the nights I'm sleeping better, I'm performing better the next day in the gym.” Honestly, by chance just happened to me when the cofounder was in the whole foods, he's wearing an Oura t-shirt, and my girlfriend spotted him, and the rest of sort of history. I end up personally investing in the company, joining the board, and then the team and the board asked me to join as president. Then about a year after as president, the board promoted me to CEO. That's a long-winded answer, probably longer than what your audience wanted to hear, but how I got here at Oura ring.
Melanie Avalon: No, I love it so much. You come with this personal experience that I think so many of us struggle with. Now, it makes sense, because for listeners, the Oura ring, if they're wondering what all it monitors, it looks at so many things, it looks at your heart rate, which will talk about your heart rate variability, your respiration, your activity levels, and you just touched on it. People struggle with diet, with weight gain, with physical activity, they struggle with sleep, and insomnia. That's been the biggest thing for me personally. I think, really, for anybody who is struggling with anything that they're trying to take charge of, there's so much insight that can be found in this simple ring. I have so many questions for you, but I guess to start, can we talk a little bit about the actual technology in the ring, so listeners can know what it's actually monitoring? I know it has like, three or more different sensors. So, how did those all work and what are they monitoring?
Harpreet Rai: Inside the Oura ring, we have two LEDs. So, that's a light-emitting diode. Those are two of the three bubbles you see on the inside. The bubble in the middle of something called a detector, or receiver. Just how this technology works, for those who don't know about it optical, it's called PPG sensing, photoplethysmography. I can never say that word. All wearables are basically using the same technology. Whether it's Fitbit or Apple Watch, those blinking lights or an Oura ring, what we do is we shine light to a certain part of the human body, and we try to see a signal. We happened to use infrared light and we happen to be measuring at 250 hertz. Those three bubbles on the inside of the Oura ring, two LEDs and one detector. We also have three temperature sensors inside the Oura ring that are measuring your temperature continuously throughout the night and day. We have an accelerometer and a gyroscope, which effectively is a movement sensor. Then we also have a standard sort of microprocessor. All that is inside that little tight and lithium-ion battery, a tiny lithium-ion battery, so all those things are inside the Oura ring. All wrapped in that small titanium metal package for users.
Melanie Avalon: This is so crazy. Okay, some more questions about the sensors. What is the accuracy of all of these sensors? I know I was reading that it monitors your heart at night because of accuracy. What's going on with all of that?
Harpreet Rai: Yeah, it's a really good question. And something I wish frankly, more people who use this technology understood. Like I mentioned, all of us are using the same exact sensors really, these optical LEDs at different wavelengths or colors. Then also different speeds, or frequencies. If you can imagine optics or light, and then you're seeing a signal back, it's almost like a radar, or even like a satellite. The way it works is we shine light and we see a signal back. Now in terms of accuracy, and back to your question of like, “Why measure at night?” Well, turns out, any of these technologies, if you try measuring that signal when there's lots of movement, ends up being really inaccurate, or really noisy. Imagine, trying to shake a radar gun, and also measure a car that's moving by, you need it to be stable to see the reflection of that car going by, or a satellite. Imagine a satellite moving at the same time a house is moving in space, the signal is going to get jumbled. It's the same with LEDs and PPG technology.
When you shine that light if the person sitting still, you can see a very clear signal back. It turns out actually that that signal’s much stronger on the finger, which we can get to later than the rest. When you start moving, that signal that you see that looks like a heart rate, heartbeat pattern, gets very, very noisy. When you're moving and running or doing any type of hit workout, the signal gets very, very jumbled. In fact, I probably estimate that really, less than 10% of the time when you're moving, can you see a clear heart rate signal from wearable technology? I think most people don't understand that. What do companies do? Well, they estimate your heart rate during that movement. What they try to do is you take a chest strap, something that'll EKG sensors, something that is connected to your chest, that'll have a great heart rate signal, and then you try looking at this messy, noisy optical signal, and you try comparing the two and you try to train an algorithm.
It turns out, for things like running, or biking, or walking, a very cyclical movement where the repetition, the pattern the same, you can start to suss out some of that noise. For random movements throughout the day, if you're just doing chores, if you're just doing any type of CrossFit workout, it's very hard to distinguish any real heartbeats or see them clearly when you're moving. What all the companies tried to do is just really extrapolate it. They may see a heartbeat, and then they just estimate, “Well, that must be your heartbeat for the next 10 or 20 seconds,” because we don't get another clear heartbeat until that. I think that's something we realized, it has its shortfalls, people are trying to measure their heart rates in certain zones and use that workout data. You're relying on unreliable data. We took the approach of, actually, when is this data and when is this technology the most accurate?
Well, it turns out, the most accurate when you're still, when there's no movement. Why not really focus on capturing all that relevant and accurate data without all this noise? It turns out, that the best time to do that is actually at asleep. If you start looking at the sleep patterns and sleep patterns in general night after night after night, you can start to see changes. Why was my heart rate really high that night? Or my heart rate variability really low? Was it that stress because I was up till 10 AM, 10 PM working in front of a blue light? Was it because I had that coffee at 6 PM? Or, actually ate really late or ate a lot of fat, for my last meal what, what might it be? Then people can start to now rely on accurate data collected at night without movement to see and understand those changes and make healthy lifestyle decisions, as you said.
That's why we focused on that period to collect data. It also turns out that sleep and sleep patterns is perhaps one of the most underrated and probably most effective things you can do to understand your health getting the right amount of deep sleep and REM sleep has tremendous, both physical and mental benefits and long-term health implications. I think that's really why we focused on a ring, why we also focused on sleep for measuring these signals. Hopefully, that makes sense, I got a little technical there.
Melanie Avalon: It does. I have a quick question. Is it for the movement being an issue? Is it the relation of the device to your body that movement? If you kept the ring, and it didn't move in relation to your finger at all? Would it be accurate?
Harpreet Rai: No, it's actually the movement of the optical sensor. If something's moving on a train, like that whole train, everything inside is moving. Even if the ring or any optical risk-based device is really, really tight, sure, that'll help, but it's actually just the basic laws of physics that you're sending a signal at one point in time you're moving, and so the time that signal is received is a different point in time and different sort of plane, which ends up moving the optical signal. It's a fundamental optics, technology limitation with movement.
Melanie Avalon: Well, it measures activity during the day, but then the heart rate and everything at night. There's so much confusion surrounding heart rate variability. I feel it's one of those things where it's a term that, especially in this world, you can say it and people will know what you're talking about. But beyond that, people are confused. It's like, what exactly is heart rate variability? Do we want it high? Do we want it low, go through the basic terminology of, I guess, heart rate compared to resting heart rate compared to heart rate variability?
Harpreet Rai: Yeah. Heart rate is just your heart rate at any point in time. Let's just take some simple math here. Let's say, I'm sitting still right now and let's just guess that I'm pretty calm. My heart rate is 60 beats per minute. BPM, I think, is the standard nomenclature for heart rate. What that means is that, okay, over the course of that minute, my heartbeat beat at 60 times, beats per minute. Well, it turns out that every single heartbeat is a slightly different timing. It doesn't mean that they happen on the second every single second. There's variability naturally with the human body, that one beat could be 1.1 seconds apart, the other one could be 0.9 seconds apart, the other one could be 0.8 seconds apart. And it'll still average out to 60 beats per minute, it's just the time between the microseconds between or the millisecond between each single heartbeat, that variation, that beat-to-beat variation over the course of a minute is your heart rate variability. Hopefully, that helps explain it.
What scientists have discovered over the last 20 years is that it turns out, actually, it's counterintuitive. You want high heart rate variability, so you want lots of variation in those heartbeats. I think I like to think about it because it's counterintuitive, like in a flow state, if you're really in a flow state, and you're really-- if you've ever been in the zone, you can take anything that's coming your way and adapt. It's almost like a surfer on a wave. This isn't a wave, this is a wave, boom, naturally I’m with it. Oh, the wave is going to turn, I'm going to turn with it, you're relaxed. You can just be in that flow state, your heart’s like-- each single beats a little bit different, like you can handle if all of a sudden, a surprise comes. I think a low heart rate variability, or what's sort of seen as a sympathetic sign, the sympathetic nervous system versus the parasympathetic. Now, high heart rate variability scenario, is that you're now sympathetic to your surroundings around you.
Imagine that all of a sudden, you see that shark in the water, you're freaked out on that surfboard, you're reacting, you're sympathetic to what's around you, the sharks in control, not you, your heart all of a sudden gets really-- your body, it feels when you get stressed, you get really tight and rigid. Well, that's really your nervous system and being reflected in your heartbeat of like, each beat is right on the dot. “It's like, “Oh, man, fight or flight, and I'm really stressed out.” That's how I think about heart rate variability. But the reality is, for listeners, to summarize, you want a high heart rate variability, a lot of variation, that's a sign of less stress, or your parasympathetic system. You're in control, you're not sympathetic to your surroundings. It's like you're in control, you're in that flow state.
Then heart rate itself, just to back up a real quick, generally it's thought of lower is better. There's obviously some limitations where it's unhealthy. But if you look at marathoners, extreme athletes, you'll generally tend to see very low resting heart rates. Hopefully, that helps, Melanie.
Melanie Avalon: Two super random questions. Are arrhythmias, a heart rate variability thing? When people perceive that, or is that completely different?
Harpreet Rai: No. You're exactly spot on. There's different types of arrhythmias. There's all different types of heart conditions. Maybe think through anytime you've watched, like, what's that TV show ER, or like House, and you see that little in the hospital, that little green screen that has your heart rate curve, it's like that little pattern that two little micro bumps, and then a very big bump, that's the different ventricles of your heart pumping that blood. It turns out that that same electrical signal has a very similar analogous signal when you move it to the optical realm when you use light instead of electricity to measure that signal. It's that pattern in that heartbeat, the difference between those sort of waves, in terms of their shape, their timing, their height, that can signify that something is either working correctly or incorrectly with a heart. Anytime you have an arrhythmia, there's a normal shape in that waveform. So that's why a lot of this technology can be used for cardiac, things like AFib and Apple Health, the Apple Watch focused on it quite a bit.
Now in Korea, we've seen actually, Samsung release changes in blood pressure or hypertension, for their users in Korea. They haven't gotten approval to do that in the rest of the world yet. That's how this optical technology can be used for things like different types of heart issues, or heart disease in the future. If you think about that again, getting back to the advantages we talked about before, you're really going to want to see that signal, that heartbeat signal, that sort of EKG, that's an optical PPG signal transform. You're going to want to see that extremely clearly. There's lots of movement, if you were try looking at that pattern, it would look all over the place, you couldn't see peaks and curves in that heartbeat. It'd be a bunch of optical noise. The human eye couldn't even see that heartbeat. And what if you looked at a graph of all that data? That's why again, why it's so important to get almost the most clean, still heartbeats throughout the day to interpret all of this wearable data.
Melanie Avalon: Gotcha. I remember one time when I was in the hospital for something, and I got hooked up to one of those machines. I was so excited because I was like, “Oh, I can see if I can psych myself out and make the heartbeat change on the machine.” Those are the things I think about. Another super random question. This is more esoteric, but you're talking about how heart rate variability is, basically the body's readiness to adapt to the situation with the heartbeat. So, would that mean that could we have really good heart rate variability, but if we were in a environment of no stimulus, like a very calm environment, then we wouldn't necessarily see heart rate variability. If you're doing meditation, what would you expect to see?
Harpreet Rai: Yeah, it's actually a great question. I know we mentioned, by the way Oura ring measures your heart rate and heart rate variability all throughout the night when you're still. We actually do have a meditation mode, where you can do the same thing. If you hit the plus button in the app, at the bottom right, you'll see something called a Moment. So, you can take a moment and listen to guided or unguided meditations. Then afterwards, you can see your heart rate variability curve, and your heart rate curve throughout the meditation session. What the research and literature has shown us is that actually really good meditators are able to relax and increase that variability during a meditation session. Essentially, the better you get at meditation, you'll be able to see that heart rate variability improve throughout the meditation session. So, it's actually pretty cool that mind is over matter, in one sense. Then vice versa, if you're in periods of high stress, you'll see that heart rate variability moved down, even during a meditation session, actually or novice meditators.
In the beginning, how you almost focused on every breath too much, or what your mind is thinking, we actually see the opposite that the first few sessions, whether it's 5 or 10, your HRV during the session may actually go down. Then once your body starts learning how to meditate more in your mind, you're able to actually increase that HRV over time.
Melanie Avalon: That is so cool. Yeah, I actually last night did the Moment session for the first time, but I did it while I was in the sauna in general. Is it okay to have an Oura ring in the sauna?
Harpreet Rai: Totally is. Yeah. I love the sauna. Luckily, I think our rings are waterproof to 150 meters. So you could technically even dive with your ring. Don't dive too deep, but I think 150 meters is pretty deep. Yes, you can take it in extreme temperatures whether it's cold, like ice baths or extreme heat, and the ring should be fine.
Melanie Avalon: Okay, perfect, because I asked listeners for questions. Somebody did ask if they could do it scuba diving. So, you answered her question. When I did it in sauna, I did it near the end of my session, and I realized I needed to have gone five minutes with a Moment to get the heart rate variability. I was at the very end, and I was like, “I can't do this anymore.” But I did get the resting heart rate and it was almost 100 just from laying in the sauna. So, that was really interesting to see.
Harpreet Rai: It's an environment essentially of heat and stress that eventually causes a positive reaction from your body and your whole immune system after the sauna. It's a really good positive stimulus just like exercise. Your heart rate goes up when you exercise. That's how it's all about, it's called super adaptation, or so you have to break the muscle down, and then it repairs and get stronger. It's that same concept. The sauna is a great one. Yes, you do have to do a heart rate a moment for five minutes to see your heart rate variability numbers. That's mainly because the way that heart rate variability was created, the measurement is in the time domain called RMST, which stands for root mean square of success of differences. So, they actually do the root mean of the success of differences in the heartbeats, and you need about five minutes according to the standard calculations to get enough data to do that calculation. So, that's why we make that sort of just the scientific standard to do it.
Melanie Avalon: It is so exciting all of the data that you get in the app. I want to applaud you, because there is so much information in there, but it does not feel overwhelming. It's so easy to go through and read and synthesize. I really applaud you on the user-friendliness of the app. Back to the resting heart rate, because for listeners, when you have the app, you can see, like we said, it measures at night, and so when you wake up the next day, you can see graphs showing your heart rate throughout the night, you can see trends, you get all of these different scores, you get a sleep score, readiness score, there's an activity score, there's just so much that you can learn. I think my favorite thing is just how-- this is a question I have about this is how unique it is to the individual because it really takes in your data. And then every day, listeners, friends, when you wake up, it tells you how ready you are to start the day based on a myriad of factors. What all is going in there? How personalized are the recommendations in Oura to the individual? How is it determining your level of readiness? How you should handle the day? How is it determining all of that?
Harpreet Rai: Great question. And thanks for the kind words, but really, the kind words belong to our whole team that work together to create all these scores. It's a good combination of a user experience, UX design, along with some great physiology and science behind it all. Everything that we do in the app is actually personalized. I think it's sort of the mantra of a little bit like yoga, it's your practice. It doesn't matter where you start, it's all about self-improvement for you. Translating that to a wearable, it's all about-- it doesn't matter if you get 30 minutes of deep sleep on average, or 10 or an hour. It's all about how can we get better? How can we see the trends? It's not absolute value, but it's actually change.
All of our scores get smarter in the first two weeks, but really after the first month of understanding your baseline, your data, and then we start to see, okay, wait normally your resting heart rate actually happens-- I'm just going to make this up. It gets to its lowest point and the last 20 minutes, but all of a sudden one night, your resting heart rate actually gets to its lowest value and halfway through the night. And so that's a physiological signal that you're less stressed that day. Some people may even have resting heart rates happen-- their lowest resting heart rates happen in the early part of the night. The first of their sleep, so they're really relaxed. All of the data and scores, all gets personalized to your baseline or your norm, because that's what really matters. It doesn't matter that if you get 30 minutes or 40 minutes deep sleep, what matters is actually, “Hey, I realized that my 30 minutes or 40 minutes increased to 50, 60 or 70 minutes,” or vice versa, it dropped by 50% down to 15 minutes, because I had some tequila last night.
You start to realize that the changes in my data, right, this data change for me, the score sort of reflects that for you. And then you ask yourself, we see this with our users, they ask themselves in the morning, when they check the data. “Wait, what did I do yesterday?” They start to realize, actually, even if I have blue light blocking glasses on, when I'm still working late at night, my mind gets really, active gets really sort of my adrenaline starts going and then it's really hard for me to get a good resting heart rate during night and to be relaxed because I'm so wound up. I think you can start to realize what works for you and what doesn't. I think that's what's so cool about how we built our scores. It's all about relative changes in your baseline that helped people interpret this data and understand it.
Melanie Avalon: If it is individual to the person and compared to their baseline, are some of the things that it is testing some of the factors, an absolute baseline to compare against something that is ideal or is everything potentially to the individual?
Harpreet Rai: The weighting and the algorithms are mainly towards the individual, but we do take and the relative change in the individual, that's what matters most. We do look at certain averages as well. We give people that. If you look at REM sleep in sleep section of the app, and you click on that the contributor bar for that sort of where it says sleep contributors, and you have all the different colors and bar lines. If you click on REM sleep, it'll say that the amount of REM can vary, it can make up 5% to 50% of your total sleep time, but on average, it accounts for 20% to 25% of your sleep time. It usually decreases with age. We try to give some of that information so users can start to understand, okay, what is normal, but most of the way the algorithm work is done and the scores would come up, it is on that relative change. That's why we hear from users a lot, “Wow, the data just feels right. Man, I felt like I slept awesome. I looked at this, and I had great heart rate variability and I had great sleep.” Well, that's because versus your averages, you did have a really good night. If we just gave that absolute level and developed all our algorithms on that, someone who has low deep sleep or low REM sleep might just get really punishing messages every single day. And that can actually be very demotivating.
It's almost like, you're just going to the gym for the first time and you can't do one pull-up or five pull-ups. You may be like, “Man I really suck. Most people in the gym can do 10 pull-ups, I can only do, not even finish one.” Even if you go from one to two, you may feel really demotivated. In reality, that one to two pullups is a huge progress. You want to be able to actually credit for that progress to motivate you. And so that's why we built our scores, mainly all waited on the relative changes.
Melanie Avalon: Oh, my goodness, that explains why-- because you know how I said in the beginning that my hesitancies was information overload. I think my biggest hesitancy was what if I get it? I've always struggled a bit with insomnia. I was like, what if I get it and it starts saying that I'm not sleeping and then I start overanalyzing, and then I just feel basically demotivated? That makes sense if it's adjusting to you, and it seems so much more approachable. It makes sense why I haven't had that reaction at all that I was a little bit nervous about. I know it's not just me because a lot of listeners asked me that about the psychology of using it, would it make them more neurotic or more empowering? Should they get it? Friends, that was my one concern, and I have not experienced that at all, and now it all really makes sense hearing you say all of that.
Well, another question that relates to that. For example, in the sleep section, it looks at all these different factors. So, total sleep efficiency, restfulness, REM, deep sleep, latency, and timing. What I've noticed for me is I can actually get on some days, like really, really good on every single one except timing, because I am a night owl, and I go to bed very late. My timing score is a massive fail, so because of that, is timing one of the things that is objective? Well, I never be able to get 100 sleep score, even if I had like 100% on everything, but the timing of it was night owl.
Harpreet Rai: It is a really good question. Again, it is still relative base. If you're inconsistent in timing, meaning, one night you go to sleep at 10:00 PM, next night you go to sleep at 1:00 AM, you'll get more penalized in your timing contributor than if you just keep consistently going to bed at 1:00 AM. Again, it's all about the relative versus absolute that has more waiting. Timing is the one though we're actually-- the more you keep using the device, we start to learn what actually is your optimal timing. You'll actually see an evening if you open up the app, you'll actually see when is a good time to go to bed. I don't know if you can see it yet, Melanie.
Melanie Avalon: Yes. It was so exciting. I was like, “Oh my goodness, it's telling me I can go to bed late.”
Harpreet Rai: Yeah. Even if you open the app now, even if it's not close in the evening, I don't know which coast you're on, or where you are right out, but if you scroll to the bottom app, you'll probably see something called Bedtime. I don't know if you will see it or not because you're still a relatively new user. You've only had the device for I think two months, but let me know if you see that. And if you do, you can start to see, it'll show a trend of your bit of your baseline bedtime and your ideal window. We start to get smarter, the more and more use it. I forget when we start giving the ideal bedtime recommendation. Maybe two months, I'm not exactly sure if you see that yet or not. When you keep using it--
Melanie Avalon: I'm not seeing at the bottom of there. I think it's because it's not late enough yet. I was looking at it last night and it was giving me my ideal bedtime, like when I was going to bed and my ideal bedtime.
Harpreet Rai: Yeah, we try to insert that it's sort of the right time of the day or evening, so more users pay attention to it.
Melanie Avalon: Okay, yeah, that's incredible. The thing I was looking at what timing is, in the info window it says, your optimal if the midpoint of your sleep falls between midnight and 3 AM, I was like, “Well, I don't think I'm ever going to hit that.”
Harpreet Rai: [chuckles] Well, you know why they call it midnight? Because it's supposed to be [chuckles] halfway through your sleep, it's mid night.
Melanie Avalon: Are you an early person?
Harpreet Rai: No, I don't go to bed at 8 PM either, I wake up at 4, but that's actually where this thing came from. Look, I do think as humans, our hormones fluctuate all throughout the day. If you actually look at how we evolved. When the sun went down, and we didn't have any artificial light. Our melatonin would start to get released, and we start to get sleepy. Before electricity and the modern lightbulb as a society, we used to go to bed way earlier, and your hormonal cycles were all really centered around the sun. I think in today's modern age, it's gotten a lot harder to do that we're stimulated by light all the time, by electronics, by everything's on-demand, like food, whatever you want. It throws over natural sort of circadian rhythms off. We still, again, we try to show people that data, “Hey, what we've noticed after a month or two months data is, this is your ideal window, and here's where you get the best sleep scores when you fall asleep.” I'm just making this up, 11:30 PM versus 1 AM. So, you'll start to get more and more that data as you keep using the device over time.
Melanie Avalon: Yeah, that was one thing I noticed was when I first started using it, it was giving me a slightly later ideal bedtime. Now recently, it's been pulling it up a little bit earlier. I wasn't sure if that was because it's noticing that I'm not quite recovering, or I guess, there could be a lot of factors.
Harpreet Rai: No, that's exactly what it's noticing is that over time, as we get more sort of better nights versus worst nights, we'll start to realize most likely that those nights for you are happening on earlier when you go to bed earlier. And so that's why we're trying to encourage you to go to bed earlier. I think it's also one of those things like slightly earlier, it's delta over absolute. We don't want to say, “Hey, Melanie, you're terrible.”
Melanie Avalon: Go to bed at 7 PM.
Harpreet Rai: If you're consistently going to bed at midnight, that's not the right way, [unintelligible [00:37:11] of things you have to change, your life is going to be so great. But, hey, maybe we can get you going to bed 20 minutes earlier, or 30 minutes earlier on average. And then we see that even helps, and so then maybe we start suggesting that, “Oh, even go to bed earlier after that.” It's smaller changes lead to big outcomes, versus big changes are oftentimes hard to stick to lifestyle-wise.
Melanie Avalon: This is just brilliant. Another question is, and this is something that a listener asked me, and I was actually thinking about as well. There's also a readiness score and it has a lot of factors that it brings in based on how you slept, your activity level, the previous day. When you wake up, it says, basically, how ready you are to tackle the day, and if you should have a more vigorous day or a more recovering, relaxing day, does it matter at all the reasoning for why that happened? A listener asked, for example, what if their readiness is lower and the reasoning they think is probably because the day before they way overindulged in a meal the night before? Actually, their intuition tells them they want to be exercising, and that's the opposite of what Oura suggesting. Where are those suggestions coming from for readiness? What does it mean exactly when it says we should take a rest day or a recovery day?
Harpreet Rai: Maybe I'll give you some history on why we created a readiness score in the first place, and maybe try to-- I think that'll help understand users on how to use the data. All of us probably know we can hammer through one bad night of sleep. If I've been sleeping seven to eight hours every day, and then when I get five hours, I don't feel that terribly bad. If I get a week, almost of six-hour nights, which a lot of people do, I am exhausted by the weekend. I've accumulated all this sleep debt. What we tried to do is actually create the readiness score, is something that looks at a little bit of short-term data and a little bit of long term or midterm data to account for that, it's the cumulative impact that hurts us over time versus just one given data point or one given night. The way the readiness score works is, we take basically your last night of sleep, and your last day of activity, like how active you were, then we look at both the two-week average of your sleep patterns, and the two-week average of the activity, that goes into half the readiness score, a short term and a long-term thing on sleeping activity.
Then what we do is we look at a couple physiological signals from the prior night that we think imply a lot about stress. That can be your absolute level of your lowest resting heart rate versus your norm. “Hey, was your resting heart rate actually 47 versus 50? It was a lower or higher?” That's an indication of stress. The timing of that resting heart rate, like I talked about before, did your resting heart rate happened late in the night, early in the night, that also is a sign of stress, essentially you want that resting heart rate to be your lowest at the midpoint halfway through your sleep. Then, also, we look at heart rate variability and changes in temperature as well in the readiness score. So that's everything that goes into it. Imagine if you're getting sick, we'll start to see increases in temperature, increase most likely in heart rate, decrease in heart rate variability, and also changes in respiratory rate, which was shown the readiness score.
Even if you sleep a lot, or get good activity, but all of a sudden, it looks like you're coming down from sick, we're going to let you know the readiness score that, “Hey, something is off here.” We've found a lot of people, every flu season, but obviously, particularly this year with COVID, find that information super valuable. The readiness score if for example, you eat really late, or eat a lot of food, yeah, your heartbeat is likely to be jacked that night, your HRV is likely to be down and maybe even your temperature is up a little bit because you're metabolizing it, 2000 calories for dinner because it's Thanksgiving versus your average 600. That actually does impact you the next day. If all those things are happening, you haven't actually recovered that much, you didn't sleep that well, so that's actually going to affect how you perform the next day. You can see that in alcohol, you can see that if you eat a lot of ice cream. You'll sleep worse, all those metrics will go down. Even if you're at a time yourself on the mile and we're consistent about it, you find yourself struggling to meet your normal mile times.
Yeah, it's even though the human tendency is out, I think a lot of people, let's say they drink a lot, they're like, “Oh, I'm going to work it off,” that can actually be counterintuitive and put a lot more stress in your body and even take you longer to recover than taking an easy day. That's why we give that guidance in the app. Frankly, for us, we try not to be too prescriptive. So, taking a rest day, an easy day, I think for different people, depending on their fitness levels, or activity levels, that may mean different things. If you're going to gym five days, a week, or six days a week and you're doing compound lifts, and hit interval training, a rest day for you may be, “Hey, I'm just going to go do some light work and maybe just get a 10-minute, 20-minute jog in and do a lot of stretching and mobility.” Versus for someone else who's not in great shape, “Hey, 20-minute jog,” maybe they haven't jogged for 20 minutes in a year or two years or longer. That's why we like to leave that up to the user, like they know themselves as well. Frankly, it's also something that we think is really important for behavior change.
Oftentimes, if you're too prescriptive people can get offended. We've seen this with wearables, if you tell people, “Hey, reach 10,000 steps,” and then after two weeks, you realize every day you're only doing 5000 steps. Again, even if you do 6000, that's a huge improvement, that relative change is a huge improvement, and we should applaud users. We try to make sure that we build our messaging, build our design, build our behavior change, implications, all about relative change, and try to leave that up to the individual a little bit versus being too dictated, and saying, “You have to do this today. Otherwise, you get bad points.”
Melanie Avalon: Yeah, it's really impressive. It really feels like a very kind person talking to you specifically. It doesn't feel like a random generated message from our robot. It feels very personal and it doesn't feel demanding. I'm going to this for life, like I said. I haven’t been wearing it long enough, does it tell you if you have a temperature? Does it give you an alert?
Harpreet Rai: Yeah, you'll get that messaging in the app. Like you sort of said, we give you a little bit of recommendation every day and the readiness score when you open the app. We call that our Insight Engine. We try to give you a little bit of insight every day. If we start to see patterns that you may be getting, we will pass on the insight that, “Hey, it looks like your temperature was up a degree or whatever it may be, and your heart rate is elevated, you should take it easy today.” So, you'll see that insight message actually changed, depending on what the data is.
Melanie Avalon: Oh, wow. And you guys have been doing work with COVID?
Harpreet Rai: Yeah. Actually, we were the first wearable before Apple, before Fitbit, before WHOOP to announce a COVID research study. When COVID was really starting to increase during March, we were already doing research with UCSF before and in a way of research that was planned, and all that research was going to get canceled because you can't recruit subjects or a research study in a lockdown. All the research institutions actually were trying to do as much research as they could on the virus and during the pandemic to help for us to learn. We luckily sprung into action with UCSF and we're like, “Wow, how can we design a study that could perhaps teach all of us how to interpret some of these new technologies and if people are getting sick.
We started to study with UCSF, we donated 3000 rings to frontline healthcare workers to kick it off because they're going to be working in the hospitals, in the COVID wards, and we felt like they're most likely to get ill. And so yeah, we started the study there, but then we quickly open it up to our whole user base. We've had nearly 70,000 people enroll in our study with UCSF right in our app. We've been able now to-- luckily, UCSF was able to get a lot of funding from different grants, they received over 5 million in funding to send COVID test to people that suggested they had symptoms of COVID, or if they saw the data was really high in the app. Luckily, I think we should have some exciting findings coming in a couple weeks in a journal. So, can't wait for that to happen.
We've even had two other studies with different research universities follow suit. We also announced a study with West Virginia University, the Rockefeller Neurosciences Institute there. Also Texas A&M with both DIU Defense Innovation Unit and DTRA, Defense Intelligence Threat Reduction, I think, Agency, I forget what that one stands for, but using these rings on soldiers, and both West Virginia and Texas A&M, the DIU studies have come out with press releases, early findings, not complete yet, saying that Oura ring data has been shown to change two to three days in advance, up to two to three days in advance of people feeling symptoms, so we can actually see changes in data before people feel sick, which can be of huge implications, and not only this pandemic, but future pandemics.
Melanie Avalon: Wow. Yeah, that is absolutely incredible. Question I have to ask, because this is probably one of the biggest concerns within my audience. What is the EMF exposure with Oura?
Harpreet Rai: Great question. I'll probably answer that in two ways. The first way is we created an airplane mode. You can actually turn off all the Bluetooth on the device, so it won't emit any Bluetooth. If you click the battery icon, in the top right corner, I believe, and you open that, if you click that, you'll actually see a nice little thing from the home screen that is about your ring. Then if you swipe to the right or-- sorry, you'll see there, right there, there's something called Ring Airplane Mode. That'll actually turn on airplane mode or turn off any Bluetooth signals that we send to your phone. In order to turn it back on, you just need to put the ring back on the charger, and so that'll trigger it to turn regular mode turn off the airplane mode. So, you can actually store data on the Oura ring, without ever syncing into your phone for two or three weeks.
Technically, if you just wanted to never sync it to your phone, we've Bluetooth off, we'll store that data on the ring for two, three weeks if you don't want to-- if you really want to go low EMF. That's the main thing we've done, which other wearables have not done. The other thing that we've done is really focus on things that we know are good for health. If you look at other wearables, you'll see green lights are those can be really distracting, especially at night, and bothersome, and we chose infrared. Everything we know about infrared light, that it's healing to the body, not harmful. Then additionally, it's actually not visible, so you don't even see it, so it doesn’t bother you late at night or when you're sleeping some bright light in your face if you're cuddling with your partner. That's another thing we took into account.
Then lastly, really why this is a ring is it's because that pulse signal on the finger is so much stronger, about 100 times stronger than veins on the wrist, sort of where your wristwatch sits. As a result, we need a lot less power, 1-100th of power to see that pulse signal, so because of that, we're able to use a much smaller battery. If you look at our battery on average, it's about a 15-mA battery. I think if you look at the latest Apple Watches or garments, it's like a 200 to 300 mA battery, so it's 10 to 20 times bigger. I'm a big believer in physics, energies neither created nor destroyed, but Oura ring’s battery is tiny, and it lasts a week. We're not really emitting that much power versus other things are almost like hockey pucks of batteries on your wrist, and the battery life is way shorter. They're sort of illuminating a lot of power and a lot of potential EMF. I think those are all the ways that we've thought through it and all the design choices we made to be as EMF friendly, as wearable as you possibly could be.
Melanie Avalon: Yeah, that is incredible. I mean, I don't wear any of the other wearables and that's one of the primary reasons but then looking into Oura, I read some of that, I was like, “This is fantastic.” So, it really checks all the boxes. So, thank you so much, this has been absolutely incredible. I know my listeners have been dying to hear this episode and now I can-- I was already sold with being on the Oura train for life, but now I just want everybody to get one. The last question that I ask every single guest on this episode, and it's just because I realized more and more each day how important mindset is surrounding everything. So, what is something that you're grateful for?
Harpreet Rai: I guess I'd say I'm grateful for having my health and having my family. Those are the people that shaped me to who I am. Being healthy as part of that, because I'm able to function in a way that I want to, and I think we can't take that for granted. Ultimately, health will unfortunately [unintelligible [00:50:26] all of our lives, and so our time is sort of precious on earth, and being able to be healthy and understand my health and be able to work on it as a company, I don't know, what could be more meaningful. I'm just truly grateful for that. Personally, for my parents, my mom and dad really raised me to be curious to explore, to try different things, to be bold, and if it wasn't for their encouragement, and their persistence, I definitely would not be here today. So, it's good to be thankful for them.
Melanie Avalon: I love that. Does your whole family wear Oura rings?
Harpreet Rai: [laughs] Everyone but my sister. My mom and dad are wearing it. It actually took them a while. So, they started, I think, really, about a year ago, they got into it. It's pretty cool to see because my mom's like not that in a technology. I love my mom, greatest person on earth, she's my superhero. She's not the person that's going to-- honestly, if you ask her to forward an email, she'll be like, “Well, where is that button?” But it's so cool, because even her like, every morning, she just opens the app, and she sees a little bit of data and she just asked herself, “Wait, what did I do yesterday that it's different today? It's that self-introspection that we think is universal, regardless of how much you understand the data or not. It's been pretty cool to see that. One day, I'll get my sister on it, but I think she's worried about the orthosomnia and the neuroticism of having too much data. But, yeah, both my parents have been using it--
Melanie Avalon: Tell her I said, “It's fine. That that was my concern, and it's totally fine.” [laughs] All right. Oh, wait, really last question. Will you ever do custom Oura rings? I saw the diamond one, and I was like, “That'd be a good proposal, engagement ring.”
Harpreet Rai: Something that I think we think would be really cool. It is a little hard because all the variants with sizing the ring, make it a lot harder. It's like, “Oh, you need a custom one in this size, that color, that model.” What we've been trying to do is actually introduce more colors. We just released a gold ring three weeks ago. I think a lot of our female users obviously been asking for that. It took us a while to make sure we got it right, so the color didn't fade. We'll do hopefully a lot more colors and a lot more design choices over time, and hopefully even some partnerships. There's some really cool jewelry brands out there that we think we can innovate with and make Oura ring even more appealing and make it look better to different audiences.
Melanie Avalon: Sign me up. That's exciting. All right. Well, thank you so much. Enjoy the rest of your day. And hopefully we can talk again in the future.
Harpreet Rai: Thanks so much for having me, Melanie, and really appreciate everything you do. I think the people you have on your podcast, the inspirational and plus the health angle, I really just think helps people be better versions of themselves. So, I really appreciate you for doing that.
Melanie Avalon: Thanks. I'll talk to you soon. Bye.
Harpreet Rai: Bye.