My POV on HRV
Is Your Oura Ring Really Disconnecting You From Your Body?
It is an obvious irony that, in a society where we are have no end of gadgets to track our health and countless devices to prompt or aid relaxation, the level of stress-induced illnesses continues to rise. This observation prompts healthy scepticism in many areas, especially the world of somatic therapy. I hear of more practitioners recalling sessions in which they’ve opened dialogue as to the level of stress the individual is currently under and, rather than initiating fruitful discussion, their question is met with a screen full of numbers and graphs.
I refer here to the various apps used to track Heart Rate Variability (HRV), a metric that has become ever more popular in various health communities but also one that has driven concern in others (concern that I feel is valid, but unwarranted).
HRV is a measure of the variation in time intervals between heartbeats, influenced by the autonomic nervous system (ANS). The ANS is responsible for regulating involuntary bodily functions, and it consists of two branches: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). HRV, therefore, provides valuable insights into the balance between these two branches of the ANS and the body's ability to adapt and respond to different stressors. The most commonly used device is the Oura ring, although many other manufacturers now offer their own option (from heavyweights like Apple and Samsung, more niche suppliers like Garmin, Polar and Whoop and newcomers such as Superhuman and Circular). While the rings are especially popular, but this can also be measured using chest/arm straps and watches.
The Different Types of Nervous System Response, and what HRV Measurements Tell Us
The autonomic nervous system is the name that refers to the circuitry that dynamically adapts to environmental stimuli. It does so through influencing both energy distribution and alertness, with the sympathetic and parasympathetic branches employed to action these changes. The sympathetic nervous system is vital to mobilize energy resources and boost attention (eliciting the so-called ‘fight-and-flight’ response) while the parasympathetic branch acts as a brake on such activity. This parasympathetic activity comes in two flavours; one that is driven by the ventral vagal complex (and simultaneously drives investment in healing tasks and digestion, earning it the title of ‘rest-and-digest’) and another that is run by the dorsal vagal complex (which aims to shut down all non-emergency activity altogether in the less understood parasympathetic stress response, often dubbed the ‘freeze’ response).
The state of the autonomic nervous system therefore stands out as the central factor in what physiological activity is permitted and, accordingly, on how we feel and how we respond to interventions (be they dietary changes, lifestyle modifications, supplements or somatic approaches such as breathwork). Or, to put it into simple words, whether we have a fair chance to benefit from any given protocol. It is therefore no surprise that we as practitioners focus so heavily on supporting the nervous system and cultivating the parasympathetic ‘rest-and-digest’ state that is a prerequisite for healing to occur.
Heart Rate Variability (HRV) is a metric that allows us to determine the state of the nervous system, exploiting the effect of our breath on cardiac activity. This is possible because, whenever we breathe in, we activate the sympathetic nerves that feed into the heart; conversely, breathing out triggers firing in the parasympathetic nerves. This means that our heart rate rises and falls on an ongoing basis, completing around 15 such cycles each minute. The difference – the variability – between the sympathetic- and parasympathetic-dominant phases is referred to as Heart Rate Variability; when there is strong parasympathetic activity, the braking effect will prompt a cyclical drop in heart rate. When it is absent, there will be little variability.
This indexing of the nervous system helps to explain why HRV measurements have been so reliable in predicting individual responses to intervention, especially when the such interventions are energy-intensive. Think detoxification protocols, anti-microbial programs for the gut. It also provides us with a good idea of the ease with which someone may take to meditative pursuits (which includes somatic approaches and breathwork), or the lack thereof. HRV measurements tell us a) what our systems are doing with our energy resources and how much investment is currently permitted, whether that be investment into the digestive process, into the third stage of detoxification at the liver (normally the rate-limiting step) or into the prefrontal cortex, and b) how active the sympathetic nervous system is (and, with it, the level of adrenaline being released into the system). Turns out that we have evolved to not ‘go inwards’ or even rest if the level of circulating adrenaline is sky-high; if there are hormonal signs that a tiger is nearby, then our survival is best served by staying alert and agitated.
Takeaways:
Energy metabolism governs everything, but the nervous system governs energy metabolism
The balance of the sympathetic and parasympathetic nervous system affects the cyclic variability in heart rate that we see with each breath cycle, and HRV is based on these variations
Should I be measuring HRV? Does it help or harm interoception?
Like most subjects in the health and wellness spaces, there are differences of opinion on the use of HRV measurements. The argument is not whether HRV is a useful metric, although I have heard professionals declare the measurements ‘unreliable’ when they have relied upon the black-and-white interpretation provided by apps. These apps do not account for the role of parasympathetic stress, aka ‘freeze’ (and therefore remain prone to misinterpretation of the data when taken from those with major metabolic burdens, falsely proclaiming these individuals to be in peak condition).
The real discussion centres on whether the process of tracking HRV inadvertently disconnects us from our bodies or even becomes a source of stress (which would, ironically, then negatively impact the very factors we aim to measure). These concerns rest on users finding themselves reliant on a smartphone app in order to find out if they are stressed or not, or waking up to find that their day is already doomed on the basis of a ‘bad’ figure.
Conversely, the alternative viewpoint focuses on the utility of HRV to better inform our choices. Used skilfully, these measurements can provide valuable feedback to adjust the load we take on each day and act as a spur to take corrective measures to support our resources. Perhaps most importantly, such measures can actually be used to train our connection to our bodies, provide explanation as to the responses we are seeing (especially when such responses are unexpected) and, most importantly, provide a point of reference that allows us to build awareness of the subtle (and not-so-subtle) patterns and signals our systems provide us with on an ongoing basis.
Incorporating these measurements shows us where someone is at and consistently helps to explain a) why they may not have seen the responses they expected from any given intervention and b) identify what milestones we want to first meet before they have a fair chance of responding. Just as importantly, these measurements allow us to determine if the body is shifting into the parasympathetic rest-and-digest state; as discussed in depth here, this is a shift that often occurs alongside challenges (such as tiredness, aching, a sense of unease or unexpected physical tension). Equally, they can show us if someone is transitioning out of a parasympathetic stress response (a shutdown often dubbed ‘freeze’, where our system deploys an shut down of the fight-and-flight activity in an attempt to conserve resources), a response is known as ‘mobilization’ and sees many of our defensive responses become reactivated. This reliably sees individuals experience an increase in energy and general functionality but, temporarily, also in vigilance, tension or inflammation (this transition is examined here).
In these circumstances, the guidance provided by HRV data can serve as both reassurance as to why we are experiencing such patterns - if they are simply a downstream effect of a healthy response, or if they require attention - and as an opportunity to spotlight our own individual responses following a change in energy investment; it’s easier to consider why we feel different or notice new symptoms from a shift into parasympathetic state when we are made aware we are shifting into a parasympathetic state. In short, it can enhance our interoception (the ability to feel what’s going on in our internal landscape).
This interoception is what allows us to separate feeling ‘bad’ from feeling anger, sadness or fear and take action to restore homeostasis (whether that be removing ourselves from toxic situations or taking steps to update maladaptive responses to environmental stimuli). It is what allows us to notice the subtle cues our body provides us with when our resources are being stretched (and avoid the ‘crash’ or disrepair syndromes that otherwise occur when we stay in an energetic overdraft for too long).
Interoception is not a skill that yields much attention in our productivity-obsessed culture, one where we grow up rewarded for our abilities in overriding internal sensations and dishonouring our needs in the name of ‘staying on task’, hitting arbitrary targets and generally not making others uncomfortable with our ‘messy’ emotions. A lifetime of glorifying materialist-rationalist thinking and decades of disconnection from sensory signals and often leaves us actually believing that emotions are simply inconveniences to suppress or medicate, a nuisance to work around in order to maintain an incessant stream of achievement. This is understandable if we never the chance to observe the profound – and real – effect they have on our physical responses.
This is why HRV measurements, through providing objective and quantitative data on the state of or nervous systems, can act as a platform to become more self-aware. This is especially relevant for those who are unconvinced that emotional health and nervous system activity is all that important – those that may take the position that, ‘sure, I get that stress is bad, but I what I came here for was a protocol to sort out my gut, not work on my nervous system’ - as well as those eager to understand their ‘unexplained’ symptoms, ie. why their system displays so many signs of excess stress while they do not feel stressed.
Takeaways:
Modern societies inadvertently encourage poor interoception and a lack of awareness of our inner landscape
Tracking HRV provides insight as to the physiological shifts playing out in our nervous system, whether we are consciously aware of them or not
Outsourcing our awareness to an app is likely to disconnect us from our bodies, whereas using this as a platform to develop self-awareness is likely to do the opposite
Using HRV: Case Study
“Jenny” was in her mid-30s and had suffered digestive challenges for as long as she remembered. This had traditionally been constipation - passing a stool just twice per week on average – but, in recent years, had begun to experience bloating and fatigue after most meals. She worked long hours in a high-pressure job that meant there was no margin to not be on top form and, as a result, she would skip breakfast and eat a very light lunch in order to avoid these effects. She came to me to deal with these digestive issues but also to tend to ‘out-of-control’ cravings she had each evening (where she would end up consuming huge amounts of carbohydrates, and then experience immense discomfort that would leave her unable to maintain a high work rate in the evening; a report that ‘should take me an hour takes me twice that after dinner’). She had tried multiple protocols for SIBO (Small Intestinal Bacterial Overgrowth) and various gut cleanses with predictably poor results.
I explained to Jenny how it would be impossible to see the desired results from these programs while her system was under so much stress. She seemed irked from this, and eventually confessed that she did not believe that stress was a limiting factor; she acknowledged that her 13-hour days represented a burden on her system and that it would be preferable to disengage in the evenings, but made it clear that she didn’t see this as an option right now and, moreover, that she’d ‘been working this way for years without any issues’ and that she had ‘never been affected by stress’ (pointing to how there were plenty of projects she’d worked on in the past that had seen her put in 16-hour days for two weeks straight, and felt no difference for this). I explained that, not only would it be physiologically impossible for the human nervous system not to be affected by this load, but how it is wired to notice ‘what is changing’ above ‘what is’. In other words, it is impossible to accurately perceive stress if you have never experienced its absence.
Her initial readings came in between 14-18 rMSSD (extreme sympathetic dominance, aka ‘fight-and-flight’). After the first round of changes, she now saw the same lows but, on rare days when she would rest or see friends, these measurements now reached the 30s. She still didn’t feel any different for slowing down. However, she could now see reliable changes in the bloating on these days (it was still present, but noticeably less). Equally, she could now see a clear pattern whereby the days when her HRV was in the teens were also the days when she would experience puffiness (with rightness in her rings the most obvious sign). She became a ‘believer’. After becoming aware of this connection, she then recognized that she would also feel a sensation of heat alongside the puffiness. As she continued to track this, she noticed that this sensation of heat would actually precede the puffiness and was actually present whenever she began to push too hard.
This was a major in-road to connecting to her inner landscape. She began to take short walks outside the office whenever she noticed the sensation of heat. Over time (and with some exploration in breathwork sessions), she became more familiar with this response (and the subtle signs of anger, sadness and fear, which progressively became less and less subtle). She developed a practice that allowed her to process these emotions, as well as those of joy, and was now equipped with a firm framework of what relaxation felt like in her body (and, as a result, what stress felt like for her). She could clearly see the costs of pushing too hard and, as almost always plays out when this is the case, she made changes that dramatically reduced the load on her system. She felt better, her HRV now soared (most of the time, anyway).
Her digestive symptoms were dramatically better than ever before, although some patterns still lingered in the background. However, we were now able to apply the very same protocols that previously failed, this time with very pleasing results. Although it was the HRV measurements that first alerted her to the effects of stress on her, she was now able to respond to these shifts in her inner landscape on a ‘live’ basis (without external tools).
Takeaways:
If we are stressed all day every day, we are unlikely to feel stressed (instead feeling ‘normal’, but subject to a growing list of disrepair syndromes)
HRV can provide clarity on our nervous system response, telling us when we are overdoing things and providing the often-needed evidence that healthy changes are having an impact (even if we don’t feel them to begin with)
Summary
We can summarize the importance using a phase I’ve employed above: energy metabolism governs everything, but that the nervous system governs energy metabolism. The type of nervous system response – be this sympathetic, parasympathetic or a combination of the these – has a profound impact on energy investment and, as a result, on our cognitive function, mood, and whether we have a fair chance to maintain optimal activity in digestion, immune system and healing processes in general, so too on our ability to switch off and get refreshing sleep.
In a society that inadvertently rewards us for successfully suppressing sensory signalling, it has become increasingly common for individuals to become disconnected from these messages and to experience ‘mystery’ symptoms that refuse to budge regardless of what cutting-edge protocols they employ. There are many options to rehabilitate our connection to our nervous system, although HRV stands out as one that does not require long-term commitment to yield convincing evidence (that we often need in order to follow through on the changes that are necessary). It does not require faith in the judgement of others, (be that a partner, friend or practitioner).
There is no doubt that use of external devices has the capacity to disconnect us from our inner landscape, generating a scenario where we wait passively each morning to find out if we are stressed or not. Or a setup where we squeeze an ever-increasing number of ‘wellness hacks’ into our schedule in order to manage the number.
All the same, it stands out as a valuable means of providing feedback from our system when we have lost access to that from our own intrinsic instruments and its explanatory power is often pivotal in allowing individuals to recognize the role of the nervous system in their otherwise ‘unexplained’ challenges; this can be vital if we are feeling hopelessness, a very human response when it seems there is no solution to our woes. It also provides objective feedback on how much our stress response is impacting day-to-day patterns and what changes help the situation (even when we don’t necessarily feel any different, which is common in the early stages).
As well as helping practitioners like myself identify suitable milestones to work towards and tailor the order in which interventions are deployed, these measurements can help individuals recognize the connection between nervous system responses and frontline patterns. These can provide both irrefutable evidence of the importance of nervous system activity and leverage needed to develop our interoception… depending on how we use them, of course.