My experiences with the Oura ring and my thoughts on wearables
The hidden downsides to "zero risk" non-invasive monitors
Non-invasive monitoring of health data is becoming popular and common place. Direct to consumer health products improve access, but I wonder if more data and access are always a good thing. With new biotechnology comes debate around questions like what ideal use cases are, which population would benefit most, and what the risks are. Here are my initial experiences.
I’ve been semi-obsessed with sleep quality, and I’ve been tracking my sleep with the Oura ring for the past 2 years. Briefly, the Oura ring is a ring worn at night that measures heart rate (HR), heart rate variability (HRV)1, and movement. It takes this data to estimate time spent in each sleep stage, total sleep time, and then gives you your “readiness score” quantifying how prepared you are for the day.
The greatest benefit I perceived from the Oura ring was getting immediate feedback on the detrimental effects of having late and large meals, and alcohol on my sleep quality. Those two factors reliably reduced my resting HR, HRV, restfulness, and amount of deep sleep. To avoid bad numbers, I found myself drinking less and eating lighter and earlier meals. So for a time, wearing the ring produced what I believed were productive behavioral changes.
It wasn’t all good though. I started fixating on the numbers to the point of it affecting my mood. I became discouraged when my numbers were worse than expected, despite having done everything right. I was checking my phone first thing in the morning, so my ring can tell me how well I had slept, and tell me if I should take it easy or challenge myself that day. Good numbers made me happy, and bad numbers left me frustrated. Gone were the days when waking up feeling rested was enough. I now needed an app to tell me how I should feel.
The anxiety led to try looking for explanations. I tried increasing my step count, running, working out more and less, changing my macros, deep breathing, etc. It also led me down a rabbit hole of analyzing my snoring with yet another app, enough for me to consider getting surgery to fix it2. When I couldn’t find a direct correlation with my actions, I even starting considering phenomena outside of my control like the phase of the moon, the season, or ambient temperature3. Looking back, I wasn’t too far off from doing a modern day equivalent of the rain dance to optimize my readiness score. I had discarded logic and was instead falling into cargo cult science4.
Because at the end of the day, as scientific as all these metrics ma sound these are all unvalidated biomarkers and algorithms without strong clinical data supporting it’s use in any case. All interventions, including seemingly risk free interventions like non-invasive monitoring have downsides. And without clearly delineated upsides, net harm is probabilistically guaranteed. More data is rarely better if you don’t know how to use it.
I doubt widespread use of wearables will make for a healthier population, despite the hype and claims. I would recommend caution around all the new technology (e.g.the Apple watch, continuous glucose monitors, and wearables for HRV, sleep, oxygen saturation, heart rate, temperature, blood pressure, and heart rhythms) until more data supporting their use becomes available.
Now that it’s been two years since buying the Oura ring, I hate to admit that I’m still using it. I no longer check my results every morning, however, but once a week or so. I don’t have a good reason as to why I still do it, beside habit and probably some anxiety around wanting to know. I remain curious about long term variations in my HR and HRV. I realize now, however, that this practice is likely a net detriment to my well being. I’m back to my normal frequency of late meals and alcohol. I suppose we are not always rational beings. Better to have never started.
Heart rate variability:
This is the variability between heart beats. If the heart rate is 60, that means the heart beat 60 times a minute, or once every second on average. Each heart beat however doesn’t last exactly 1 second, so HRV measures this variability. Overall, HRV is used as a surrogate for quantifying the balance of sympathetic and parasympathetic tone. The greater the parasympathetic tone, the greater the HRV. In general, the higher HRV at rest, the better.
This would be an all too common example of how noninvasive technology with seemingly zero risk produces a situation in which the patient decides to get a high risk invasive procedure.
It’s not as farfetched as it sounds. Studies exist in which there are observed seasonal changes in HR, HRV and blood pressure. All metrics get slightly worse during the winter.
Cargo science is a reference to Richard Feynman’s book.