82 - Dr Jay T Wiles - Heart Rate Variability in Long Covid Recovery

Episode 82 of the Long Covid Podcast is a chat with the fabulous Dr Jay T Wiles, who is a Clinical health physiologist specialising in sports performance and holistic & integrative health. He is also board certified in biofeedback and heart rate variability biofeedback which is what we're going to be covering in this episode.

We chat about what HRV actually is - and then how to apply it to daily lives, especially in the context of Long Covid & chronic illness. I learned so much from speaking with Jay - I hope you do as well!

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For more information about Long Covid Breathing, their courses, workshops & other shorter sessions, please check out this link

(music - Brock Hewitt, Rule of Life)

Transcript

Jackie Baxter  
Hello and welcome to this episode of the long COVID Podcast. I am delighted to welcome my guest this evening, Dr. Jay. Wiles, who is a clinical health physiologist specializing in sports performance in holistic and Integrative Health. He's also board certified in biofeedback and heart rate variability biofeedback, which is what I'm kind of hoping to dive into a bit today. So a very warm welcome to the podcast. 

Dr Jay Wiles  
Yeah. Thanks for having me on.

Jackie Baxter  
I really excited to have you here. So would you mind just to start with just saying a little bit more about what it is you do?

Dr Jay Wiles  
Yeah. So I have a bit of a unconventional background in the sense that I'm a clinical health and performance psychologist by trade. And that is my discipline that I went to school for. But I specialized in the niche area of psychophysiology and biometrics, which is just a really fancy schmancy long winded way of saying that I was really interested in how can we pool information about someone's nervous system functioning, or their stress response from information that we can gather from their body. 

So a lot of people when they think about that, intuitively, they're gonna think about heart rate, they're gonna think about, you know, skin sweating, or these other kinds of metrics. But I became fascinated with heart rate variability and heart rate variability, which I'm sure we'll dive deep into here in a minute, is just an amazing mechanism for tracking the subtle or large scale changes in the autonomic nervous system or in the human stress response. So we can actually use that metric as a guide to determine whether or not someone's stress response is being activated, or is being deactivated, which we may refer to as the relaxation response. 

So back in 2021, or I guess, I should say, August 2021, I formed my company, which is Hanu Health, we're a biometric company that utilizes wearable technology to continuously track changes via heart rate variability, heart rate of the autonomic nervous system to provide users with feedback on changes in their stress response so that they can become more self aware of their stress response, and then become more self-regulatory of their stress response, or in other words, learn how to manage their stress response in the moment with different techniques such as breathing and meditation, mindfulness and kind of a large slew of tools there. So I am the co founder and chief scientific officer of Hoanu Health, and that is what I do in my day job. All day long, I work on creating the best digital mental health products that we can, leveraging biometric technology and leveraging just what we know from evidence-based practices in psychology and psychophysiology.

Jackie Baxter  
Wow, that sounds like such an exciting thing to do, as well.

Dr Jay Wiles  
It is, it is for sure. It's amazing.

Jackie Baxter  
I first came across you and your work through Patrick McKeown, the sort of the "breathing God." 

Dr Jay Wiles  
that's right

Jackie Baxter  
And he described you as somebody who was "able to present information about HRV in a way that is easy to access and practical in a day to day life". And in preparation for speaking with you, I asked some of my listeners what they might want to know about HRV. And I realized that partly from my own experiences, and from some of the questions that they were coming up with that "easy to access and practical advice" is exactly what we need here. So could we maybe demystify it a little bit, and just dive into what exactly is HRV?

Dr Jay Wiles  
Yeah, I think it just makes sense to start there. One of the main reasons is because HRV, or heart rate variability, has become rather ubiquitous to many individuals, especially if they own wearable technology. So when I say wearable technology, I'm talking Apple Watch, or Fitbit, or Garmin, or aura, or whoop, any of these devices that are monitoring changes in the body. And what we know is that we can indeed impact or make change by assessing change in the body. 

So heart rate variability at its core, is indeed exactly how it sounds in its wording. It is the variability that occurs in heart rate, especially across the respiratory cycle. Now that in and of itself may kind of sound a little bit confusing. So let me unpack that, and then make sense of it. So let me use something that is pretty intuitively understood by most people, which is heart rate. If you were to put on a heart rate monitor right now, you would see a number that comes up with the letters BPM behind it, which is beats per minute. What that number is giving you is an average of how quickly your heart is beating in a given minute. 

So let's take for instance, easy math, 60 BPM or 60 beats per minute. Well, what is that information telling us? It's telling us that on average, your heart is beating at a pace of 60 beats per minute, or again, simple math - 60 seconds in one minute, which means that your heart is beating at an average pace of once every single second. Now, if that was true, then what would that actually mean in terms of the variability of your heart rate? Well it would mean that your heart rate is varying zero. So while it says 60 beats per minute, that is just saying on average, how fast your heart is beating. 

But what we actually know is that your heart over the course of a minute is speeding up really quickly, and it's slowing down, and it's speeding up really quickly, and it's slowing down. And the main driver behind that is our breathing. This is a process or phenomena called respiratory sinus arrhythmia. Arrhythmia doesn't mean something bad, it's actually quite natural and quite good. We want arrhythmia. Now we don't want things like afib, or atrial fibrillation, which is an arrhythmia of the hearts, chamber or electrical output, we do not want that type of arrhythmia or afib. What we want is the natural arrhythmia that occurs across the respiratory cycle. 

So as you inhale, we actually know that our heart rate is going to naturally speed up - well, why is that? The primary reason that heart speeds up is because there's more oxygen available for delivery. So the body senses, via many different physiological mechanisms, that it needs to speed up in order to deliver oxygen all throughout the body - makes complete sense. There are also physiological changes that are occurring as well, but that's the main one. And then as we exhale, the heart significantly slows down. And the reason that is happening is because there are physiological changes that are occurring, but the primary one is that we're actually activating our vagus nerve to slow the heart down. If there's not as much oxygen readily available, then let's go ahead and conserve the energy of the heart and the cardiovascular system. So again, we see this increase and this decrease. 

Well, if the heart is increasing and then decreasing, then that means that there must be some absolute changes in heart rate across the respiratory cycle, which means that each heart rate to heart rate or beat to beat interval is going to change in its amount of time. So as we inhale, the time between heartbeats is going to go down. And as we exhale, the time between heartbeats is going to expand. The change in the heartbeat to beat intervals is heart rate variability. 

And what we know is that as someone is experiencing a stress response, heart rate variability actually goes down, we don't see as much of that rise and fall of the heart rate across the respiratory cycle. And the primary reason behind that is because naturally heart rate elevates. And then what we know as the vagal brake, or the brake of the vagus nerve will come off, and the nervous system ramps up to attend to the stressor that's involved, or that's occurring. And so we see Heart Rate Variability decrease. So as heart rate variability decreases, we know that someone's stress response is being activated. And then as someone engages in relaxation, we'll see Heart Rate Variability begin to inflate or go in an upward direction. 

So basically, HRV is going to serve as a guide, it is a directional guide, that allows us or helps us to understand how adaptive or how resilient the nervous system is, to experience of stress at any given point in time. And the more resilient we are to stress, the higher we see our heart rate variability inflate. But when our resources are overly taxed, when we're experiencing significant physiological or psychological stressors, we'll see the suppression of Heart Rate Variability indicative of again, attacks to resources on our nervous system. Hopefully that wasn't too much all at once.

Jackie Baxter  
I think if I was listening to this episode, I would probably actually just rewind by about five minutes and listen to that all over again. Because like, it was amazing. I just feel like my head would need to take it in for a second time. I mean, that's amazing, because it puts it into kind of language that certainly I feel like I can understand. If you were to Google heart rate variability, for example, you'd probably come up with all sorts of kind of medical jargon that is probably going to go, Whoa,

Dr Jay Wiles  
For sure. There's a lot of complexity to heart rate variability, because it is a very intensive biometric. What I tell people is that they don't need to understand the ins and outs of how its quantified, the algorithm, you know, the mathematics behind it, the physics behind it. What people just need to know is how to understand it as a directional guide. And with that, it can actually be quite easy to understand. It's not super difficult to understand, but of course, you can go and dig into the weeds of HRV. And it can be quite dense.

Jackie Baxter  
Yeah, yeah. And that's exactly the sort of thing that I would do and I would find myself completely overwhelmed by all this stuff! *laughs* So actually, a higher HRV is better?

Dr Jay Wiles  
This is a good clarifying point. I would say 90% of people who email me who are looking to come and receive services, let's say through Hanu, because we provide a software hardware platform, but we also do coaching services. 90% of people come to me because they believe their HRV is too low. And they are like, how do I raise my HRV? And I'm not saying that that is inherently a bad question, per se. But what I would say is that it's probably the wrong question. 

The reason being here is because HRV is very relative, it does not operate like many other metrics that we use. And what I mean by that, is that other metrics that we take in terms of health biometrics, or health biomarkers, a lot of times, they're compared to what we call a normative range. So if you were to go get, let's say, a cholesterol panel done, or a blood lipid profile panel, or take your blood pressure, we have certain ranges, where we want people to fall into. And when they fall outside of that range, well, then there's pathology, potentially, something's going wrong, we need to mediate and come in and do something to assist that individual. Because we see something that could potentially lead to negative health outcomes. 

HRV actually doesn't work like that - we don't have this range, where we say, if you are outside of this range, you have quote, unquote, low HRV, or you have quote, unquote, high HRV. And we need to stabilize that number for you. We just don't have those metrics. So what we actually say is, is that we need to look at HRV over the course of time. If you were to take let's say, for instance, one snapshot of HRV, if I put an EKG on you, or we measured it kind of within a two minute framework, that number in and of itself would be essentially meaningless, because it has no basis of comparison. There's no context to it. But if I measure it day in day out, and I start to see trends, well, now we have something, information that we can do something with. 

So let's take for instance, and kind of to your point of, you know, should we want a high HRV, we would be looking for an HRV, that is higher to our baseline number relatively. So I just will use kind of, again, simple math, if I see that one day, I'm looking and my HRV is 50. And the next day, it's 40. And the next day, it's 30. And the next day, it's 20. I'm seeing a downward trend in heart rate variability, this is indicative that the nervous system is overly taxed and having a hard time adapting to whatever is in its environment, whether it be physiological recovery, or stress, or psychological recovery and stress. 

The same thing goes in the opposite direction if I see an increase in HRV, from 50, to 60, to 70 to 80. That upward trend means that my body is actively engaging its relaxation response. And we see kind of this dynamic shift that is representative of someone who is recovering well, someone who is more or less resilient or adaptive from a nervous system perspective. So we have to take all that information in within its own context. 

So if we say a higher HRV is better, what we're thinking about is better relative to what our normal baseline is. Because my 100 milliseconds heart rate variability, and your let's say, 150 millisecond heart rate variability, those two numbers, it's like comparing apples and oranges. Because it might actually be that I took a shot of my 100 milliseconds, and it sounds like, oh, it's much lower than your 150. But maybe yours is normally 200. And now it's 150. And mine is normally 50. And now it's 100. So you can see how the direction of mine is - mine moved way up, but it's still a lower number than yours, and yours moved way down. Well, how do we actually kind of make sense of that information, we can only make sense of it based on the direction and the information relative to us. 

So I hopefully that wasn't too confusing, because I just think it makes sense to explain that if we're looking at HRV as a number, what we really want is stability. We actually want a good stable heart rate variability. It's the downward directional trends that are indicative of stress and overtaxation on the nervous system. And an upward trend can be pretty significantly indicative of someone who is recovering well, or having a good relaxation response being kicked into high gear.

Jackie Baxter  
Yeah, I mean, that makes complete sense. So, much better to compare you to you rather than you to someone else. 

Dr Jay Wiles  
100% 

Jackie Baxter  
And that probably works across the board with a lot of other things as well. Why is this other person recovering faster than me, is really not that helpful is it? So what I would be interested in, I mean with something like long COVID, and I think this probably translates into probably all chronic illnesses, we have this huge fluctuation of symptoms and how we're feeling. So for example, I might wake up in the morning and feel absolutely dreadful, but by the afternoon, I'm actually doing kind of alright, and is this HRV? Is that potentially going to fluctuate along with those kind of patterns of up and down?

Dr Jay Wiles  
Yeah, heart rate variability changes on a moment to moment basis, because it is a very sensitive metric. For instance, if you were to start pacing your breathing right now, so increasing again, those waves of heart rate, the increase of heart, the decrease of Heart, heart rate, you would see significant changes in HRV. Most people would. It's, you know, heart rate variability began to go up, which is why breath work is so incredibly powerful for resiliency. And biofeedback is so incredibly powerful for stress resiliency. So it changes really quickly, depending on the context. If I were to jump around the corner and scare you really quickly, your heart rate would fly up and your heart rate variability, yeah, would go down like a rock, and then it would come back and it would stabilize. 

So depending on what you're experiencing, physiologically, psychologically, contextually - HRV is going to change. So it may very well be that in the morning, when you're feeling rough, symptoms are kicking into high gear, the immune response, having a hard time keeping up. Your nervous system is being overly taxed, we will see Heart Rate Variability suppressed. And then now as the day goes on, we might actually see Heart Rate Variability go up because your body is adapting and is becoming more resilient to the stress that it was enduring. 

So we can use it again as a guide. And I think that's the best application of heart rate variability is a guide as to how well or not so well, we are adapting to stress. And when we find that we're not adapting so well, that's the opportunity for us to then begin to implement some of these other strategies for overall stress resiliency, mental resiliency and nervous system resiliency.

Jackie Baxter  
Yeah, of course, I mean, that makes total sense. Because I mean, for example, if you were, I was gonna use the example of a run, but we're talking about long COVID here, so maybe maybe a walk, you know, you decide to go out for a walk, because the sun is shining, and you feel like you have some energy, and your heart rate is going to go up because you're taking some exercise. But then when you stop walking, your heart rate is then going to drop back down again. So you would then expect your HRV to reflect that?

Dr Jay Wiles  
Yeah, no, that's right. You go out and you go walk, heart rate variability is gonna go down and heart rate goes up. The reason that is happening is because it requires a lot more energy, you have to mobilize a lot more energy when you're doing a walk. And especially with someone with long COVID, you're exerting even more energy than the average individual. So you're going to see a higher increase in heart rate, a declination in heart rate variability. And then when you stop, when you are rested or relaxed, we should see that swing back in the opposite direction, or heart rate variability stabilizes and heart rate comes down. 

With someone who has an overly taxed nervous system, we can actually use kind of the recovery of heart rate and heart rate variability after we mobilize or exercise, we're using a lot of energy, to determine whether or not that person is recovering in a timely manner. So I've seen many individuals actually who have come to our clinic who have Long COVID, who instead of heart rate variability stabilizing, heart rate stabilizing really quickly after a walk, it takes an extended period of time, it's not just a two to five minute stabilization period. It's more like a 15 to 30 minute stabilization period. And what that's telling us is that the nervous system is having a really hard time keeping up with the demands of energy mobilization. And that is reflected in those numbers. 

So it would be as if someone were to go do a, let's say, a really long exercise, let's say someone's training for a marathon, and they're going out to run one of their longest runs prior to the race, 20 miles, and they came back after that exercise and I see a suppression of HRV by let's say, 50% or so. And that stays suppressed, let's say for six straight hours. Well, what does that tell me? That person unfortunately has overtrained and their nervous systems not bouncing back like it should, and they need to prioritize recovery and rest. 

Well, we have to take kind of those same principles and apply them to everyday living, even if we're not training for the marathon. We can see the same thing reflected just in small scale energy mobilization. And with that knowledge we have to ensure that we watch our metrics to determine whether or not we have indeed pushed ourselves a little bit too hard. Or should we be placing more emphasis or priority to energy conservation - or what we refer to as relaxing and resting?

Jackie Baxter  
Yeah, I've been whether you're, you know, training for your marathon or walking to the postbox, I guess the principle is the same, isn't it? 

Dr Jay Wiles  
Yes. 

Jackie Baxter  
And a common symptom of long COVID is this post exertional malaise or post exertional symptom exacerbation. Where you know, you do too much, but you don't realize it until later that evening, or the next day, or, you know, whenever it is, I think it can be up to maybe 48 hours sometimes. And how can we use HRV - can we use HRV - to kind of help that not to happen?

Dr Jay Wiles  
What we know is that, as we see a downward trend in heart rate variability, especially over the course of a few days, or especially if it elongates out to be like a week or so, that change or that dynamic shift that is occurring in heart rate variability, is telling us a lot of information, it's providing a lot of actual inherent value. We have to listen to our body, but we also want to listen to the objective data. I tell people that we have to rule in both our subjective experience, and we have to marry that or couple that with our objective data. I don't like one or the other. It's both, I think that both can be quite helpful. 

So yes, we can use it as a mechanism to determine the adaptability or resilience of our nervous system after we have exerted energy. And we also can look at using it in terms of overall recovery. We know that as people engage in more excessive movement or energy, when their heart rate variability is low, they see a reduction in performance, they also see a increase in injury. And the reason being is because when the nervous system is not operating at its highest capacity, well then that shuts off or at least reduces the efficacy of other parts of the body, whether it's in the peripheral nervous system, in your central nervous system, motor movement, muscular propensity, like all of these things go down when heart rate variability is suppressed. So again, I say that HRV is not necessarily the end all be all. But it obviously can serve as a really good guide, or proxy to the shifts that we're seeing in the nervous system.

Jackie Baxter  
So if your HRV is kind of on the low side, and it's maybe been on the low side for a bit, or you've had a downward trend that you've been tracking, today is probably not the day to see if you can walk a little bit further than you did last week?

Dr Jay Wiles  
Yeah,. What we don't want it to serve as is a self fulfilling prophecy,; a lot of people will see that data point and say, Ah HRV suppressed, so therefore I kind of have an excuse not to do anything, or, you know, my, a lot of people will see their sleep data and say, Well, my sleep data said, I slept like crap. So therefore like, yeah, it's gonna be a bad day, I'm gonna feel no energy, and they kind of live out that self fulfilling prophecy. 

We don't want it to be like that. That's why we have to kind of coming back to couple it with our subjective experience, I think that that is probably the most inherently valuable thing that we can do. So use the data, judiciously. Don't simply just take it for its face value and say, This, therefore is going to determine my behavior. It may very well serve or act as a guide for behavior. And we have to listen to it. 

But I don't kind of like the dichotomy of saying this is telling me Yes, do this or No, do not do this, that we as human beings had to put a little bit of the investigator detective head on, if you will, and kind of come to the conclusion based on the data and because of the data, not simply solely on the data in and of itself.

Jackie Baxter  
Sure. So it's a really useful metric, but it's not necessarily the whole story?

Dr Jay Wiles  
Yeah, I would agree. I would agree with that. It gives a lot of really great information. That information in of itself should be paired with other things.

Jackie Baxter  
What would sort of useful but not overdoing it kind of level of, you know, monitoring it? You know, every hour or every day or every week, what sort of level might be kind of useful?

Dr Jay Wiles  
I think it's going to be different for everybody, because some people are just going to be able to use that data effectively and want as much of it as possible moment to moment; with something like Hanu, which is capturing HRV continuously every single second, it updates. Some people are gonna want that, some people are like Nah just once a day is enough data for me to understand trends. And there's some people that for them, that's too overwhelming, I'd rather have just once a week, kind of look at the trend that's happening over the week. I think we just all have to know thyself and know kind of what our limits are. And for some people, it's going to be that they have zero problem with checking in all the time. For some people, the data is going to be too overwhelming. 

Like, if you come and you work with one of our coaches here at Hanu. We like to tailor the programs to the needs and the knowledge base and the expertise of the individual. And hand-hold as much as possible, or let people run free, kind of as much as possible. But the whole idea was to become, we want to become our own source of data or biofeedback machine. So we can leverage technology initially, but not become overly reliant on it, so that when we are free of technology, we have a good level of self awareness, and interoception, which is our ability to check in with our physiological response. We want to develop that naturally. So I just say that a kind of expedited or quick way to do that is to leverage technology.

Jackie Baxter  
So it comes back to it being a really useful tool, rather than a sort of instruction manual? 

Dr Jay Wiles  
Right, right. 

Jackie Baxter  
Yeah,

Dr Jay Wiles  
There's some interesting examples of what we've seen and how we've seen HRV operate kind of since COVID-19. When I got COVID, I got COVID in - it was the the OG, the original, I was it was back in like middle of 2020, and maybe a little bit closer to late. So it was pretty early on comparatively. And it was the first strain for me, not to provide any level of comparison, but just for reference, my HRV is generally around 100 to 110 at night. And when I got COVID-19, I have pictures of this, it went down to like 14 milliseconds. So like from 110 to 14 milliseconds, my body temperature was up like five degrees, like it hit me pretty hard. 

Now, I was very fortunate and lucky that I did not, you know, experience any of the long COVID symptoms, most of my symptoms were gone within just a few days. But the thing that continued to linger was a suppressed HRV. Now it wasn't down in the fourteens. It was more like in the 50s. But that was still 50% of what I used to have. And it took a solid three months after COVID until things got back to normal. That is not uncommon whatsoever with people who have gotten COVID-19. 

With long COVID, we've seen a significant suppression that stayed down. And I think that that is where it gets very interesting. And it gets very concerning, because we see kind of this nervous system that is basically stuck, more or less, in an activated fight or flight state and is responding harshly, probably more from an immunological perspective, responding very harshly to the symptom presentation and to the kind of residual ailment. And so we'll see a suppression in HRV. 

Now, I've worked with many individuals who have long COVID. And the whole idea behind kind of working on nervous system functioning is retraining a more adaptive response amidst a nervous system that is being quite taxed. So that comes through the implementation of a lot of heart rate variability biofeedback and breath work, mindful awareness and meditation. There are a lot of strategies that I've used, and it has helped people significantly in improving these overall outcomes, especially if we focus on breathing and the effects of breath work, and proper, you know, cadence of breathing changes in the biomechanics and biochemistry of breathing, we see this really cool, dynamic shift in nervous system resiliency.

Jackie Baxter  
Yeah, and that's really interesting. Because, you know, I mean, I think a lot of people probably have been tracking their HRV along with all sorts of other things. And as you say, it can be really useful, but it's also quite easy to get a bit kind of stuck in the numbers, which again, isn't always helpful to be too stuck?

Dr Jay Wiles  
It's like reliance, people become reliant on the numbers, and they use it as the primary determinant as to how they feel. And I think that while data is powerful, it's not that powerful. What's more powerful is your intuition and your ability to feel into your level of recovery. What we use the information or data for is as information, as a guide, as a assistant, as a level of accountability, not as the end all be all.

Jackie Baxter  
Yeah, definitely. And that comes back to what you were saying before about, you know, listening to your body being kind of just as important. But yeah, it's interesting just to have an example of your kind of figures from before you were sick, and then when you were and how long that took to come back. And that's really, really fascinating. 

What would be really good to talk about, you just touched on breathing, and I love breathing. This is totally my rabbit hole. But I would love to talk a little bit about how we can improve our HRV. How can we make it better?

Dr Jay Wiles  
What I would always say is keep in mind what it means to increase your HRV. And why. I am not nearly as concerned with people trying to increase their HRV for the sake of having a higher baseline number. What I'm more concerned with is people using HRV as a guide for changes in their nervous system. And as HRV increases, that means that we're more adaptable and more resilient to stress, which is a good thing, because in today's modern day and age, with stress and anxiety being at an all time high, we need to develop whatever mental and emotional health fortitude as we possibly can. Because what we know is that there's such a strong inner correlation between our physical health and immunological response, and our emotional well being. 

So when I think about increases in HRV, I think about people implementing and using the tools to help build a more fortified level of mental and emotional health. What does that look like? Well, we know in the research, we can increase heart rate variability, and improve mental health and mental well being and functioning through things like exercise, increasing things like low state cardio or low heart rate cardio or high heart rate cardio, like high intensity interval training. Now I know for people who are listening and who have long COVID, these may be way too far reaching and may not be beneficial for you right now. So I'm just giving more or less what the research shows, but not saying that it's necessarily applicable to everybody, because I have to know thy audience. So I do not want to present things that you're like, well, that's kind of out of reach, so I'll get to the ones that are more in reach. 

General movements, though increasing general movement has been demonstrated to help with the nervous system and resiliency, emotional health and heart rate variability, things like walking, things like doing mobility movement, yoga, stretching, you know, more like pliability, or myofascial release, those things can be really helpful. 

The other thing would be nutrition. And this is something that's extremely important for everybody. But as we increase inflammation in the body, as we remove processed foods, as we focus on increasing high quality food, making sure that we're not eating too much as well. These are things that are extremely important in nervous system resiliency. And we can enhance Heart Rate Variability by decreasing inflammation through what we put into the body. 

The next one would be Sleep; sleep is the foundational pillar to all things mental health - you can have everything going right in regards to your health behaviors. But if sleep is lacking, if sleep is not a priority, then we're leaving a lot at the table and we're probably doing a lot more damage than we are good even though we're doing all the other things. So prioritizing sleep, ensuring that we're getting really good quantity but also really good quality sleep, and enhancing our deep sleep and REM sleep cycles so that we can enhance overall cognition, brain neuroplasticity, nervous system repair, that is where we recover the most is via sleep. So I really place a lot of emphasis on dialing in sleep and utilizing things like sleep tracking and sleep data to help monitor the overall efficiency of sleep, and just the overall quality of sleep. 

And then the last one, which is probably the most important one and obviously I'm biased - is going to be stress mitigation skills and emotional health, through things like biofeedback. So basically, if anybody's wondering what biofeedback is, it is a tech savvy way of doing breath work. So with breath work, we change the biomechanics, biochemistry and cadence of breathing. But in breathwork traditionally, you don't need kind of the use of technology to monitor the effects. But with HRV biofeedback or heart rate variability biofeedback, you basically watch what's happening with your heart rate and your heart rate variability in real time with the inclusion of changes in breathing or what we refer to as breath work. 

What I love about this, and what the research demonstrates, is that if you add this component to your breathwork practice, you're able to see in real time the significant movements of your relaxation response. And for most people, they want to see that hard scientific data and evidence that what they're doing is actually working, it's actually creating change within the nervous system. So as we pace our breathing, as we've change the way that we breathe, from thoracic chest breathing, to low, slow, deep breathing, we'll see this really beautiful upward curve of heart rate variability. 

What is that telling us - it's telling us that what we're doing right now, is activating the parasympathetic nervous system, it's activating our relaxation response, which we know has a slew of physiological and emotional mental benefits. Just the evidence is so robust in this area. So a lot of times people will do let's say, meditation, or mindfulness training or breath work. And at the end of the session, they say, I think I feel better, like I feel less stressed, I feel less anxious. That's great. We that's what we really want people to do. But then a lot of times the behavior falls off and they don't stick with it. And a lot of times, we have to say, well, what is that - a motivation problem? Is it just that the effects wore off, it could be all of the above. 

But what the research has demonstrated is that if you're able to show them consistent improvements in nervous system functioning with the data that I'm talking about here, through heart rate variability biofeedback, it gives people more of a buy-in, it turns from, Oh, I don't just subjectively feel it, but I see the evidence, I see the data. So I'm a huge advocate of that. And there's a lot of robust research on how HRV biofeedback can improve heart rate variability. 

And breath work in and of itself, you do not, let me be clear, you do not need the technology and the data for breathwork to work. There's nothing magical about the data in making it work any differently in your physiology. So spoiler alert, your HRV is going to increase no matter if you're looking at it or you're not. However, it can serve as a guide to help you stay motivated, give you the accountability, and then also demonstrate to you what's working, and maybe what's not working as effectively. So it helps you to dial in that practice. Other things like yoga Nidra, non sleep deep rest, meditation - these can be very valuable ways to influence and increase heart rate variability. 

And the last thing that I'll mention is, and this kind of goes more into the nutritional category than anything, is reduction of alcohol. We know that as people consume more alcohol, and again, I don't want to be the one to demonize alcohol. But I do know that consistent alcohol drinking can significantly suppress autonomic nervous system functioning, and will significantly reduce heart rate variability. I think it's kind of clear in the scientific community that alcohol is a poison, like alcohol is a poison. 

It's not to say it can't be used sparingly, you know, with with friends and having it and there's nothing I love more than a nice glass of wine. But a habit of it is not a great thing. We kind of know that. And we see that clearly in biometric data. It used to be thought, oh, yeah, you can drink the glass of wine, it's got great anti inflammatory properties. That research is basically kind of just been nullified by the fact that there are too many damaging properties of alcohol that outweigh the potential benefit that it may have, by a significant portion or range. 

So those are the primary ones that I would go to. So again, just to kind of recap, exercise, nutrition, sleep and stress mitigation skills. I think that's kind of foundation for good quality health anyway, but making changes in those areas combined can help to improve nervous system resiliency and HRV.

Jackie Baxter  
Yeah, there's loads of really, really useful things in there, which is fantastic. It's very interesting, what you were saying about the data being useful for sort of motivation, or, you know, if we're gonna get off our arse to do something, like breathing, for example, or if we're going to make changes to our diet, you know, and give up chocolate or reduce our alcohol or, you know, whatever it is that you're making your change in, you want to know that it's actually going to be worth it, don't you? Especially if you have long COVID, and your energy isn't very good, you know, it takes energy to change your diet. So you want to know that it's actually making a difference. So it is useful like that. 

I think what I also - I fell into this trap, where I had a period where I started feeling better, I thought, Oh, you know, and I've been doing lots of gentle yoga. I'd been doing lots of breath work. I'd been doing lots of yoga nidra and it had been helping, which is wonderful. And then I'd been starting to feel better. And then two weeks later, bam. And I was like, oh, oh, you Yeah, I didn't do any yoga for the last two weeks, I wasn't thinking about my breath work, you know, I wasn't doing these things. So it's a bit of a trap to fall into, isn't it? You know, the curse of the good day?

Dr Jay Wiles  
Yeah. Yeah, for sure. It is, you know, it's one of those things that I think - it translates to so many different areas of life. When you think, oh, man, things are going well, you can somewhat like, let up on some of the things that you've been doing. Then when things start to kind of spiral downwards, you say, Oh, well, I know, I remember what it was. That was the catalyst, that was the change agent, and you go back to it, and then you start feeling better again. So it's all about kind of creating those small habits and behavioral changes to move us in the direction of something that can be sustainable. And that's the key - keep it sustainable.

Jackie Baxter  
Yeah, yeah, definitely. Yeah. Trying to do too much too soon is never gonna work. And I think we've all learnt that lesson the hard way. I certainly have.

Dr Jay Wiles  
Yeah, I think it just comes back down to being a guide, and how we can use that information as a guide to improve resiliency, through things like what we mentioned earlier, all those tools.

Jackie Baxter  
Yeah, definitely. So what has been quite interesting is the people that have been talking about the relationship between HRV and PMS. So I've noticed this myself, but HRV, I think tends to be lower during PMS - would that be right? Because it would be a downward trend. And it's definitely something that you see cropping up in terms of symptoms occurring more around about that period.

Dr Jay Wiles  
Right. What we know is that during the time of ovulation, it is a very stressful period - no pun intended - for the woman; the body is having to mobilize and utilize a lot of energy. And not to be kind of too overly descriptive in what I'm about to say. But there are two processes that are occurring. One is either going to be disposal, or the other one is going to be fertilization. And because of that the body is naturally evolved to say, both process require a lot of energy. And if there is the potential for fertilization, or a pregnancy, during this time, as the egg has dropped, then all hands on deck, like we've got to increase the mobilization of energy down to the ovaries to work in a very meticulous and fast-paced fashion. 

And so therefore, what we see is that three primary physiological metrics are going to change during that time, because again, we're mobilizing energy, we're gonna see an increase in respiratory rate, we're gonna see an increase in heart rate, and we're gonna see a decrease in heart rate variability. Does that mean that the person is stressed? Well, yeah, kind of, I mean, the body is going through a stressful period or a time, whether it is prepping for disposal or fertilization. Either one of them requires a significant amount of energy. And so therefore, with the hormonal changes that are occurring that kickstart that process, we see that dynamic shift in nervous system functioning. 

We actually know that there is immunological suppression during that time, because a lot of energy is being shunted to that process. And because there is immunological suppression, or we can put simply - suppression of the immune system - that there's a higher propensity for women to become ill or to become sick during that time. And that's also because there's a significant release of cortisol as well during that time, the stress hormone. So everything's kind of playing in to the fact that during the female cycle, we see a dynamic shift in overall changes in nervous system functioning and stress response. Now, after this process has occurred, and either there is disposal or there is fertilization, we see a direct stabilization of heart rate variability, heart rate and respiratory rate back to where it once was.

Jackie Baxter  
Sure. And I suppose the follow up to that would be - is there a way to kind of reduce the effects of that? So would improving our HRV help there? Or is it just kind of like tough shit?

Dr Jay Wiles  
Yeah, a little bit tough shit. But also, I would say be more on the lines of what can you do to affect change from an emotional health perspective? A lot of women, a high percentage of women I should say, when they're going through pre-mentruation will experience significant hormonal changes that lead to significant emotional changes. Now I don't want to just put everybody into kind of the stereotype of you know, the pissed off woman on her period. However, there is a little bit of truth to that from what we see physiologically and from the research. So if we know that tempers, maybe let's say, flare up a little bit faster, we resort to a little bit more anger. Well, we know that as those emotions become exacerbated, as they increase, especially if they're not regulated, that can cause more hormonal dysfunction, it can cause more physiological dysfunction. 

So the great mitigation tactic for this would be to intervene with other practices for emotional well being. There's some aspects that are just a part of, you know, a female's physiology, and she has to naturally go through that process and endure, I guess that is her cross to bear. However, however, if we want to mitigate the negative effects of the emotional sides of things, that's where I would implement biofeedback, breath work, using data to help kind of catch you in the moment. I mean, that's why we created Hanu - Hanu is intended to monitor people in real time, so that we can provide feedback on changes in their nervous system, so that we can intervene earlier, we can self regulate before it spirals down into not so great emotional well being.

Jackie Baxter  
Yeah, that's fascinating. And I think there's a whole chapter in Patrick's book around about that. I think it's called something like "breathing for women. Yes, it's different." 

Dr Jay Wiles  
Yeah, that's right. 

Jackie Baxter  
That is incredibly interesting. Yeah.

Dr Jay Wiles  
The redheaded stepchild of health, it tends to be emotional health. We all acknowledge that it's there, we all acknowledge that we should do something about it. But for some reason, it just doesn't stand out as sexy as changing our diet or changing our exercise, or like buying all this cool stuff, or sleep and supplements and all. Emotional health takes a little bit of a backseat. But I would argue, and I think most people would agree with this nowadays, that emotional health should be - it should be a core pillar, it should be on the same level, as exercise, as sleep, as nutrition. It's really freaking important. 

And if you disregard it, and you allow things to compound and for stress to compound over time, humans have the propensity to do one of two things. We either explode or we implode, we either go off on somebody else and make a fool of ourselves. Or we go and we implode, we socially isolate, we get depressed, we move away from people. I think it's incredibly valuable and important for people to understand that that's kind of the two paths you go down if you don't take into consideration the impact and role of emotional health and overall health. 

So I think we should quit making emotional health the redheaded stepchild, and we should focus on making it a primary pillar. And just one tool that I think we have at our disposal right now is using HRV as a good guide. And that's kind of really what I like to teach and preach, is that it serves as a really great guide to improve emotional health. And emotional health is important.

Jackie Baxter  
Yeah, yeah, definitely. And I like the analogy of the pillars. There's certainly been a lot of people that have been told that, you know, long COVID is, quote, unquote, just anxiety or, you know, it's all in your head. And, you know, it's obviously not, but putting mental health and physical health and all the other things next to each other, I think is very important. They are both there. And they are both impacted by something like that. And they are both important.

Dr Jay Wiles  
Yeah, yeah, absolutely. Absolutely. It's all important. And if you disregard one of the pillars, then the rest of the house can fall. And it's just that clear, right? It's like if we knew that it took four pillars to build a really strong home, we wouldn't build three, we would build four, and they would all be equally as strong as one another. And as we knock one of those legs out, we know that the house falls down. So it's really good to pay attention to each of those categories.

Jackie Baxter  
Yeah, absolutely. Yeah, three pillared house. Not ideal *laughs*

Dr Jay Wiles  
Not ideal. That's right. 

Jackie Baxter  
Brilliant. Well, thank you so much for joining me today. It's been amazing. I feel like my brain is sort of exploding a little bit, but in a good way. I've learned so much. So I'm sure it will be the same for everybody else who has been listening. So thank you so much for your time.

Dr Jay Wiles  
Yeah, absolutely. Thanks for having me on.

Transcribed by https://otter.ai