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Manage Stress with the Apollo Wearable with Dr. David Rabin: Rational Wellness Podcast 195

Dr. David Rabin speaks about How to Manage Stress using the Apollo wearable with Dr. Ben Weitz.

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Podcast Highlights

3:27  The Apollo is a wearable device that was first conceived of while Dr. Rabin was studying psychiatry at the University of Pittsburgh and he was inspired by the ancient practices of meditation and breathing that change the way we handle stress. So many people today have stress related chronic problems, including anxiety, depression, PTSD, insomnia, and many others. When we are experiencing real or perceived threat, our nervous systems will be in our fight or flight, sympathetic mode much of the time, instead of being in the rest and digest and recovery response, parasympathetic mode of our nervous system. This also translates into low heart rate variability, negative effects on our digestive system, reduced ability to absorb nutrients, negative effects on our reproductive system, our creativity, and our sleep.  This also translates into various physical ailments as well, including chronic pain.  Safety makes our heart rate variability go up, which is a good thing. Safety and the perception of safety turns on our immune system, our metabolism, our digestive system, our ability to absorb nutrients, our reproductive system, our creativity, and our sleeping system. All of this good stuff that makes our lives really lovely.  But this can’t happen if we under real or perceived threat and in modern life many of us feel that stress much of the day, which means that we are in flight or fight sympathetic mode much of the time, instead of being in parasympthetic mode most of the time.

7:48  All mammals, including humans have developed this system where as soon as there’s a perceived survival threat of something coming to eat us or kill us or the lack of shelter, food, water, or air, our survival system kicks in, as you said, to divert all available resource to our muscles, to our heart, to our lungs, and to the motor cortex of our brain to fight, flight, or freeze, get out of that situation to safety.  If we are accidentally diverting resources to our reproductive system at a time or digestion when we’re supposed to be running from a bear or a lion, we will not likely make it out of that situation. So that system is tightly evolved to save us.  But we no longer have bears and lions around, but that sympathetic nervous system gets turned on by too many emails or cell phone notifications or our work responsibilities, etc.  Gentle touch applied to our skin can help to create balance by sending a signal to our amygdala, which is the fear center in our brain, that we are safe.  If you are safe enough to take the time to feel like you could pay attention to the feeling of gentle touch on your body, you can’t possibly be running from a lion right now.  This happens on a subconscious level. 

11:32  Dr. Rabin chose touch as the type of stimuli because touch can stimulate the release of a number of hormones, from our brain, including dopamine, serotonin, oxytocin, endorphins, natural endogenous opioids.  The other thing about touch is that you can be touched while you’re doing other things, including performing surgery, giving a talk, seeing a patient, running a meeting, driving, etc..  You can be touched gently, and it’s not distracting, and it can improve your performance and your presentness and focus.

13:54  Different vibrations have different effects on the body.  Different types of music, different rhythms, tempos, and styles have different effects on our body. The Apollo is based on how music affects us in waking us up, stimulating us, relaxing us, or making us fall asleep. The frequency patterns of touch in the Apollo is based on what music makes us feel good and these patterns are predictable for 90 to 95% of people.

22:00  The Apollo can help manage stress and reduce anxiety and depression.  A significant percentage of people with depression, anxiety, and PTSD do not respond that well to treatment, so it’s great to have another alternative approach to helping patients. 50% of patients with PTSD and 30% of patients with depression do not respond well to treatment.  And this is a very safe, natural approach that does not involve invasive procedures or pharmaceutical drugs.  A number of people who have been using the Apollo have reported that they voluntarily were able to taper off their medications, including opioid narcotics, benzodiazepines, and methamphetamine.

27:50  Heart Rate Variability.  Heart rate variability (HRV) is a marker for anti-aging, for various diseases, and for athletic performance. We want to have a high heart rate variability, which means that when stress occurs, our heart rate jumps up quickly to respond to the situation.  This means we will more likely recover from our workout or from illness.  If we have a consistently lower HRV, we are more likely to develop mental and physical health problems, our immune system isn’t going to work as well, and we will probably not sleep as well on a regular basis and not feel as good on a regular basis.  If we, on the other hand, use techniques like deep breathing, getting at least 30 minutes of exercise most days of the week, eating healthy, doing meditation, yoga, mindfulness, or soothing touch, listen to soothing music, and getting good sleep, then we can reverse that process and train our nervous system to be more in balance more of the time, which is reflected as high heart rate variability and more likelihood of recovering from illness, better likelihood of performing consistently at a high level and a better likelihood of just feeling good more of the time.  While the most accurate way to measure heart rate variability is with an EKG, outside of a clinical setting, the Apple Watch, the Oura Ring, and the WHOOP do a decent job of measuring HRV.

 

                       

                             

         



Dr. David Rabin is a board-certified psychiatrist and neuroscientist, is the co-founder & chief innovation officer at Apollo Neuroscience, the first scientifically-validated wearable system to improve heart rate variability, focus, relaxation, and access to meditative states by delivering gentle layered vibrations to the skin. Here is more information about the Apollo wearable: https://apollo-neuro-fact-sheet.carrd.co/  The following affiliate link will give you a 10% discount if you would like to order one:  Get 10% off Apollo, the wearable wellness device for stress relief | Apollo Neuroscience, Inc

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.



 

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast. Hello, Rational Wellness Podcasters.

Today we will be speaking about stress, the science of the part of our nervous system that regulates stress and about a new wearable device, the Apollo that uses gentle vibrations to help us to activate our parasympathetic nervous system known as our rest and digest nervous system so we can have a better balance with our sympathetic flight or fight nervous system.  In today’s fast-paced world made even more stressed by worrying about getting COVID-19 and dying, many people are in sympathetic mode too much of the time. This can lead to a number of symptoms and health problems. In fact, it’s a very long list, but it can include anxiety, depression, insomnia, hypertension, adrenal dysfunction, other hormonal imbalances, and a weakened immune system. Given that we’re still dealing with COVID-19, having a weakened immune system is not exactly a good thing right now.

                                The Apollo wearable device, which is the wearable device that we’re speaking about also improves heart rate variability, which also translates to better athletic performance. Today we’ll be speaking with the inventor of the Apollo, Dr. David Rabin, MD, PhD, a board-certified psychiatrist, a neuroscientist. He’s the co-founder and chief innovation officer at Apollo Neuroscience, which is the first scientifically validated wearable system to improve heart rate variability, focus, relaxation, and access to meditative states by delivering gentle, layered vibrations to the skin.  In addition to his clinical psychiatry practice, Dr. Rabin is the co-founder and executive director of the Board of Medicine and a psychedelic clinical researcher currently evaluating the mechanism of psychedelic assisted psychotherapy in treatment-resistant mental illness. Dr. Rabin, thank you so much for joining us today.

Dr. Rabin:            Thank you so much for having me. It’s a pleasure.

Dr. Weitz:            So tell us how you developed the Apollo wearable device and about some of the research that went into it.

Dr. Rabin:            Sure. Happy to. So Apollo was a technology that originally wasn’t called Apollo, was just an idea starting in 2014 at the University of Pittsburgh-

Dr. Weitz:            Was there an original name?

Dr. Rabin:            There were a couple names actually. So the first name was Emoto, which was named after the famous Japanese scientist, who discovered that water can store vibrations and frequency patterns.

Dr. Weitz:            Interesting.

Dr. Rabin:            So the idea that applying a vibration pattern to water creates what’s called structured water, which actually changes the way that the water molecules interact with each other, and that can be a visualized in what people call cymatics, which is like patterns of vibration in water or some kind of liquid. You could just google cymatics with a C, C-Y-M-A-T-I-C-S, and you’ll see a lot of this stuff. But there was a lot of inspiration that goes back thousands of years to the ancient practices of breathing and meditation that change the way that we interact with different parts of our bodies and how we become aware of our bodies that led to a lot of this work.  I think you kind of summed it up in the introduction with the balance of the stress response, sympathetic nervous system, and the parasympathetic rest and digest and recovery response nervous system, which we can get into in more detail. But the main gist of it is that people who have chronic stress-related illnesses, and I’m just going to talk about mental illnesses, for the time being, but this does apply to physical illnesses like chronic pain as well, and nerve pain and things of that nature. People who have these illnesses tend to have higher. The illnesses that you mentioned earlier, depression, PTSD, anxiety, insomnia, these kinds of illnesses get worse with stress almost all the time. Invariably, the symptoms get worse with stress.

                                So we can measure this by looking at heart rate variability, as you mentioned earlier, which is a measure. It’s one of our most accurate measures of the way that our heartbeat changes in response to stress in the environment or safety from the environment. Safety makes our heart rate variability go up. Safety makes us feel recovered and helps us feel like it’s safe enough for us to allow our recovery nervous system to turn on, which means recovery means turning on the immune system, turning on metabolism, turning on our digestive system, our ability to absorb nutrients effectively, our reproductive system, and our creativity system, and our sleeping system. All of this good stuff that makes our lives really lovely.

                                But we can’t be under threat, or we can’t perceive that we are under threat or believe that we are under threat for that system to turn on. So many of us who have experienced any kind of trauma or negative experiences, and this is the population that I worked with at the University of Pittsburgh that kind of spurred this idea, a lot of veterans and people who have treatment-resistant PTSD, and we saw that they all have low heart rate variability. This was actually seen in the literature for many other scientists and doctors who were looking at these folks and that they’re meaning low heart rate variability, meaning their stress response system is always up here, always on and very active, and their parasympathetic recovery nervous system is always underactive. They’re always perceiving themselves to be unsafe or in a survival threat situation and-

Dr. Weitz:            Just to interrupt for a second.

Dr. Rabin:            Yeah, sure.

Dr. Weitz:            That’s where the whole concept of the sympathetic and parasympathetic nervous system, it’s often explained by thinking about the zebra on the Savannah, and it sees a lion. So we’re designed for our sympathetic nervous system to put us in this state of stress and have all the blood go to the muscles, which means there’s no time to deal with digestion or all the other things that the parasympathetic nervous system is associated with, because right now, the zebra has to run for its life to avoid being eaten by the lion. Under normal circumstances, maybe that occurs once or twice during the day and the rest of the time, the zebra is calm, and-

Dr. Rabin:            Exactly.

Dr. Weitz:            … our body’s designed to go into this sympathetic nervous system, but only for short periods of time.

Dr. Rabin:            Right, and only-

Dr. Weitz:            In modern life, we-

Dr. Rabin:            Yeah. And only to get us out of danger in the moment.

Dr. Weitz:            Exactly. In modern life, we’re constantly feeling like we’re in this state of stress, real or perceived, that we constantly have to be in this revved up state.

Dr. Rabin:            Right. Part of the reason for that is evolutionary, right? We purposely evolve the system, which is not unique to us. All mammals, almost all animals on the known earth that have brains have this system in place, even going back to very ancient sea snails that only have like 12,000 neurons. Just give you an idea, we have like a hundred billion neurons. So all of these animals have the system where as soon as there’s a perceived survival threat, lack of something coming to eat us or kill us, lack of shelter, food, water, or air, our survival system kicks in, as you said, to divert all available resource to our muscles, to our heart, to our lungs, and to the motor cortex of our brain to fight, flight, or freeze, get out of that situation to safety. Right?   If we are accidentally diverting resources to our reproductive system at a time or digestion when we’re supposed to be running from a bear or a lion, we will not likely make it out of that situation. So that system is tightly evolved to save us. But we don’t have bears and lions around us most of the time anymore. So that system unfortunately starts to get turned on by other things, like too many emails or too many cell phone buzzes and pings or our kids screaming or work responsibilities or you name it, pandemic thoughts and the election and whatever else is going on in the world, right? Every little thing starts to trigger this system because we don’t have the context to say, “Oh wait, this isn’t a survival threat. This is just something that’s annoying me.” All right.

                                So that is critically important to understand, because what is important, because that helps us to know that we are in control of the outcome. So if we recognized that our emails are not actually a survival threat, even just for a moment or our kids or our work responsibilities, whatever it is, is not actually a survival threat that’s triggering us, and we can recognize that by taking a deep breath, taking a walk, pressing on our chest, doing some basic self-touch exercises, doing a brief meditation. This is not necessarily easy. It can be tricky to do in the moment.  But all of these activities naturally bring us very quickly back into balance because they send a signal to our brains, our amygdala, which is that fear center in our brains that governs the balance of this stress response and recovery response system that says, “Hey, bud. If you’re safe enough to take the time to feel like you could pay attention to your breathing right now or pay attention to the feeling of a gentle touch on your body or the feeling of Apollo vibrating on your body, you can’t possibly be running from a lion right now.” Right?

Dr. Weitz:            Right.

Dr. Rabin:            That’s mostly subconscious. It’s beneath our awareness, and that creates an instant loop. That’s a positive loop that says, “I am safe enough to be able to think about myself right now. I’m safe enough to feel my breath right now. I can’t be in a survival situation.” That gradually brings the amygdala activity down, and that helps us to cope with stress more effectively. So Apollo, we designed at the university to tap into this network and activate the safety response system to help people who are struggling with treatment-resistant mental illnesses recover and be able to have more of their cognitive resources available at any time when they would normally feel unsafe by helping them remember that, “Hey, you’re actually safe.”   If you can feel Apollo right now, you’re safe enough to take your time to make a good decision rather than a decision that’s impulsive and based on a past pattern that isn’t serving you.

Dr. Weitz:            So the various types of stimuli, why did you choose touch?

Dr. Rabin:            So we chose touch because, number one, touch is the most evolutionarily tight pathway that connects to safety. So if you look back at ancient animals, like we were talking about, we don’t even have to go back into sea snails, but we can go into old mammals, right, like monkeys, and earlier than monkeys, all of these mammals, which are millions of years older evolutionarily than we are, they all use touch to convey safety to each other. A mother holds their young, right? That comforting of touch in and of itself allows the body to reregulate itself through the secretion of natural hormones that many of us, unfortunately, self-medicate to get those hormones released, but they actually could be secreted by our brains naturally, and those hormones are the best ones that come from touch.  They’re dopamine, serotonin, oxytocin, endorphins, natural endogenous opioids from our own brain that makes opioids that are natural that reduce pain, and even endocannabinoids that reduce inflammation and help balance our nervous system through the endocannabinoid receptors in our body. There’s others too, but those pathways get activated by touch. They get activated by touch, not just in us and all of these other animals, and then those pathways help to reduce inflammation in the body very, very quickly and help to remind us very quickly that we’re safe.   The best part about touch is you can be touched while you’re doing other things, right? So if you’re performing surgery, giving a talk, seeing a patient, running a meeting, whatever it is, driving, you can be touched gently, and it’s not distracting, and it can improve your performance and your presentness and focus.  Music is harder to do that with.  Music’s great, but it’s harder to take with you everywhere you go. So based on convenience and the evolutionary psychology and the biology, that is how we ended up settling on touch.

Dr. Weitz:            Interesting. How do certain vibrations and the Apollo wearable device work to create this balance? Explain why certain vibrations have a different effect.

Dr. Rabin:            Sure. So I think this is one of the most interesting things about neuroscience in the body, because we’re actually experiencing this phenomenon that you described in every day of our lives. When we turn on a song in our house, right, or in our headphones or wherever we are, that song has a certain tempo, a certain rhythm, a certain energy level to it, and we don’t listen to the same kind of music when we’re working out or dancing or hanging out with our friends that we listen to when we’re meditating or relaxing or going to bed. Right?   We would almost never switch those musical types, because they are very different energy levels and different mood states. So that pathway of frequency rhythm, that impacting our energy level and our mood is well described and characterized in music for thousands of years. It’s not new by any stretch. Actually, our whole founding research team all had musical backgrounds. We all either played instruments growing up or still played instruments or were just heavily influenced and lovers of music, and we were always fascinated by the way that music affects our bodies.  So when I started doing this work in 2014, a lot of my strategy was, what can I take from our understanding of the neuroscience of music, the understanding of the neuroscience of touch and use what we know to compose songs for the skin instead of the ears. Right?

Dr. Weitz:            Right.

Dr. Rabin:            That’s really what Apollo is. Apollo is music that is composed for our touch receptors on our skin instead of our ears that you can wear with you and take with you at any time. So the frequency patterns are in large part derived from what music makes us feel good, what music rhythms make us feel good, and also what breathing rhythms make us feel good, and we kind of mash the two together based on the scientific literature that had been done before us, and we ended up coming to these really incredibly powerful patterns that are not just powerful. They’re predictable for 90% to 95% of people where we can send this to you, and as long as your goal is aligned with the energy of the frequency vibration, you’re very likely to get the outcome that you desire, which is really interesting, which is very similar to what happens with music.

Dr. Weitz:            Interesting. I think you just answered my next question, which is going to be, do all people respond in the same way to the same types of vibrations? Is there a range of response?

Dr. Rabin:            Yeah, there is a range. Not everyone is the same. The reason for that is because we have different associations with the stimuli, right? We have different associations with vibration, just like not everybody likes the same kind of music, not everybody’s going to like the same kind of vibration. So we did a lot of testing before we put this out onto the market. Apollo was released in January of 2020. We had been working on it in the lab for about five to six years before that, and then we had done I think three clinical trials and about 2000 case studies in the real world with prototypes before we released the commercial device to figure out how to get the best results.   We tried to remove as much of the subjective experience as possible in terms of, from music where somebody could say, “Oh, I like the song. I don’t like the song.” We didn’t want that. Right?

Dr. Weitz:            Right.

Dr. Rabin:            It shouldn’t be personal. It should just be the bare minimum that activates the nervous system in a soothing way. So after a lot of refinement and an enormous amount of experimentation in the lab and the real world, we figured out that there are specific rhythms that work in, as I said earlier, roughly 90% to 95% of people based on a goal-directed behavior. So you say, “I want to wake up.” If I want to wake up, you set up the wake-up frequency, 90%, 95% of people will wake up. Same for clear and focus, same for socializing and creativity, same for recovering after exercise.  But if you say, I want to wake up and you put it on a sleepy mode, it probably won’t wake you up. Right. It’s going to do the opposite. So the whole goal is to align your outcome with what your action is and for anything we do. So the way that we’ve designed the app sort of helps with that alignment. It’s going to get better over time, and that helps increase the outcomes, because people are goal directed in their behavior.  There are about 5% to 10% of people who interestingly we call paradoxical responders, and there’s a lot of reasons why people respond differently. But again, this is a wellness product that is not… No product works 100% of the time for everyone. Right?

Dr. Weitz:            Right.

Dr. Rabin:            So what we always tell people is if you’re one of those people who this doesn’t work the way you expected, play around with the different modes, because sometimes the modes that energize you might actually be the modes that calm other people down, and the modes that calm you down might be the modes that energize other people.

Dr. Weitz:            Yeah. I have patients, the same thing. They’ll say that any drug or nutritional product that is designed to stimulate me makes me tired and the opposite.

Dr. Rabin:            That’s exactly right. A lot of that has to do with, I think, two things, one of which is just our body’s makeup, that we’re mostly the same, but we’re a little bit different between each of us. I think the other part of it is just our past experience and the association we have with that feeling. So for example, if you have a negative association with touch and that you’ve never been touched in a loving way, or it was always associated with pain or discomfort, then it may take a little longer for you to get comfortable using the Apollo if you associate it with touch in that way.   Again, that’s a cognitive association that’s associated with trauma. So that’s just one example, but there are lots of other situations that are fairly uncommon, but people do have these kinds of experiences where there’s a little bit of variability. In the future, looking into 2021, 2022, we’re really excited to increase customization of the Apollo. So the software will grow and learn about each user to deliver a more personalized experience for each person starting with timing and then gradually customizing the patterns as well.

 



 

Dr. Weitz:                            I’ve really been enjoying this discussion, but now, I’d like to pause to tell you about the sponsor for this episode of the Rational Wellness Podcast. This episode is sponsored by Pure Encapsulations, which is one of the few lines of professional nutritional supplements that I use in my office. Pure Encapsulations manufactures a complete line of hypoallergenic research-based dietary supplements. Pure products are meticulously formulated using pure scientifically-tested and validated ingredients. They are free from magnesium stearate, gluten, GMOs, hydrogenated fats, artificial colors, sweeteners and preservatives.

Among other things, one of the great things about Pure Encapsulations is not just the quality products but the fact that they often provide a range of different dosages and sizes, which makes it easy to find the right product for the right patient, especially since we do a lot of testing and we figure out exactly what the patients need. For example, with DHEA, they offer five, 10 and 25-milligram dosages in both 60 and 180 capsules per bottle size, which is extremely convenient.

                                                Now, back to our discussion.

 



                           

Dr. Weitz:            How can Apollo improve anxiety and stress and depression, and can it be an alternative for people who maybe don’t do well on antidepressants or want to get off them, and they’re phenomenally difficult to get off of?

Dr. Rabin:            Right. Yeah. So that’s a great question. That was actually the focus of when we first developed Apollo. The whole goal was, how do we help these people who have treatment-resistant depression, treatment-resistant PTSD, anxiety disorders, substance use disorders, people who have tried everything under the sun nearly and never had good results and outcomes. How do we help those people feel better?  The reason why we focused on that group, because in PTSD populations, that’s like 50% of the population, maybe more. In populations of depression, that’s 30% or more of people. These are two of the most common mental illnesses worldwide. So it’s a real problem. It’s-

Dr. Weitz:            Anxiety is really growing, especially among younger people.

Dr. Rabin:            Right. So it’s a real problem if 30% to 50% of people are not getting better with what is considered to be the gold standard of treatment or several gold standards of treatment. So when we originally developed a technology, this population was a huge focus for us, and veterans were a big part of that and still are. So we have found that these people in our preliminary findings from people just telling us about their experiences in the real world, but also from our early clinical trials actually respond really, really well to the Apollo. It’s hard to say exactly why, but we do know that certain stress response, stress recovery techniques actually work better when people are more stressed out.   When the body is more activated on the stress response side, there’s a bigger shift and for longer. There’s a bigger shift noticeable when people experience an intervention that makes them feel safe because all of a sudden, they’re like, “Oh, wow. I haven’t felt this feeling in a really long time.” So that in and of itself is therapeutic because it helps them recognize that, “Hey, I didn’t really have to do that much to achieve this, but it didn’t require a medicine. It didn’t require a pill, and I can just press these buttons and activate the state as often as I need to and kind of deep breathing it over time actually trains the body or trains us to remember and learn how to enter these states more effectively without the device.”

                                So oftentimes people who use it start using it a lot from the beginning. They use it every day for a month or three months, and then after several months of using it, they actually start to decrease their usage naturally because they’re getting more benefit with less frequent use, and they start to use it more intentionally for specific goals. But yes. So the goal was to develop the technology down the medical path, which we are going in addition to the consumer path to help these people with these illnesses. From the report so far, which again, are not published yet. They’re still in progress, but from the report so far, we are seeing really incredible results for these illnesses, and it’s incredible.  Again, I will say as a caveat, this is not yet a FDA approved or clear treatment tool. It is a consumer wellness product, and we are working down that path. But right now, it’s a consumer wellness product, and we’re not making any treatment claims about it. But it does help with- It does help a lot.

Dr. Weitz:            Yeah. It’d be great if you included in that if you could do study with people who are on SSRI and similar medications

Dr. Rabin:            Oh, I forgot to mention that.

Dr. Weitz:            … who are trying to get off those medications and use this as part of the program of weaning them off those medications as well as maybe other lifestyle factors.

Dr. Rabin:            Yeah, that’s a great point. I forgot to mention that. So that is one of the most interesting things that we found is we do see that people who use Apollo are voluntarily able to taper off of some of these medicines, everything from… SSRIs, we haven’t done a study yet with those, but-

Dr. Weitz:            Those are really, really hard to get off of.

Dr. Rabin:            They are really hard to get off of. But the medicines that we’ve been seeing people come off of are, I would say, harder to get off of, they’re opioid narcotics, benzodiazepines, and methamphetamine. So I would say they’re in the same category of tough to taper. We’ve seen people who have chronic illnesses who are using Apollo, people in the real world, They’re just writing us, and people from our trials are writing us and telling us that they are using Apollo, and they’re finding that they don’t need their Xanax anymore. They don’t need their benzodiazepines for sleep. You’re able to use less or none of their pain medicine. We just had a person write in today that on our reviews, they decrease their pain medicine dosing from every day to once a week within a month of use. I mean, yeah.

Dr. Weitz:            That’s amazing.

Dr. Rabin:            So this is why this is so exciting, because it starts to show us how much of our suffering might actually be caused by our stress and how we address stress and how we approach it, which is completely 150% within our control most of the time.

Dr. Weitz:            Absolutely. I treat a lot of patients with the functional medicine approach for gut health challenges, like IBS, reflux, and I could see where this device could be really helpful. Have you tested for digestive disorders?

Dr. Rabin:            We have not tested it for that yet. We have a lot of interest from folks in the microbiome community. So we will be looking at that, but we don’t have any of those studies ongoing currently.

Dr. Weitz:            Yeah. Cool. So you mentioned heart rate variability. Maybe you can explain more about exactly what this is and how heart rate variability can be improved with the Apollo and then also how heart rate variability is associated both with various types of diseases. I was looking at some of the data. It’s associated with increased risk of coronary heart disease, risk of death from heart disease, and it’s also associated with improved athletic performance. It seems to me HRV should really be a good anti-aging marker as well.

Dr. Rabin:            Yeah. I mean, I think that’s really where this is going, because we haven’t for many years, I mean, forever. We haven’t had good biomarkers in science for tracking the effects of aging or stress and how quickly we are aging. HRV, heart rate variability is a really interesting biomarker because what it is is it’s a measurement of the rate of change, how quickly our heart rate goes up or down with the environment. So as you were saying, if we have a low heart rate variability, meaning our heart rate takes longer to go up in response to stress and longer to come down when the stress is gone and we’re in a safe environment, then we are more likely to perform inconsistently. We are more likely to be injured in intense performance, to demanding performance, especially in the elite athletics literature, more likely to become sick and more likely to have to suffer from a metabolic disorder, heart disease and to die if we get sick. Right?   So what this is saying… The complete contrary is true. If we have high heart rate variability, which means that when stress comes, our heart rate jumps up really quick to adapt to the situation, and then when stress has gone, our heart rate comes down very quickly to adapt to the situation of safety and enter a recovery mode. So what this is really saying is that if we’re in a chronically stressed state more of the time, then we can measure this as low heart rate variability. That is a biomarker that shows that if we stay in that situation without doing anything about it, we are more likely to develop mental and physical health problems, and our immune system isn’t going to work as well, and we’re going to probably not sleep as well on a regular basis and not feel as good on a regular basis.

                                If we, on the other hand, train ourselves using the techniques like deep breathing, getting at least 30 minutes of exercise most days of the week, eating healthy, doing meditation practices, yoga, mindfulness, or soothing touch, listen to soothing music, and getting good sleep, and all of these kinds of things are a combination of some of these things, then we can reverse that process and train our nervous system to be more in balance more of the time, which is reflected as high heart rate variability and more likelihood of recovering from illness, better likelihood of performing consistently at a high level and a better likelihood of just feeling good more of the time.

Dr. Weitz:            What’s the preferred way to measure heart rate variability. What do you use?

Dr. Rabin:            So that’s a tough question, because the preferred way as a scientist or a doctor is an EKG machine, and you have to do… Traditionally, to measure heart rate variability accurately, you actually have to do an EKG of a person at rest for three minutes, and that is not easy to do outside of a laboratory or outside of a clinical setting. So now there’s wearables that can measure heart rate variability, because a lot of companies have realized, “Hey, this is really cool, and we’re already tracking heart rate. So why don’t we just try to measure HRV from the heart rate data that’s coming in.” Because it’s just taking a fancy… It’s just taking the heart rate data and doing a fancy mathematical calculation.

Dr. Weitz:            Are there devices that do a better job of this?

Dr. Rabin:            Yeah. So the Apple Watch is fairly decent and the Oura Ring. This guy is fairly decent. I would say those are two of the best. However, the caveat is that the quality of the measurement has a lot to do with when you’re taking the measurement. Right? So if you’re taking the measurement when you’re moving in any respect or you’re in a an environment that has lots of noise or physical, electrical noise, sound noise, lots of ambient vibration, like you’re in a car or a plane or something like that, you will get consistently inaccurate unreliable results from these measurements. Even with an EKG, you would get unreliable results in a noisy environment.  So it’s really critical for people to understand that the wearables they use at home to track their biometrics, like HRV are notoriously unreliable, and they have to be looked at in an over time kind of fashion, not in a short-term fashion. The short-term data is sometimes useful, but most of the time it’s not, and it’s hard to tell when it is and when it’s not. So the trends over time are way more interesting, and what we want to aim for is trending our resting heart rate, coming down, our HRV, heart rate variability going up, and our deep sleep and REM sleep going up, and our total sleep efficiency going up, which is a… These are all the common measures these devices use.

Dr. Weitz:            So right now, there’s no really good device for just regular every day clinical usage if you’re not going to be doing an EKG for three minutes.

Dr. Rabin:            There’s no great devices for HRV specifically for the average person to use at home right now. For heart rate, there is good stuff, like the ones I mentioned. WHOOP is also good, and resting heart rate is a pretty good measure that could be very useful. We’re getting there on the HRV front. Devices are getting better. The technology is rapidly getting better, getting smaller, getting more precise. But I think we’re just at a point where we’re not quite there yet. Even if you are using these other wearables, you really have to be in a quiet setting to get accurate measures that you trend over time. But we will get there eventually.

Dr. Weitz:            Right. What about arrhythmia. I, not long ago, interviewed Dr. Aseem Desai who has a book about arrhythmia, and he talked a lot about training, emphasized the parasympathetic state and how nervous system stress plays a big role in arrhythmia. That’s a really common problem for people these days. (See episode 181: https://www.drweitz.com/2020/11/atrial-fibrillation-with-dr-aseem-desai-rational-wellness-podcast-181/)

Dr. Rabin:            It is.

Dr. Weitz:            I could see where this would be beneficial.

Dr. Rabin:            Yeah. We don’t have any studies on arrhythmia yet, but we do have a number of people, and I work with a cardiologist in Pittsburgh, an interventional cardiologist who’s a really wonderful help to us.

Dr. Weitz:            Is that Joseph Maroon?

Dr. Rabin:            No, Dr. Brian Donahue. Joseph Maroon is a neurosurgeon who we also work with.

Dr. Weitz:            Oh, okay.

Dr. Rabin:            But we all work together, and it’s been really interesting to see how many people have used Apollo for atrial fibrillation or for arrhythmias, as you said on their own. We don’t instruct anybody to do it, but people will use it, and they have told us that they feel like they have less frequent arrhythmias because they’re calmer on a regular basis. I think that it just shows again how much stress actually impacts us without us knowing it. When we haven’t been taught to recognize what’s going on because it’s just of the normal day-to-day, being stressed all the time, we sometimes forget that stress really does play a major role in our health.

Dr. Weitz:            Absolutely. So yeah. You mentioned that there’s different modes that the Apollo device has. So I know there’s one mode to help improve concentration and work performance. Maybe you can explain how that works differently, and it’s fascinating that the same device that can improve sleep can also improve alertness and performance.

Dr. Rabin:            Yeah. So again, going back to the music analogy, right, our speakers can do this too. As long as you choose the right song and the right volume, we can do the same thing with music. I think that with Apollo, what we did was we were in the lab at the University of Pittsburgh, and we wanted originally because people with PTSD and people who are chronically stressed out have notoriously struggled with intense cognitive performance tasks and they require a lot of attention, and especially boring tasks.   So we ended up giving 38 healthy subjects one of these very boring and taxing tasks that NASA gives to astronauts before they go into space to test their ability to do very tedious work under frustrating conditions. So what was really fascinating was when we put people through this task, our goal was, and this was the first study that we did, which was a double-blind, randomized, placebo-controlled, crossover study in healthy folks at the University of Pittsburgh.  We found that there was a specific increase in heart rate variability in these folks with Apollo frequencies only and not with placebo and with no vibration conditions, and every subject had every condition and had no idea what condition they were getting. Nobody knew what was what this was supposed to do. To clear and focus mode was the mode that put people into the best of what we would call a peak performance or flow state, where people felt like zoned in.  So people on this mode, some of them had up to 25% increase in performance in three minutes. So if you could imagine what that is, that’s like the amount of difference on this kind of task that people see with amphetamines, with just a vibration on.

Dr. Weitz:            [crosstalk 00:38:36] stimulate the sympathetic nervous system in some way, like amphetamines do?

Dr. Rabin:            So it’s both. So I think what’s really interesting about flow or peak performance is that it’s not… The sympathetic and parasympathetic systems, they coexist all the time. They are never just one or just the other. They coexist all the time, just at least a little bit, and because we need both systems to function. So what’s interesting is if you can boost parasympathetic and sympathetic together, which is what many scientists have classified as the state necessary to access flow or peak performance, then you can bring the body into a state where there’s increased energy, sympathetic, right, increased awareness, sympathetic, but also increased attention control and increased emotion regulation, and the combination of those things directly increases performance. Right?

So that was what we aimed for in that trial, and we hit it right on the money, which was really exciting. So then we started looking at, what other states can we induce, right? That was also initially a part of that study as well, where we gave people like 20 different frequency patterns that we came up with in the lab, and we just said, “Feel this for 30 seconds and rate on the scale how it makes you feel.” Is it possible for people to tell in 30 seconds that a brief vibration changes the way they feel?   We actually saw there was pretty reliable reporting. People generally said close to the same answers for the same vibration pattern. So that started to give us the beginnings of an algorithm that was not just one pattern or two patterns that can induce one or two states, but really a mathematical understanding of how you can change the frequencies reliably a little bit in different directions to reliably and do certain states because our states of energy are actually on a spectrum from sleep to running from a bear, right?   So all the performance and recovery states actually when we’re awake, lie in between running from a bear and sleeping. So everything exists between those two, and those are the two that form the top end and the bottom end of the Apollo modes.

Dr. Weitz:            So what are the modes that the Apollo has?

Dr. Rabin:            So the most energizing mode, which is not… I would not say this is calming at all, personally, but it’s very energizing. It’s like having a shot of espresso for most people, but it lasts a shorter time, and that’s the energy and wake-up. Then there’s the social and open, which is like a social creative flow state that’s a calm… Most people use it when they’re working in groups or socializing when they’re tired. Clear and focused is the next one down, and these go in order from most energizing to least energizing.  So energy and wake-up, social and open, clear and focused is that deep focus flow that’s kind of like amphetamines, and then the one lower than clear and focused is rebuild and recover, which is basically the most balanced, even sympathetic and parasympathetic, which is with the goal of just rapidly calming the body down after a physical or mental or emotional stress of any kind. I really use that after travel or after exercise in particular, and we’ve shown that brings heart rate down much faster after exercise, which is really interesting.   Then we go into the much more calming parasympathetic frequency. So that’s meditation and mindfulness, which is great for meditating. It’s also great for what we call calm flow. So this is just like being like a Buddha master, just going throughout your day, just feeling in the zone and calm, but not worry, not anxious, not like you have to do anything.

Dr. Weitz:            You can use this while you meditate to reach a deeper meditation state, right?

Dr. Rabin:            Yes. We showed that in a study at the University of Pittsburgh as well that’s in the works and then-

Dr. Weitz:            It’s really fascinating, because people say you have to spend enormous numbers of hours meditating before you can finally reach this state. People say you have to spend 12 hours a day for weeks on end to reach a deeper state if that’s something that could be achieved.

Dr. Rabin:            Yup. Yeah. Sometimes hundreds of thousands of hours of breath work and meditation to learn how to enter deeper states, which is really interesting. So we’ve shown that Apollo within 12 minutes can start to make a non-meditator’s brainwave patterns look like an experienced meditator’s brainwave patterns.

Dr. Weitz:            Wow, fascinating.

Dr. Rabin:            So that’s something that is really exciting because transitioning into a meditative state, it’s also like a safety situation, right? When we’re meditating or sleeping, and for us to really recover deeply, which is doing things like meditation, yoga, sleep, that kind of stuff, we have to feel safe, right? When you’re meditating and your eyes are closed and where you’re sleeping, “That’s the time that we are more physically vulnerable than any other time.” So if there’s any part of our reptilian old brain, the amygdala that thinks that we are not safe in those situations, we won’t be able to meditate, and we will not be able to sleep, and we will not be able to access these higher states of consciousness that facilitate very powerful healing for ourselves.   Which is what I teach people in my clinical practice. So Apollo helps people state change, and whether that’s going from stress to calm, calm to work, calm to focus, focus to meditation, meditation to socializing, whatever the state change is, automatically, all state change for human beings or any animal creates a stressor. So what Apollo does is it just smooths out the transitions. By calming the body, it reminds us that this change of state is not threatening to us.

Dr. Weitz:            Wow.

Dr. Rabin:            In and of itself. Then that smooths out the transition from one state to another.

Dr. Weitz:            This is really fascinating, right? I just can’t believe how fascinating the applications of this device can be.

Dr. Rabin:            I mean, we couldn’t either at first, and then it was really exciting when these results came back, because I’ve been doing research for a long time. My colleagues that I worked with on this have been doing research for a long time, and I can tell you that it’s like once in a lifetime that you actually come up with something that works this well.

Dr. Weitz:            Now, where do you wear the device? You wear it on your wrist, or you wear it-

Dr. Rabin:            I actually wear it on my ankle? The device comes with an ankle strap and a wrist strap. Most people I think prefer to wear it on the ankle, and the main reason for that is because the primary use case of Apollo that most people use it for is relaxation and sleep. Then the second one is focus. So for sleeping, most people prefer to have the wearable on the ankle, where it will never be near anyone’s head when they’re sleeping and-

Dr. Weitz:            Are there EMFs produced by this?

Dr. Rabin:            Only what is produced by any Bluetooth device. It’s been tested for all of that radio frequency signaling. So it’s under all the legal limits and all that. That being said, there are people who are still sensitive to EMF below the legal limits, and we have included an airplane mode from the beginning to turn off all signaling for people. So the device actually works and can be completely untethered from the phone, and you could turn off the radios entirely so there’s zero EMF in airplane mode, and we have-

Dr. Weitz:            [crosstalk 00:46:36].

Dr. Rabin:            Yeah. The device doesn’t use EMF as a therapy. It uses sound waves. So the sound waves are very safe. They’re one of the safest things that we know of to deliver to the body. So the sound waves can be still delivered and activated with the device on the buttons on the device, and you can adjust the intensity with the buttons on the device even when it’s not connected to the phone, which is really nice because personally, I get it. I don’t want to have my phone on me all the time or have to have my phone on me all the time to feel good. I want to be able to set my phone down and be able to still have my tools with me that work without requiring the phone. Then if I want to go back to the phone, I can go back to the phone. But it’s more intentional with that.

Dr. Weitz:            Will it hold a charge for a long time?

Dr. Rabin:            So it holds a charge if you don’t… In standby mode, I think it’s something like 12 days, 15 days.

Dr. Weitz:            Oh, wow.

Dr. Rabin:            If you use it, it will last… If you use it as we recommend, which is roughly two, two and a half hours a day or two to three hours a day, then you get about two days out of it. If you use it more than that, then you have to charge it more frequently. That’s not a big deal. You just find a time to charge it, and it charges within one to two hours, and then you have another full battery capacity out of that. We are constantly working to make the battery life better, but it just takes time and-

Dr. Weitz:            Yeah. As long as it goes through your whole night sleep or most of your day, that should be fine, I would think.

Dr. Rabin:            Yeah. Yeah. It does. I think the people who do use it more often, that use it all, all the time when they first get it, they actually schedule in time during their day and usually during a meal to plug it in, which is funny. But it’s good because that structure of having a schedule is also very helpful to us in terms of recovering, because it sets boundaries that says, “Hey, it’s time for recovery now, not time for work.” Right? Then you kind of have these from self-imposed, but still from boundaries that allow us to disengage from one state of mind or activity and then enter into another.

Dr. Weitz:            Interestingly, I talked to a lot of people are working from home right now, and that’s become increasingly difficult when they’re working at home, and they just end up, can keep working.

Dr. Rabin:            Yup. Yeah, I did that too. I am a complete perpetrator of that. It is very difficult, and it’s something that I’ve really struggled with in the last year, in particular with COVID. But now, it’s really just a matter. What I started do now is I made a schedule, and I just really hold myself to it, and I just got it because I know that if I do it, I just feel so much better. That’s all there is to it. I want to feel good.

Dr. Weitz:            Oh, I feel the same thing. Besides my full-time practice, I do the podcast, and I’m always working on show notes or working on notes for the next interview or et cetera. So it’s hard to shut off. That’s one of the reasons why we need a device like this.

Dr. Rabin:            Oh, yeah. I mean, yeah, the struggle is real, for sure. I think that’s why, especially with doctors. I used to work in the psychiatric ER when we first had this prototype, a prototype of the Apollo. I was working in the psychiatric ER a lot. I was seeing a lot of very, very high risks mental health patients. Having the Apollo was just a game changer, to be able to have something that allowed me or helped me figure out again how to call myself down quickly without taking a supplement to help me sleep or without having a glass of wine or… Not that having a glass of wine is a bad thing. It’s not, but we shouldn’t be dependent on it for rest because it doesn’t actually help us sleep. It actually just makes us feel like we sleep better, but we actually sleep a lot worse and are actually less rested at more of a sleep deficit down the road.  So I think ultimately, what working on Apollo really taught me that was so incredible was that we have the ability in ourselves to heal ourselves. We through learning how to use the tools that we have access to in ourselves, we have the ability to heal ourselves and to really make ourselves so much better than we are. Life is like a constant game of growth, and how fast can we grow out as well as we can grow in the direction we want to grow. Right? We think we want to grow.

Dr. Weitz:            Absolutely.

Dr. Rabin:            Working on Apollo really taught me and using Apollo over time taught me that there’s a hell of a lot more going on in here than I thought there was.

Dr. Weitz:            Cool.

Dr. Rabin:            Because the anxiety and the fear is what… Kathryn, my wife is the CEO of Apollo, we came up with this funny term, which I think is really true, which is the fear that we are either taught to feel or feel for whatever reason about uncertainty or newness or unfamiliarity or anxiety or whatever, it’s really fear of the unknown. It’s fear of uncertainty and fear of losing control of our lives, our situation, and that creates a box around us that we eloquently entitled the fear box, that literally creates the reality that we live in.  In every moment of our day, we have the opportunity to pay attention to love or fear. There’s love and fear and every moment coexisting together in every moment of our day, and if we direct our attention to fear, we will live in that fear box, and if we direct our attention to love, we will climb out of the fear box, and we will find our actual path.

Dr. Weitz:            Right. Awesome. Great way to end this interview. It’s been very fascinating. How can people find out… How can they order the Apollo and find out more information about you-

Dr. Rabin:            Well-

Dr. Weitz:            … and the device?

Dr. Rabin:            Sure. Yeah. So, for Apollo, you can go to apolloneuroscience.com or apolloneuro.com, A-P-O-L-L-O-N-E-U-R-O, dot com. I believe we have some sales that are either going on or coming up. So stay tuned there. You can also sign up for our newsletter on the website where we send out a lot of very helpful tips that I have helped to write myself based on things that I’ve done and that I do with my clients, which is basically free information to help people feel good at a time where things are really crazy in our world and to feel frankly just more in control of our own lives. That’s what this is about.

                                If we spend more time paying attention to things we can control, we will feel more in control. Breath is the start of that, and movement, and these things, everything we’ve been talking about. If you’d like to find me or get in touch, you can check out my website. It’s drdave.io. That’s my clinical practice website. I also can be reached through social media at Twitter @DaveRabin and on Instagram @drdavidrabin.

Dr. Weitz:            Awesome. Awesome. Thank you so much, and I’ll send you links after we post this in about six weeks.

Dr. Rabin:            Sounds good. Thank you so much for having me. I really appreciate it, Ben.

 

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