Managing Moods and Stress with Wearable Technology

The Apollo Neuro for Stress, Sleep, Depression, and PTSD with Dr. David Rabin

Stress and its associated symptoms such as impaired sleep, depression, PTSD, and lowered cognitive performance are among the most pressing mental health issues of our time. Many turn to stimulants and other substances to help them cope. 

A wearable technology developed by neuroscientists may hold answers. The Apollo Neuro, based on decades of research, uses touch therapy in the form of sound waves to deliver a gentle vibration to the skin and helps the wearer shift mood and energy level. 

The Apollo holds promise for improving HRV (heart rate variability), an important marker of nervous system health, and enhancing overall health in the process.

In This Episode

Episode Intro … 00:00:45
Merit of Vibrations & Supporting Research … 00:18:03
Clinical Trials … 00:21:04
Apollo Neuro & Response Time … 00:35:01
Application of Apollo Neuro – Continued … 00:41:25
Apollo Neuro Personalization … 00:42:57
Apollo Neuro as a Psychologist’s Tool … 00:45:44
Episode Wrap Up … 00:47:18

Managing Moods and Stress with Wearable Technology - Podcast325a David Rabin

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Hey, everyone. Today I speak with David Rabin about a product called Apollo Neuro, which is a wearable device that can help stimulate a parasympathetic response. It may also help with heart rate variability, recovery sleep, and even PTSD. It’s actually quite an interesting device. I have to admit that I’m much more keen to actually run my own experiment with this again after having a chance to pick David’s brain and get some more clarity. This device definitely does pique my curiosity, especially knowing that for many of us, help getting into a more relaxed state can help with gut, brain, sleep, and mood. This device has some preliminary published evidence and some ongoing trials to help validate and verify it does what it claims to do. This is also obviously quite reassuring. It was a very interesting and insightful conversation with David Rabin from Apollo Neuro. We will now go to the interview.

➕ Full Podcast Transcript

Episode Intro:

Welcome to Dr. Ruscio Radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player for weekly updates. Visit drruscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now, let’s head to the show.

DrMichaelRuscio:

Hey, everyone. Today I speak with David Rabin about a product called Apollo Neuro, which is a wearable device that can help stimulate a parasympathetic response. It may also help with heart rate variability, recovery sleep, and even PTSD. It’s actually quite an interesting device. I have to admit that I’m much more keen to actually run my own experiment with this again after having a chance to pick David’s brain and get some more clarity. This device definitely does pique my curiosity, especially knowing that for many of us, help getting into a more relaxed state can help with gut, brain, sleep, and mood. This device has some preliminary published evidence and some ongoing trials to help validate and verify it does what it claims to do. This is also obviously quite reassuring. It was a very interesting and insightful conversation with David Rabin from Apollo Neuro. We will now go to the interview.

DrMR:

Hey everyone. Welcome back to Dr. Ruscio Radio. This is Dr. Ruscio. Today I’m here with Dr. Dave Rabin. We’re going to be talking about this cool device was recently recommended to me by a colleague. I also believe Erin Ryan from our team gave this a trial, as did I, and saw some nice results with it. The device is called the Apollo Neuro. We’ll unpack what that is. This is something that may help people better adapt to stress and get a little bit more into parasympathetic tone or that side of their nervous system. Dave – welcome to the show. I’m curious to unpack and learn more about the Apollo Neuro.

DrDavidRabin:

Thanks so much for having me on your show. It’s a pleasure to be here.

DrMR:

It’s great to have you. I’m also curious to go into a bit more detail about some of the research behind the device. Let’s give people the zoomed out, bird’s eye view on you, your background, and what the Apollo Neuro is; how you came to work with this device.

DrDR:

Sure thing. So, I am a psychiatrist and a neuroscientist. I have a clinical practice that is mostly focused on what I’ve been trained to study and treat – patients with trauma disorders and treatment resistant mental illness. My primary focus is on post-traumatic stress disorder (PTSD), addiction, and substance use disorders, but also on depression, anxiety, and disorders that chronic pain and insomnia fall into. These categories are what some people would call physical illness with a strong mental health and stress related component. I became interested in this area because these disorders, all of the ones I mentioned so far, are notoriously very challenging to treat. Western medicine, in particular over the years, has had a dramatic increase in the percentages of people who have diagnoses of these disorders – particularly depression and chronic pain. These are just two examples.

DrDR:

PTSD – in the second phase of this pandemic – is undeniable in our society now. It’s something that is also very challenging to treat with the current medications and recommended gold standard treatments that we have available – to the point where less than 50% of these people are getting better with the gold standard recommended treatments. When I saw that data and I saw the impact of these treatments on my own patients and my colleagues’ patients in our clinical practices at The University of Pittsburgh Medical Center, it would become very clear that I was not the only person observing this. There were lots of people who were struggling to treat these conditions. That really forced us to ask the question – Are we approaching these illnesses correctly? If we’re not able to treat people who have a diagnosis of PTSD – as one example – into sustained center remission over a long period of time with the treatments we have available, perhaps our whole understanding of this illness is not correct.

DrDR:

Maybe we have to go back to a different framework and ask different questions. So we started asking questions about the stress response system, the autonomic nervous system, and the parasympathetic system – this is our recovery response system. It is activated by safety and devotes resources like blood and oxygen to our reproductive system, our immune system, and our empathy system; our bodies rest and recover and store energy for use. Then there’s also the sympathetic system. This is often known as the fight or flight freeze response system that is overactive in most of us in this Western world. It diverts resources to the heart, the lungs, the brain’s motor cortex, and the brain’s fear center to make sure we are able to get out of a survival threat situation in any moment.

DrDR:

The problem is that most of these people with PTSD, chronic pain, depression, and all of these disorders we’ve been describing are constantly in a state of high sympathetic tone or fight or flight response. They haven’t learned how to balance that out with recovery, because for most of their lives they have felt so unsafe on a regular basis that their recovery system never gets a chance to turn on. According to many different researchers over the years, this is a huge reason why they experience the symptoms that they do and why they don’t experience better rates of recovery. So, Apollo Neuro was developed as a touch therapy that’s based on decades of neuroscience literature and on our understanding of the neural pathways of touch and how to activate that parasympathetic safety response/recovery response system in our bodies through the sense of touch – delivered to the skin, to the ankle, or the wrist. You can gently nudge somebody into a more calm and focused state, a sleepy state, a meditative state, or a more energetic state by just reminding them. It’s as if somebody was giving you a hug or holding your hand on a bad day – that you’re safe enough to be able to be present and tackle what you have to do right now and what is right in front of you without worrying about things from the past or predicting things in the future.

DrDR:

Apollo Neuro became a tool that was developed out of working with these patient populations. However, we ultimately started studying and testing it on everyone that we knew. It’s just sound waves delivered through the skin and it’s extremely safe. Now it’s used in mostly non-patient populations – doctors, military folks, high-intensity elite athletes, entrepreneurs, and people from all different kinds of extreme lifestyles, which is very interesting.

DrMR:

A lot of great stuff there to unpack. Where do we begin? Before I launch into my questions – I have several ranging from a PTSD cohort all the way up to an athlete trying to improve performance – let’s tell people what this looks like.

DrMR:

Essentially, I would describe it as a watch that can also be expanded to be an ankle bracelet. You have an app that controls this device through your cell phone. There are different programs you can use to stimulate in the direction that you’re trying to go. Maybe you can shade in a little bit of my crude description of the device.

DrDR:

Sure. So, you’re right. It’s a small wearable about the size of an old apple watch that can be worn. Most people wear it on the ankle and then the wrist. Some people wear it on the arm. It actually works anywhere on the body. You can wear it throughout the day. I’m wearing it right now, as an example. I wear it all day for work to improve my focus and just help me stay on task and in a productive flow state.

Apollo Neuro States

DrDR:

From beta testing in the lab and then on thousands of subjects in the real world, we found that there were about seven different states that most people like to be in during each day and night. Those states range from wide awake – which is like the energy wake up mode that just gives you a sort of intense boost of energy – to social and open – which is like creative social flow energy of being present and calm with other people around you, whether you’re working or playing. There’s also clear and focused – which is basically intense, sustained focus on anything you might need to do, whether it’s something you enjoy doing or not. This most resembles the effect of amphetamines. Going down from there gradually into lower energy states, you can use rebuild and recover – which are vibration patterns that help to wind you down after any intense physical, mental, or emotional stress. Most interestingly, we’ve shown with these modes, this pattern helps the body calm down much more rapidly in terms of heart rate and blood pressure after intense physical exercise. Down from there in terms of energy level is meditation and mindfulness – which is great for meditation and mindfulness. We’ve done a study at The University of Pittsburgh showing this by increasing speed and depth of access in meditative states in both expert and naive meditators. It helps with a calm flow state. It tends to help people with aches and pains, particularly nerve related pain. Down from there is the relax and unwind – which most people would liken to a cannabis indica or a glass of whiskey before bed. It’s a very deep relaxation – almost at sleep. Many people do fall asleep using it. Then sleep and renew – which is what people use when they get into bed for deep sleep. Effectively, the way the vibration patterns relate to each other is similar to music. t’s just music composed for your skin touch receptors instead of your ears.

Apollo Neuro Vibrations & Parasympathetic Responses

DrMR:

The device itself feels like a vibration, but I suppose the vibration is sound. Can you tell us a bit more about that and how this can stimulate you neurologically? I remember back from some of my training that if you wanted to stimulate the parasympathetic system, the spine and the extremities were a pretty powerful gateway from a proprioceptive path to access this. Help us better understand how a device you put on your wrist or your ankle that’s watch-like can move you to wake up, be social, or relax. How does this all connect?

DrDR:

That’s a great question. I think what you say is true. There are certain parts of the body that are more directly tapped into the autonomic nervous system or the parasympathetic system. They are known as vagal afferents because they target the vagus nerve specifically. There are a lot of spots like this in the body. What’s very interesting about vibration in sound waves is that they don’t have to be at a specific place in the body. They’re actually called non-local central stimulation. So, everyone has experienced this at some point before – you can stimulate a part of the body when somebody you trust touches you; somebody puts their hand on your back or gently on your arm or gives you a hug. All of these feelings activate the same safety response, although to a much greater degree than the Apollo Neuro. However, it creates the same response as Apollo Neuro – that vagal activation particularly through one pathway. This was much more well-characterized over the last 40 years by a fellow named Bud Craig. He studied the anterior insula and the emotional cortical pathways that help detect and store emotional memories and the meaning around emotional experiences. It turns out that there are touch pathways that go straight to the part of our brains we call the somatic sensory cortex that detects what the feeling is. Is it hot? Is it cold? Is it vibrating fast? Is it vibrating slow? Is it intense pressure or light pressure? All of those things get detected as well in that somatic sensory part of the brain.

DrDR:

However, at the same time, there’s another signal that Bud and his colleagues discovered in human beings – and also in many primates – that sends a signal through this pathway called lamina I in the spinal column. It sends specific emotional content of an experience around touch and all senses to the limbic system in the brain. In this case it is the insular cortex. The insular cortex is interpreting the emotional response around the vibration or the touch. There are a couple different things going on here, as you can tell. If you can remind somebody of the feeling of soothing touch, even though there’s not another person around, and they perceive themselves to be in a state of threat, then their bodies will feel that whether there’s a person there or not. The fact that they even have the time to pay attention to that feeling means that they can’t be running from a lion in that moment.

DrDR:

Then that starts to rapidly deescalate in a positive feedback loop – the overactive threat, fight, or flight response nervous system. This is the same mechanism as deep breathing; the same mechanism as soothing touch. The mechanism is well-characterized. The other part of it is in the mechanism of biofeedback, which is if the body experiences particular rhythms, it will match those rhythms with breath and heart rate in resonance. The way biofeedback works is that you look at your heart rate and breath rate on a screen, and within 90 seconds, 95% of healthy people will match those rhythms to about six breaths per minute. This is where most people start to enter into a meditative state – between five and seven breaths per minute. That particular region of breathing – that five to seven breaths per minute – is a sweet spot for transitioning into meditative states and other altered states of consciousness that facilitate more of a parasympathetic dominant state.

DrDR:

So, we not only fed these vibrations to the body that resemble soothing human touch, we also made sure those vibrations were at a rhythm that were characteristic of a rhythm that the body knows how to respond to – which is around that five to seven breaths per minute range. When the body feels that, it senses it and it tries to match it. Those two mechanisms together induce a state of heightened parasympathetic tone that can help people enter into a meditative state. Or what we roughly know a meditative state is like physiologically without necessarily having to know how to meditate.

DrMR:

Right. Very cool.

Sponsored Resources:

This is Dr. Joe Mather – Medical Director of the Ruscio Institute for Functional Medicine. Stress is at the root of so many health issues and often goes untreated. I recently had the opportunity to review a fascinating device called Apollo Neuro, which is a new stress relief wearable. This technology is worn on the wrist or ankle and trains your body to bounce back from stress more quickly, shifting your nervous system from fight and flight to rest and digest. It works by delivering silent soothing vibrations that help you feel safe and in control. Apollo Neuro was developed by neuroscientists and physicians, and it’s been shown in multiple clinical trials to reduce stress and anxiety. It even improves HRV – heart rate variability – indicating a less burdened autonomic nervous system. Erin Ryan – a busy mom from our team – observed lower stress, better energy and improved sleep quality while using the device. Visit apolloneuro.com/ruscio to learn more and receive a 10% discount on your purchase of the Apollo Neuro.

Merit of Vibrations & Supporting Research

DrMR:

There are obvious implications by influencing the nervous system in a certain directness, especially toward parasympathetic activity. You mentioned PTSD, recovery, sleep. I’m curious to learn more. Firstly, one of the things I always try to do is understand. Secondly, the skeptical part of my brain says this is a great theory, but what kind of evidence do we have that substantiates the clinical merit of these mechanisms? Tell us a little bit more about the research that you’ve done and what sort of cohorts you’ve studied. What sort of effects are you seeing?

DrDR:

When we first started working on this technology back in 2016, I assure you we were very skeptical as well. Even though we were musicians, our research team at the university knew the influence of music on the nervous system from an experiential perspective, and we were fairly well versed in the literature, it still seemed a stretch to find these specific vibration patterns that could not be heard, but could be felt. If delivered in the right part of the skin, would the brain follow suit? Would we be able to induce these effects reliably? At first we started to make lots of different patterns of vibration. We tested them on ourselves and we tested them on our colleagues. Like any good scientist that’s testing something non-invasive, we just asked everyone. We started to notice there were certain reliable reports coming back. In particular, after we found the clear and focused mode, which was the first mode that we discovered in the lab. That was the first mode that we felt – after trying probably hundreds of different vibration patterns – that actually felt good.

DrDR:

To give you an idea of how hard it is to find vibration that you can feel consistently and that feels good, try using the Breath app on your Apple watch. Just wear an Apple watch for a short amount of time. When you start receiving a lot of their tactile notifications, you’ll realize that with the vibration settings on your phone, most of them are designed to notify you and actually make you more alert and in some cases agitated; not to calm you down. They are designed not to soothe you. So it took a while to figure out exactly what types of vibrations could be soothing. We threw out a lot. Once we found that first one, which became the clear and focus mode, we started taking that and making variations on it.

DrDR:

Think about it like Mozart’s variations on Twinkle Twinkle Little Star that some of us used to learn when we were playing piano and violin growing up. Musicians would do different variations on different sound waves or different vibration songs to give you a slightly different emotionality or feel. So, we started doing the same with these patterns.

Clinical Trials

DrDR:

In 2017 and 2018, we ultimately created the framework for a double-blind randomized placebo controlled crossover study. Many of you will know is the most rigorous form of clinical trial because it’s not only double-blinded and not only randomized, but it’s placebo-controlled with multiple active controls. These are vibrations that actually change the body, but are not layered in the specific way that the Apollo Neuro vibrations were layered – like cell phone buzzes and tapping, for example. There are also no vibration conditions and nobody knows what the vibrations are supposed to do; what they are representative of or what patterns they’re receiving. Every subject experiences all the different conditions.

DrDR:

In that study of 40 healthy individuals, we found that Apollo Neuro vibration patterns only induced a state of increased parasympathetic tone within three minutes under stress. Anyone who has done any stress studies – or has participated in any stressful event – knows that heart rate should usually go up under stress and heart rate variability goes down under stress. We saw the reverse response with Apollo Neuro – the more that our HRV went up with Apollo Neuro and the more that heart rate went down, the better the performance improvement on the cognitive stressor tasks during the study. This went up to 25% improvement in cognitive performance on a very challenging task, which is basically the effect that you would see with amphetamines on this kind of task.

DrDR:

When we saw that response and it was only with the Apollo Neuro vibrations, it became very clear that this was representative in the EEG back patterns, the heart rate EKG, and the respiratory rate. All of these things were measured in tandem – the pupil measurements, for example – and they all correlated with the same consistent response. We knew there was something going on.

DrDR:

We made 400 prototype devices, sent them out into the real world, and then watched as 2000 people over 18 months tried it. We frequently solicited reports from them and we saw very similar results to the clinical trials, particularly in populations with mental illness. During that time we conducted four more clinical trials. We now have tens of thousands of users in the wild who are consistently reporting similar benefits. We also have nine more clinical trials underway.

DrDR:

Things have really been moving and consistent on all fronts, which is very exciting.

DrMR:

I see that you also have a sleep study underway.

DrDR:

We do. This is a real world sleep trial with wearables because COVID resulted in the shutting down of all sleep labs. So, yes – we do have a real world sleep trial going on right now, which is very interesting. We’ll be sharing the findings of that shortly.

DrMR:

I can’t wait to hear about that. The open label trial with treatment resistant PTSD – I think this has some implications for our audience. Not to say they have PTSD per se, but I see a lot of similarity between those who have had chronic symptoms. Maybe it’s chronic bloating or chronic food reactivity, or perhaps they’ve had mold in the past, and they’re still trying to feel okay in buildings that are new. As an example, they could have a fear that there could be mold and this is where I see a PTSD-like situation. It makes me wonder a little bit more about the PTSD trial and your thoughts overall on what sort of impact the Apollo Neuro device is having on PTSD.

DrDR:

So I can’t share the details of the results with you yet. Although, I can say they are very promising for folks with PTSD to the point where people are having very positive recovery responses using Apollo Neuro. That’s been very exciting to watch and also, to expand into further trials.

DrDR:

I think there’s another part of this that’s really interesting that you brought up, which is the relationship to stress and diet. We know that stress makes inflammation worse and we know that inflammation often makes symptoms worse in many of our many different conditions. Very early on, stress can affect digestion through our gut, what the pH of our microbiome is, and how we metabolize, digest, and break down food; how much food we absorb. There’s so much direct connection to that – to how we feel with our mood and energy levels. In PTSD, the person has suffered either one or multiple intense, meaningful, very stressful, or threatening events over time. This has induced a state of threat in the body, which is perpetual. It’s a state where the body and mind are consistently perceiving threats from the environment – lack of safety from the environment – on a sometimes continuous basis.

DrDR:

When that happens, a lot of resources get diverted directly away from the digestive system, the reproductive system, and the immune system. It also affects the parts of our bodies that regulate sleep, recovery, circadian rhythms, and all of these important features we’ve been talking about that help us to feel good and stay healthy. So, if we can recognize that and work to manage the way we adapt to and cope with stress more effectively, that will in turn reduce our inflammation. This can help us recover from not only PTSD, but also from some of the physical complications that can arise like IBS, depression, and anxiety.

Dr Ruscio Resources:

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Apollo Neuro Usage

DrMR:

I’m curious to better understand the protocols for use. I have the device and the app is very clear cut. You have these seven different modes you can go into – I would use the wake up when I was getting up, but I would use the clear and focused or the rebuild and recover after exercise. Having you here with all your knowledge, let’s take a few different scenarios – sleep, performance, PTSD. Starting with PTSD, is there a certain way someone should be using the device? A certain number of sessions per day? Should they be hitting some of the seven and not others? What does the application look like for PTSD?

DrDR:

It’s a good question. This is the first version of Apollo Neuro that we’re all talking about here. It’s the only version that’s out currently. Although we have many exciting software updates on the way, the device is very much customizable within each user’s environment right now. The best way to understand how to get the best experience with the device is to check out the blog article on our website called ‘How to get the most out of your Apollo.’ As a general rule, I think that article has everything you need to know for anyone who wants to use the device.

DrDR:

Overall, I think these three different populations are good ones to start with. For folks with PTSD – or anyone with a chronic stress-based lifestyle experiencing burnout, constant overwhelm and stress – this is a great protocol to use. Try to use Apollo Neuro to guide structure in your day to day life by starting with your circadian rhythms, which is what we recommend for most people. This is particularly important to people who are under extreme chronic stress, suffering from burnout, or have PTSD. This starts with just setting Apollo Neuro in the morning to energy and wake up or clear and focused right when you get out of bed to get the day started. A lot of people drink less coffee and less caffeine and stimulants as a result of using Apollo Neuro in this way. Then use it on clear and focused throughout the morning and early afternoon to avoid that afternoon slump; to avoid drinking early afternoon caffeine or stimulants. This always helps us get a better night’s sleep. That is the way to start the day.

DrMR:

One quick clarification there. Should I use it during my work day? Maybe I’m working from nine to five – should I use it three times? Once per hour? Is there a certain sort of frequency that you should be hitting with the clear and focused?

DrDR:

You can use it as often as you want. The idea of Apollo Neuro is that, like music, it’s a way to gently nudge your body towards more energy or more calm; a different energy state at any time you need. It’s like turning on a song when you get into your car, except you don’t need a car and you don’t need a speaker because you have the thing attached to your body. People can use it as much as they want. That was a big part of the way we designed it. One of the most common reports is that if you’re a patient with PTSD, you often don’t feel in control of your energy and mood. You basically don’t feel in control of how you feel. This is also the same with kids with ADHD. When you have a pill or seeing a therapist as your only tools to get better, then it takes away your sense of individual autonomy and self-control over your state on a daily moment to moment basis. The whole point of Apollo Neuro was to make something that people can use as often as they feel they need to and let them be in control of it.

DrDR:

You can’t overdose on it. You can’t use it too much. It’s just music, right? That allows people to titrate their schedule to their specific needs. People with PTSD, interestingly enough, will use it all the time. When they first get it, they use it all day until the battery dies. Then they’ll charge it up during a meal or shower or workout. Then, they will use it again at night until the battery dies and then they’ll restart it again the next day. What’s really interesting though, is now that we’ve had this technology on the market for over a year and a half with a year and a half of market research, it’s become very clear that Apollo Neuro is actually training the body. So while many people will start using it all day, every day, when they first get it, they actually decrease their use over time because they feel that – contrary to opioid medication – Apollo Neuro’s effect actually sensitizes the body to its own parasympathetic response like meditation and deep breathing.

DrMR:

That’s great.

DrDR:

So the more that you use it, the easier it is to access those states of mindfulness on your own and the less you actually need it. Do people continue to use it consistently? Yes, but they’re not using it all day, every day. They’re using it three hours a day – spread out at different time points – depending on when they’re feeling a little sluggish or when they’re feeling like they need an extra boost. Three hours a day, five days a week, tends to be the sweet spot where we start to see dramatic clinically significant improvements in biometrics: On average, 4%+ decreases in resting heart rate; 11% increases in heart rate variability;18% increases in deep sleep; 14% increases in REM sleep.

DrDR:

That’s with anywhere from three to eight months of use. We see these cumulative improvements over time with consistent regular use of the technology. It’s the same thing you see with breath work, meditation, regular exercise, or a yoga practice. They induce very similar responses.

Apollo Neuro & Response Time

DrMR:

I’m so glad you made the remark about the time to response because this was one thing I had no idea on. I wasn’t sure if this was kind of an acute simulation where I would see my sleep scores change and my HRV change. I think I did maybe a one or two week experiment. I don’t think I noticed much of a change during that interval, although I wasn’t super detailed in that analysis. Sometimes I run experiments with no confounding noise or as close to none as you can get; sometimes there is other stuff going on and I’m just running the experiment because I don’t want to wait. This was not the cleanest window. Should I have looked at this as something where I re-evaluate on a monthly basis? For clinicians who might recommend this to their patients and they’re trying to objectify how well it’s working, what would the follow-up assessment interval be that you’d recommend?

DrDR:

We have a 60 day return policy because almost all of our customers see response rates within 60 days. There are a percentage of people – probably 30% to 40% – who notice an effect right away. The other 60% to 70% tend to notice the effects over the period of days to weeks. So if you’re an individual, doing N of 1 experiments is fun, but if you’re using a technology like Apollo Neuro, and you’re also changing your exercise routines, your nutrition, or your stress levels, then there’s lots of other things that can throw artifacts into your N of 1 individual experiment. It’s hard because the consumer wearables are just not accurate enough to make N of 1 experiments particularly useful. They can be fun if you’re a data nerd like we are.

DrDR:

If you’re a clinician and you’re recommending a tool like this for someone, you want to track it on a two to four week basis. Ideally, try to get a sense of the individual using it and where they are when they start. This way, they can understand how to relate to where they’re at in two and four weeks. We, like everyone, often have a short memory. We forget what we felt like two weeks ago. We forget how well we were sleeping, what our mood was like, or how we were feeling overwhelmed, stressed, or tired – especially when we’re feeling energized again. Try to take some notes or fill out a clinically validated survey with your clients about how they’re doing at baseline. Then you have something to compare. We see the best response at about four weeks in.

DrMR:

Gotcha. I track my sleep nightly with an Oura Ring. I also do a morning chest strap heart rate monitor HRV assessment with the app called ithlete. I’ve got a pretty good range of where my sleep score oscillates and where my HRV oscillates. It’s helped for me to use this as much as I can. The one thing I wasn’t sure about was overuse or overstimulation. That was one really important question that you answered. Thank you again for that. I’ll use it as much as I can and give myself that two to four week interval until I reassess. So that’s really helpful. For the clinicians – and even for the layperson here – I’m always trying to find other ways of helping people get to this better autonomic balance.

DrMR:

In the past, we’ve discussed some of the limbic retraining programs on the podcast – like The Gupta Program and Annie Hopper’s DNRS (Dynamic Neural Retraining System.) Those are great, but not everyone likes doing this 20 minutes per day (ideally up to about an hour) of this deliberate meditation. Some people are a bit more fidgety or they have more going on and it’s a harder sell for them. That’s where I want to have many options, so we can really personalize the support to the individual. As an aside, I can see this for the population of those limbic and PTSD-like cases.

Dr Ruscio Resources:

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Application of Apollo Neuro – Continued

DrMR:

We left off with the PTSD – wake up mode in the am and clear and focused throughout the day. So take us from there through the rest of the day.

DrDR:

For sure. For the second half of the day, I’ll just use myself as an example, but this is similar for a lot of my colleagues that use the Apollo Neuro. If I have to go work after work – like go socialize or go do something that requires energy and I’m tired – then I’ll always put it on. I put Apollo Neuro on social and open. If I want to go exercise, then I’ll put it on clear and focus before exercise and then rebuild and recover after exercise. When I wind down for the night when I get home, it’s usually rebuild and recover or meditation and mindfulness. Before bed, the award-winning combo is relax and unwind for 30 to 60 minutes during wind down an hour before actually getting into bed and then sleep and renew when you actually get into bed. That particular combination with any of the wakeful frequencies during the day to help offset some of that stimulant use is what seems to be getting the most dramatic benefits in sleep scores in the short and long term.

DrMR:

Gotcha. So it sounds like this is the protocol that’s just the most effective. It’s not necessarily different if you want to improve your HRV, your performance, or improve your sleep. You’re finding this base protocol works well for all cohorts?

Apollo Neuro Personalization

DrDR:

It works well for 90-95% of people, which is pretty interesting. Given the variety that’s available in the current device with intensity and when and how you use these patterns in combination with one another, there are 5-10% of individuals with differences that each user has to figure out for themselves. One of the core things we’re working on as a feature for the next year is really increasing the personalization – getting to know each person so we can give better, more personalized programming recommendations for them; that are more tailored to what they specifically need based on their lifestyles and their stress levels. Like anything with AI, that takes a little bit of time.

DrMR:

Sure. One of the things I’m reminded of is a conference I just got back from this weekend. There was an exhibitor hall there. One of the things I struggle with is when there is a similar device as this and they’ve got 30 different protocols. My thinking is – there is no way all of these have been assessed. It’s not easy to get data; to have multiple people run the same protocol to get enough of a sample size to know that you have some signal as opposed to just background noise. So, I’m totally there with you in the sense that start with a core protocol to kind of validate. Then from there you can personalize and individualize. One of the things that concerns me is some of these device companies seem to go way too into the weeds before they can even validate a core model. I’m on the same page with you in that regard.

DrDR:

Yes. I think there’s a lot of stuff out there right now that is questionably researched. It’s unfortunate because it’s hard for the average person to figure it out on their own. However, there are a lot of exciting technologies coming that will get proven out in the market just by the nature of the way things are going. People will start to see what is actually having the biggest difference on their outcomes.

DrDR:

Gradually over time, more studies will be coming out showing improvements on health, overall wellbeing, and different metrics we can measure the in real world. Some will be in university trials and some won’t. It’s a very exciting time for science right now in particular. It’s a good time to be in the field.

Apollo Neuro as a Psychologist’s Tool

DrMR:

Yeah. To your earlier comment about the field of psychology – I don’t think they have the best tools in their toolkit. I think that that’s an area where I’m sure providers are saying, “Well, we wish we had more.” Devices like the Apollo Neuro seem like a really welcomed additional tool in the toolkit.

DrDR:

Yes. Particularly given the low side effect profile, at least as far as I’m concerned as a psychiatrist. Most of my colleagues have the same concept. Most of our medicines that we prescribe to patients have a very high side effect profile. They commonly cause anxiety in the short term of the early four to six week timeframe. They take four to six weeks, on average, for many of the anti-depressants to even work in the first place or to notice benefit. In that four to six weeks, you can have anything from increased suicidal ideation to anxiety to restlessness, to a decreased ability to orgasm. That can persist afterwards. When you really think about that side effect profile in an anti-depressant or anti-anxiety medicine, it forces us to think a little extra. Is this something we really want to jump on in the beginning to prescribe to somebody? Or do we want to spend some time trying other stuff first before we start using medicines that could have these side effects for a person?

Episode Wrap-Up

DrMR:

Well said – I fully agree. Where can people find out more about the device? If people want to learn more, where can they plug in with you?

DrDR:

You can find out more about Apollo Neuro at apolloneuroscience.com or apolloneuro.com. You can also find me at drdave.io or apollo.clinic, which is my personal clinical practice website. It’s also a way to get in touch with me. You can follow me on Twitter @DaveRabin and on Instagram @drdavidrabin.

DrMR:

Awesome. Any closing thoughts you want to leave people with?

DrDR:

The main thing I want to leave people with is that regardless of how we want to think about healing, healing is at its core the restoration of balance in our minds and our bodies. This includes our emotional selves and our spiritual selves. It’s all of us – balanced across the whole board. If we neglect or ignore any part of ourselves and the process of healing, we will not achieve that balance. If you’re somebody who hasn’t ever been taught how to meditate, deep breathe, practice mindfulness or yoga, go pick up an Apollo Neuro. See what it feels like to access one of these states of flow and these deeper states of your own consciousness; to feel in control of your energy and your mood. Use the Apollo Neuro as a tool to teach you how to access these states on your own.

DrDR:

The whole goal of healing is to not be reliant on the device. It’s to not be reliant on us – the healers or the system itself. It’s to really use the tools at hand to teach ourselves how to take healing into our own hands; to be in the driver’s seat of our own healing experience. We can do that at any time by recognizing the power of the words we use to describe ourselves and by recognizing the power of these emotional skills – self-gratitude, self-forgiveness, self-compassion and self-love. They are at the core of all ancient and modern psychological healing practices and therapy techniques, which is really interesting. Self touch, breathing, soothing music, meditation, yoga, eating healthy, and getting exercise are all part of that picture that can help restore and maintain balance over time. It can really help give us the best chances at fulfilling, joyful lives.

DrMR:

That’s poetically said. I really agree – many phenomenal points there. I really appreciate what you’re doing, David. This device has really piqued my curiosity. Having a chance to pick your brain has made me even more excited to self-experiment and then potentially start experimenting with this in the clinic. So, I appreciate the work you’re doing, your dedication to the science, and giving people another tool for helping to improve their health. Thank you again. It’s been a real pleasure chatting.

DrDR:

Likewise. Thanks so much for having me.

Outro:

Thank you for listening to Dr. Ruscio Radio today. Check us out on iTunes and leave a review. Visit drruscio.com to ask a question for an upcoming podcast, post comments for today’s show, and sign up to receive weekly updates.

 


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