Episode 58: Beyond a Simple Sleep Tracker ft. Petteri Lahtela

As wearables increasingly rise in popularity (the market is expected to double in 2021), users will have to choose carefully what device they want to invest in and for what reason. You only have enough human "real estate" for one smartwatch, for one pair of smart glasses, and for one set of smart earphones. A wearable must rise above the competition to provide real value to the end consumer, and the Oura Ring aims to do that. 

Petteri Lahtela, the CEO of Oura Ring, joins us this week to share the cutting-edge technology behind the ring and its implications beyond sleep. Is one finger really a better sensor point than the entire wrist (ala Apple Watch)? What else can heart rate variability tell us about the performance and state of our bodies? How can we use information from multiple biosignals to optimize sleep? We discuss and ponder over it all in this hour-long episode.

We're giving our listeners a time-sensitive discount on the Oura website!

  • You can save $100 off your order by putting in the code "HVMN" at checkout.
  • This offer ends 3/12. After this date, you will be eligible to receive $50 off your order.

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Transcription

Geoff: Hey listeners. Welcome to this week's episode of the HVMN Enhancement podcast. I'm really excited to have Petteri Lahtela on this program today, and I'm really excited to talk to him because he is a founder and CEO of one of the hardware products in the biometrics, bio-hacking space, I think is the most compelling, and that is the Oura ring. It's a really sleek long battery life, heart rate variability sleep tracker activity tracker device. And I think it stands in comparison very, very well to lot of the sleep or activity trackers that you might commonly see out there. Before diving into that, let me just introduce the guest. Petteri, great to have you on the program. 

Petteri: Great to be here, it's really a pleasure. I've been expecting this.

Geoff: We're on a ten-hour difference. We're based in San Francisco, and you are currently in Finland. 

Petteri: Yes.

Geoff: What's ... I guess ... I had some Finnish friends, and it's always the weather and the lighting there is always interesting. Is it half-dark all the time. What season is it over there now?

Petteri: Yeah, it's mid-winter now, so it's basically coldest season. And we only have, let's say, a few hours of light during the day.

Geoff: Yeah.

Petteri: In the shorter, let's say, darkest period of the mid-winter it's only couple of hours of light during the day, but now the days are getting longer and longer. So, it's good time to work, concentrate on working because it's dark outside.

Geoff: Yeah. Yeah, that's always been interesting. It would be weird if you were just sitting in dark for 24 hours a day and then you have to just use artificial light to understand what's going on.

Petteri: Yeah.

Geoff: But anyways, before we digress ... Hardware. What's your background? Hod did you get into the space initially? What's your story? 

Petteri: Yeah, first, 14 years of my career I was in the context of telecoms. I was in a small company that we developed first pc-based protocol monitoring tool for mobile metric testing. And we pioneered at the GSM monitoring and 3G and later on the other. So, from a small company of few people we grew a market leader into two product categories, a global market leader into product categories. And that was a really good way for me to learn about how to develop high-tech product and take it to the international markets. I ended up doing business in more than 30 countries, doing sales and marketing and also establishing distribution networks in Asia, Europe, US, and meeting lots of people everywhere. 

That was, let's say, not only from the career perspective but also my personal life experience perspective. It was a huge thing for me to learn so many things. But then, eventually I got tired on mobile networks, and I didn't find meaning behind, so I wanted to turn my meaning, kind of doing and use my energy on something more meaningful like on this human wellbeing, human health and performance. It became my big driver in 2004, 2005. 

Then I joined a company where we developed IT systems for chronic disease management, prevention. That was a good school for me to learn about how our body responds to our lifestyle, really, and dig deeper into that understanding that if we don't keep the balance and we reload and recovery, then we end up developing some chronic disease, and then it's really hard to turn that to your health situation. So, it was a good way for me to learn and discuss or learn from the best experts in the world. The majority of all customers were London healthcare Trusts and hospitals, doctors there, and also elsewhere in the US and Japan and elsewhere in the world. 

It was a huge thing for me to learn in that context. And actually, I got the first ideas for this product in that context. It became a thought, said, "okay, what we could provide to individuals so that they could in a very easy way learn about how their body responds to their lifestyle?" And then, they could avoid the symptoms of prolonged stress, but also, they could prevent the onset of chronic disease. That was my take into this thing. And then we combined all these different years and started to explore with different ideas of the product and we already knew we had this experience with polar products and basically all the variables in the market measuring your health condition. 

Eventually, after doing plenty of prototypes, we found out that from the finger they could get the most relevant signals, so very powerful access, an accurate access to pulse waveform-

Geoff: Which is very counterintuitive. I remember the first time I approached your product, it was ... Most products out there are wristwatches-

Petteri: Yes, yes, yes. 

Geoff: ... like an Apple watch, and it seems intuitively that the wrist has so much more blood vessels. It's a lot bigger size. The sensors on the Apple watch, if you flip it around, there's like multiple lasers shooting green light into you. How is such a small tiny device with the Oura ring ... I was using all weekend. I misplaced it somewhere, and I missed, it so I need to find it ... but the sensors on the Oura ring are so much more tiny. How do you explain that you can get as much data or better data than something on the wrist?

Petteri: Yeah, actually-

Geoff: Or how do you decide to on the finger as the area?

Petteri: Yes, so we actually rewrite the software on pulse oximeter that is used in hospitals to measure your vital signs. And from there we learned that okay, from the finger, actually, we can get really strong pulse waveform signal.

Geoff: Right, I don't understand what a pulse oximeter ... It's basically the red lights that you clip onto your finger, right? And measures your oxygen and some of the other biomed markers. 

Petteri: Yes, there's infrared signal and there is red LED, as well. So there are two different wavelengths used, so that they can get the blood saturation, oxygen saturation measured, as well. But also the pulse waveform. So, we saw that the signal in these arteries that we have ... We have two arteries on each finger on the palm side, so we can get access to them directly in a comfortable way. 

That is a big thing. If you want to have continuous data in an accurate way, it must be very comfortable to use. So therefore, ring is one of the oldest wearables in the world. People have worn them hundreds of years, maybe thousands of years. Then, by having the right kind of sensors, infrared sensors that we can access through the skin and through the flesh to the arteries directly, then we could get access to the pulse waveform very accurately, and then even do the pulse waveform variation, the pulse amplitude variation, which is modulated by breathing rates and also your blood pressure. 

So, now we are not talking anymore about having your average heart rate per minute, which normally is the case with these devices, so they estimate by sampling it. But we measure every beat at a time between the heartbeats and then pulse amplitude variation. And from those we can derive lots of insights about the whole pulse waveform characteristics. 

Geoff: Right, so how do you have so much more power in such a small device compared to something like a watch that is much bigger?

Petteri: Yeah, so first of all because the pulse signal is so much stronger here, so-

Geoff: As contrast of basically bone on the outer side of the wrist, right?

Petteri: Exactly, yes. Exactly, and it's a much more targeted signal, because it's in the small space here, and there are two arteries there. And also, there are those small pumps that are kind of lenses. And then we can target the infrared signal very directly to the artery and then get good reading of the pulse waveform. So it's also that the ring stays on very in a way that it doesn't disturb you at all. If you just turn your hand or turn your finger, it doesn't turn in any way, it stays there. And the connection to the skin is so good. So, that is the big difference there.

Also, that allows us to manage the power in an efficient way. If you compare to any other device, not even wrist devices but also other devices, this new ring it measures the continuous pulse waveform and the variation of the heartbeats around 14 hours per 24 hours, 14 hours of a day, and it can do it in the continuous basis for up to seven days with one charge. 

Geoff: Which is massive ... I mean, as we all know with wrist devices, you got to do that every night and it's annoying.

Petteri: Yes, exactly.

Geoff: And I think if you can ... If it's a week-long battery that was a huge game-changer for me. 

Petteri: Yes.

Geoff: 'Cause you can set it and forget it. I think the worst thing with technology is like, "Oh, I got to recharge it," and I think with a wrist device like an Apple watch, which I also have, it's like every night you've got to charge it or decide you want to put it for your sleep tracker. And you can't do both. And it's annoying. 

Petteri: Exactly, exactly. And also, that the sampling rates in the wrist devices they take maybe few samples per minute or a few samples per second or it varies between devices, but still they don't take continuous reading of your heart rate, the pulse waveform at the time between the heartbeats and so on. This ring does it in ECG level. We have validated it against the ECG. So the heart rate is 99.9% the same as ECG, and it's heart rate is 98.4%, the same as ECG.

Geoff: And ECGs are essentially gold standard, what you have in a hospital. 

Petteri: Exactly, exactly, yes.

Geoff: Yeah.

Petteri: Yes, and from there we can derive the respiration rate, breathing variance, and different ... This amplitude variation actually is really important for sleep staging. So that is the reason why we get deep sleep, light sleep, REM sleep, deducted so accurately.

Geoff: I want to talk a little bit about your algorithms there, but before that I really want to contrast your approach with the approaches that, essentially, every other wearable product has gone after. It seems so obvious, after the fact that ... Okay, most people that are building watches are using much more power to detect something that has a lot less signal, and it's a lot less accurate. Why have they gone down the road of going on the bony side of the wrist. I have heard some discussion that the original Apple watch wanted to put the sensors on the strap-

Petteri: Yes, exactly.

Geoff: ... and put it on the bottom side of the wrist, where there is a lot more arteries and blood there. 

Petteri: True, arteries there. Yes. 

Geoff: It seems like you and the approach with Oura is that you design the form factor and function very seamlessly together where wearable manufacturers on the wrist have gone for the form over function. If you actually went for function, you would have sensors on this wrist strap. Can you expand upon that?

Petteri: Yes, I think one of the main reasons for that is that when we started developing the solution, we first defined the use cases, so meaningful use cases from the end user perspective, and actually it ended up being very, very important for us because it helped us really do big decisions along the way when we were developing the hardware and software and eventually towards the end product, even the app, as well. We always go back to the use cases, that okay, "we are solving this use case, and this is what the user wants to learn with the product," so we follow that very rigorously and wanted to realize those. 

So I think that is the main thing that many companies ... they have missed that part, and just put the sensors into the device, and "okay, it can measure this and that," but they don't think that "okay, what is the real use case for the end user? What is the benefit?" And then, the benefit is driving us to find always the best choice to read that target. So that drove us, also, to select finger, select ring form factor, and then made us or forced us to make it comfortable to wear because we wanted to access to the longitudinal data, not only access one day or three days, but really long months and years of data. So I think that is the main differentiator.

Geoff: I want to dive into the algorithm and how your data is more accurate. Given my experience, I've had a chance to wear it for a couple of weeks now, and I was actually doing some experiments where I measured how the Oura ring was tracking me versus an Apple watch at auto-sleep, was one of the top-rated sleep tracking apps on the watch. And I knew I had woken up in a specific night, walked around, went to the bathroom, etc., and the Oura ring picked that up, and it showed when I was awake or in light sleep in various parts of the night, whereas the Apple watch, auto-sleep app, just didn't show that at all. It was just showing you light sleep, deep sleep. 

So, again, from my very non-scientific n=1, a couple of night experiment, seemed like the Oura ring was much more accurate than an Apple watch app even though it was running continuously shooting green lasers unto the back of my wrist all night long. Specifically ... why it was much better? I mean, was there some gyroscopic motion that could detect that I was up and moving around? Or did my heart rate go up and then I woke up? Can you give some insights on the differences there?

Petteri: Yeah, the biggest difference is the pulse waveform variation, and also that we can derive the breathing rate from the inter-beat interval, so the time beat within the heartbeats we can derive your breathing rate and breathing variance. And also, from the amplitude variation we can deduct it, as well. Breathing actually it correlates very much with the different sleep stages, as well as your heart rate, and the heart rate variability. So, all of them have certain kind of characteristics in different sleep phases. That comes from the interplay between the autonomic nervous system and the central nervous system. Basically, your brain and heart, they have continuous discussion, and the autonomic nervous system is one of the things that is assigned to that. 

So, we captured that kind of discussion between the brain and heart, and the heart is expressing through the autonomic nervous system. It's expressing there, hearing the peripheria from the pulse waveform and the pulse waveform characteristics. It's expressing what's happening in your brain.

Geoff: Interesting, and do you collect that data yourself? This seems like relatively novel data sets. How did you come with the algorithms that translate heart rate, heart rate variability, interval between heart rate, and then correlate that to breathing and sleep stages?

Petteri: Yeah, that is one of the most clever products of developing the products. This coworker who came from Polar, he collected the data from the sleep lapse, so the finger data and the evolution of the data and found the correlations between those signals, those bio-signals. So combining the oximeter signal, so all the movements, and then all the characteristics of the pulse waveform and heart rate, breathing rate, and heart rate variability so it gave ... Through that process he selected certain set of characteristics for each sleep stage, and had the algorithms going through over the night and correlating to the polysomnography continuously, so that's the way how we also did the validation later on. Also, that Stanford Research Institute did completely independent validation. They actually vote to only two rings from the Kickstarter campaign, and they ran a completely independent study of more than 40 young adults. And the results where really good, so they were surprised to see how accurately the ring can detect different sleep stages from the finger.

Geoff: Yeah, no, it seemed very impressive. And it's impressive that ... I think it's commendable that you don't dive into calling as much ... it is essentially the machine learning for transiting HRV into sleep stages-

Petteri: Exactly, it is.

Geoff: ... but I think it is commendable that you're not out there necessarily hyping up, dropping buzzwords of AI machine learning, but essentially you guys have built a machine-learning algorithm to learn the characteristics of HRV, which is one single signal and some of this can take from that in the transit of many downstream effects, which is very cool.

I think that some of the ... From an athletic perspective, as we're diving ... our communities, looking at both athletic and cognitive performance and metabolic performance, HRV seems to be one of these metrics that is implicated in so many downstream endpoints. 

Petteri: Yes, yes.

Geoff: HRV ... more and more people are using it as a signal for recovery to decide how heavy a workout they should be doing the next day. It makes sense because it is a reflection of the person's sympathetic system. It's kind of like of your ... It's just interesting. Could we speculate here why is this one kind of arbitrary, if you will, measure of the heart implicated, is so important that it can inform us on so many different parts of our day?

Petteri: Yeah, it is one of the important signals, but there are also others. But if we concentrate first on the HRV, something that I'd like to mention first is that it is, as you know, it's very sensitive to whatever you do. If you measure it randomly during the day, it gives you really random results, as well. So the context where you measure HRV must be kind of set, kind of a standard time slot or a standard protocol when you measure it. 

And also, as you know, in many applications, people tend to measure the HRV for the first five minutes in the morning, when they wake up, but what we learned is that it's much more accurate if you do it over the night. So, actually, the ring measures all the time every beat and the time between the heart beats, and then it derives for every five-minute clock it derives the HRV figure. Then it gives you as a trend, between the days, it gives you how it's trending. So then it's kind of a most accurate way for you to use it as ... giving you a direction at how you're autonomic balance is reflecting to what you do during the day.

And also, not only yesterday, but also the previous days. So, how well you are recovering from the load that you had, whether it's mental or physical or cognitive or whatever. But from the body's perspective, it reflects that balance. 

Geoff: One thing that I was interesting with HRV was that it's counterintuitive that you want more variability between heartbeats, which seems to be ... When I first learned that, I thought it was counterintuitive. You want to have a stable heartbeat. Why do you want more variability? So, to be clear, the more variability, the more recovered you are. 

Petteri: Yes.

Geoff: The less variability, the more stressed or... more under strain your body is. 

Petteri: Yes.

Geoff: Can we tease into that?

Petteri: Yes, and also, what is important to remember that we are all unique. Each one of us, we have our own capacity. If you think your autonomic nervous system as a water bowl, for example, then you have your own capacity. The amount of energy in your body is reflected there, as well. We are unique in that sense that what is the dynamics, the capability of our autonomic nervous system to serve you as a very dynamic source of energy in certain situations. And also, how quickly it can recover through the balance. Each one of us, we need to find our own level and also, how we can get the HRV higher, so see the trend, how it's trending, and then see what helps me to get higher HRV. So, what kind of exercises? What kind of rhythms? How is my sleep quality? Do I recover enough from what I'm doing? 

And also, it goes along with your capacity. So, how much of energy you have for the day, when you wake up in the morning. All that is reflected through the trending of your HRV.

Geoff: And I think that just scoping out a bit here, I mean, I think that's one of the interesting things with ... I think the broader community around applying engineering principles to the human platform, people might call it bio-hacking or quantified self, but I really look at ... Something that we as humans we do is, we make very precise inputs into the body, and I think companies like yours, you're tracking very quantifiably the outputs, the markers that we care about the body. I think in some future state of humanity, it makes sense that we can very much tune the inputs, whether that's something that you could eat or consume or the exercise, you fast, or your sleep protocol, exercise protocol, and really control the outputs. And I think you really need both parts to really have this type of feedback loop circle. 

Petteri: Exactly, exactly.

Geoff: And I think HRV and some of the metrics you track are very important. I think some other markers, I imagine, will be super important, will be things like fasting blood glucose, blood serum ketone levels. I'm curious, what are the key things that you track today and then, for gen 2, but ... What is gen three, gen four ... What are the key things that you track today? And what do you think are interesting things to track in the future?

Petteri: Yeah, one of the, let's say, very differentiating thing we measure in addition to having a gyro and 3D accelerometer and this pulse waveform and HRV, those things, is the body temperature measurement. So the ring measures actually in the thermometer level it measure the body temperature variation between the nights. In 0.07 degrees centigrade resolution you see ... It's like sleeping with a thermometer every night. And you know, your body temperature also is a way for your body to reflect how it is reflecting to or responding to your lifestyle, so what you eat, and what time did you eat, what kind of food did you eat, how is your sleeping protocol, how it's recovering from exercise, and so and how your internal organs are operating. It tells actually about so many things, but also, especially for women, the ring measures also your menstrual cycles, so it shows-

Geoff: Hm, that's what I was about to ask, yeah.

Petteri: Yes, so it also kind of reflects your hormonal balance, and it helps the female athletes to optimize their exercise so that for example, strength training is better to do in a certain phase of the menstrual cycle and so on. So that then they can really utilize all that power that they get from the hormonal situation in that certain phase, and then-

Geoff: Also, probably use it for fertility, as well. Right? I am sure, also it correlates in different parts of the cycle, yeah.

Petteri: Exactly, exactly. And then also, that they can avoid the over training, as well, when they are aware of the phases. So I think that is one big differentiator. There is no other wearable device or any other device that you can actually get your body temperature reading every morning, the variation of how it's changing over the time. 

And then, another thing is, when you combine these things together. You're seeing your resting heart rate curve as a trend, your heart rate variation as a trend, also, your body temperature variation as a trend, your breathing frequency variation. What we have learned is that, for example, when you are recovering from illness, what can happen ... and we have many of these cases ... When you are recovering from the illness your resting heart rate will come down first and then your body temperature will come to the normal level, but they are cases that the inflammation in your lungs can stay there still for two weeks or even longer, so your breathing rate during the night is much higher than normal. It means that the inflammation is still there. You can't return to your normal exercise routines or otherwise you can ruin everything you've done for the previous few months, even years. That's something that when you combine many meaningful bio-signals as a long-term trend, then it adds that kind of value that you can't get in any other way.

Geoff: Absolutely, at some point you want to simulate, essentially, and project forward the full human state, and I think our job is to decide what are the most important signals and then build meaningful protocols around them.

Petteri: Exact;y, and one example of this is what we are coming up with this generation two ring, is that we can really personalize the guidance to you because we can also detect your chronotype and your circadian alignment based on your chronotype. So you know based on Dr. Michael Breus there are at least four different chronotypes, and he names them according to mammals, so lions, bears, dolphins-

Geoff: Right, yeah, yeah, I've seen that. I see people say, "I'm a lion sleeper," or things like ... what you're talking-

Petteri: Yeah, exactly, so basically everyone have heard about morning persons and evening persons. Each one of us are also unique in that sense that we have our internal clock and you can't change it, basically, so it's better to adapt to that and then find out, "Okay, what are my optimal rhythms for my day? What is the optimal time to go to bed? What is the optimal time to wake up?" And then for the exercises, high intensity exercises especially but also for the mental work and that kind of stuff. Also, what are the best mealtimes for me? It connects to your metabolic rate, as well. So if you combine your DNA information then you can understand it, "okay, in the evening my metabolic system cannot handle protein or some other food so well. So, it's better for me to eat this kind of stuff-"

Geoff: Yeah-

Petteri: My diet is-

Geoff: No, absolutely, I want to double down on that. I mean, there's a lot of new data emerging around circadian rhythms. I think when people talk about intermittent fasting periods, there's some discussion. Do you want to, not skip breakfast, eat like a big late dinner? Or do you want to skip dinner, eat a big breakfast? I think there is some personalization there where, I think, a lot of the existing data is so confounded because we have every phenotype is thrown in there. You have lion and dolphin sleepers and all ... you know, morning and evening people. You get noisy signals, and you say, if you actually type people's actual circadian rhythms and then put them on protocols, you get more meaningful data.

Petteri: Yes, exactly, that's our finding, as well. I'm doing intermittent fasting myself, and-

Geoff: What's your protocol? I'm fasting today. 

Petteri: My protocol is that I normally don't eat anything after 7 p.m. in the evening, and then I'm fasting until the noon the next day.

Geoff: Okay. 

Petteri: That's my normal ... and very easily I can continue from that without basically eating anything before.

Geoff: So, you've got 15 or ... 17/7 sort of-

Petteri: Yeah, yeah, something like that, yes, yes. 

Geoff: Interesting. 

Petteri: And it works for me very well because I'm used to do longer fasting, and so sometimes even zest water fasting for three to five days easily. So, the intermittent fasting, I find it really useful for me, and it's sometimes hard for me to understand why it's so difficult for some people. 

Geoff: Yeah, I did a seven-day fast about a year a go, just with water. I mean, the longer fast I can see how it's very intimidating at first, but yes, and I think like a 

16/8 or 17/7 is quite manageable. I think you just need to decide to do it. I think people don't have the will power, the social structure around them to realize that this is like not unhealthy, this is reasonable, this is actually science and evidence backed. 

Before, I want to get your thoughts on future signals. I think obviously there's some really compelling signals and there's very good reason why you have the existing signals into that, the gen 1 and the gen 2 product. How about ... again, pie in the sky, if you had infinite resources and infinite ways to pack big sensors into small things, what do you think are the small interesting things to track in the future?

Petteri: Yeah, of course, since I have a background in chronic diseases, of course there's blood glucose variation. That's something that would be great if we would understand it better because continuous blood glucose monitoring hasn't been there for so long. We have users. We have doctors who are continuously doing that and they are correlating it with Oura ring data. They have found very good correlations between readiness score and this long term fasting glucose. So, we are continuously doing that work and kind of trying to find a meaningful way to provide that understanding, that if we can get into the blood glucose reading without actually getting your blood. That is something that we are building correlations for and it looks promising.

Geoff: Yeah, that would be ... I think just to add color to that, I wear a CGM often, and it's so important for metabolism to understand your blood glucose, and it's super important because, again, it's how you diagnose type 2 diabetes. And then, that's ... A third of Americans are pre-diabetic or diabetic, and like 80% of the people are pre-diabetic don't even know it. So I think it's definitely one these important measures and there are so many different efforts to attack it. 

One thing also that I thought was interesting is, can we correlate it intuit it with non-invasive measures, 'cause when I wear a CGM, you have the little needles sticking into your arm. 

Petteri: Exactly, exactly.

Geoff: It's not that annoying. I find it non-intrusive, but I don't know if that's going to be acceptable for everyone. I realize I'm a little bit out there.

Petteri: Yeah, yeah.

Geoff: It's like you've got a little disc in your arm, but I would much rather wear a ring. 

Petteri: Yeah, my view is that it's too intimidating for the majority of people. So those who are in the face of prediabetes, they don't want to do that. And also, that it is a combination of many things. It's not only blood glucose value that helps you to understand what's happening in your body, but it is strongly correlating with kind of a long term balance or imbalance of your autonomic nervous system. 

You have to understand that what is your capacity and how you can live your life maintaining the balance between load and recovery, so to me it's more meaningful to have this long-term perspective that for me, as a unique human being, what are the most meaningful bio-signals that help me understand this long-term perspective? How my eating habits, my exercise habits, different protocols, how restorative sleep I get? I'm always willing to go deeper into the understanding more holistic way, not only kind of tie my thinking into one specific signal, but combine it with many other signals and having a long-term perspective, so then it gives more understanding that "okay, what is causing this situation? And how my body is responding to different things." Because it can be so many things that cause that imbalance that leads to pre-diabetes.

Geoff: Sickness, yeah, or-

Petteri: Yes. 

Geoff: I think that's the way more people and more people will look at healthcare and medicine, 'cause I think you're speaking with a lot of doctors that have been on this program, and a lot of the institutional setup for medicine is find a specific number, one signal that is wrong, and then, give someone a drug to bring it back down or change it. I think it sounds like you're an engineer by training, I'm a computer scientist by training. The human body is a very complex network of systems, and it's very rarely that in a complex system you nudge something down that you don't cascade across a number of different effects. I'm sure there's doctors out there listening, realize that, yes, they agree with that. I think having more metrics that inform a practitioner or the patient, how these things manipulate when you do an intervention adds more data, adds more power and treatment or a routine for general health and wellness. 

Petteri: Yes, and also, exactly, in the context of blood glucose, I'm more interested in finding out the correlation with other signals so that I can get the understanding of how actually it should change because it is not stable signal. Again, it's like HRV, it's not stable. It is continuous variation, and it's the same with blood glucose, and also, it's the same with blood pressure, as well. So, we don't actually know how our blood pressure should be varying during the day, during the 24 hours period. 

What we see from our signals, from the pulse amplitude variation, which is ... that one of the modulators is blood pressure. So we can see the big trend is there over the night and so on different sleep phases and also when you wake up in the morning. It's a continuous interplay between your hormones. Your hormonal balance is affecting your blood pressure, your resting heart rate, because you need to be able to perform physically or mentally in different ways during the different times of the day. Your body is ... After you wake up in the morning there's a high peak in the so-called stress hormones, so that you really wake up.

Geoff: Cortisone, right?

Petteri: Yeah, cortisone and testosterone and so on, so that you really are ready to wake up. Literally your body wakes you up to be prepared for doing something, basically finding food. Your body is driving you to find food to eat and then get energy from that. And then, in the evening melatonin hits you to know your brain down so that you're prepared for your sleep. It's a continuous interplay between hormones, and blood glucose is one of the hormones that you can affect with your intentional protocols of eating habits, your sleeping rhythms, your exercise routines, and so on. So therefore-

Geoff: I think you missed but glucose isn't a hormone, but yes, it is affected by insulin or other hormones.

Petteri: Exactly, exactly.

Geoff: ...it's a biomarker and it's affected.

Petteri: Exactly, yes. So, insulin is affected ... what we can affect with our intentional protocols. 

Geoff: Yeah, I think that sweetest centers, I think it really is affected, and I think it is cool to see how you guys could actually predict or measure when one falls asleep. I think one of the cool things with the ring, the Oura ring, is that it seems to be ... I'm not checking my phone and measuring when exactly I fall asleep, but it seems pretty accurate in terms of how one is able to do that. And I guess, I presume it's intuitive through a change in all the different measures or all the sensors that you guys have.

Petteri: Yes, actually, body temperature is one of the things that when we just lay down, it's in our biology that the blood pressure is evenly kind of distributed in the body, and then also, that the core body temperature is pressed out to the peripheria, so your hands and feet get warmer. That is a basic function to build in into the biology, so that you can fall asleep. 

Geoff: Interesting.

Petteri: And some people have problems falling asleep if their hands or feet are cold... if they're too cold, so they can't fall asleep. So, you can help falling quicker asleep by warming up your hands and feet, so then you help your peripheral blood circulation that ... so, that is one of the signals that ... there's big difference there than when you lay down and go to sleep. Melatonin is hitting and that causes this to happen, so that the core body temperature, so your core body is cooling down and the other peripheral-

Geoff: - by warming up.

Petteri: ... it's warming up, yes. And then, there's a big change in the heart rate and also, heart rate variation and creating patterns. So many things change when you go to sleep and start falling-

Geoff: The transition.

Petteri: Yeah, the transition. And of course, movements. There is no movements, that kind of stuff, so all those combined, then you can find the characteristics that is interesting in different phases.

Geoff: One thing that I wanted to ask you about was the approach to having the Oura ring being very passive in terms of the [inaudible 00:45:18] data. Was that an active choice? What I mean by that is that you have the Oura app and you have the ring on your hand. You can't necessarily query the ring to pull up data, like, "I want to see heart rate now."

Petteri: Yes ... yes, yes.

Geoff: ... but one could imagine that that would be interesting. Like, "hey, I want to see my temperature right now. I want to see this right now. 

Petteri: Yes, yes.

Geoff: Was this a design choice? Was it a technical limitation? What is your thinking between passively servicing information versus actively doing so?

Petteri: Yeah, it was, again, a use case choice. We wanted to concentrate on the core use cases to get the most meaningful bio-signals, and therefore, we also wanted to make the ring as a standalone device, so that we can limit the Bluetooth connection to the mobile, so that actually we made the ring as a full-featured computer with enough processing power and memory to work standalone, so it doesn't need your mobile. The algorithms are not in the cloud, they are in the ring so that we can limit the Bluetooth connectivity to the three minutes per 24 hours and only transfer when it's necessary to follow visualization of the data. So that was one of the reasons. But also, that when we do it that way, then we can refine the data inside the ring, so we can only transfer the kind of processed data to the mobile phone. 

So whenever you stream the data, it's also possible to stream the data, the heart rate, heart rate variability and the movements and so on, it's possible to stream. Technically we have that possibility, and we have done some demonstrations showing in real time data. We have an engineering view in the app, not available for the users currently, but maybe in the next phases with gen 2 it will be there so that you can measure heart rate, heart rate variation whenever you want, especially in cases ... Again, for the daytime measurements we are thinking from the use case perspective that what helps you to add understanding about your recovery or readiness level, so then we concentrate on measuring automatically like naps and that kind of restorative periods during the day, your meditation sessions or relaxing exercises or whatever contributes to your readiness or your recovery protocol. We concentrate on those, but also allow the user to measure whenever they want, for example, after the exercise, if you want to see how quickly your heart rate is going down after the exercise.

Geoff: Yeah, I think that's smart. Sometimes I want to be active and ... you have an Apple watch, and you can say, "I want to see my heart rate now," but I can also see, from the user perspective, sometimes I just like not having to think about the device on my hand. I think the cool thing with the Oura ring ... I think, the gen 2, it just looks sexy... it's like a cool-looking product, and I think people don't think that it's like a bio-hacker computer on their hands. So, I think it is like this interesting trade-off.

But yes, I think one of the things I like to measure when I'm in a hot sauna, for example, is to just see my heart rate and get to the point where I realize I'm pushing the limits of my ... when I'm laying in the sauna, for example, and having an active view for a very specific use case. Would be interesting to unlock that functionality for more advanced users or whatnot?

Petteri: Yes, yes. We gen two there is much better possibility for that because the power management has improved. It's 10 times longer or 10 times better and the processing power is bigger, so with this one it's possible to do that. As I said, we can do continuous heart rate monitoring, and it includes every beat and the time with the heartbeats for about 14 hours per day for 7 days with one charge. So, then there's not only all night but also during the day there is several hours of continuous measurements, not sampling every minute. It may be between every ten seconds or something, but every beat and the time beat with the heart beats and so. It's big difference.

Geoff: As you know, I've been playing with the Oura ring for the last couple of weeks, and posting some photos with it on social, and a lot of people have been tweeting at me, being like, "when is it going to be available? Is that gen 1? Gen 2?"

Petteri: Yes.

Geoff: Yeah, what are the product details? When can people get gen 2? I know it's been on pre-order for a few months now. When do people get their goods?

Petteri: Yeah, we start volume deliveries in April. we have customers already in more than 50 countries and pre-orders from more than 50 countries. About 60% of them are from the US. California is the biggest area where we have users. We start deliveries in April, but I need to mention that they are already ... So big number of those pre-orders that not all of them will be delivered in April. It'll be May and so on, so we've been really, let's say, successful. Especially, our current users have been helping us find new customers 'cause like the conversion rates from the referrals from our existing users, can you figure how big the conversion was?

Geoff: What? In terms of referral? I will just guess.

Petteri: Yes, from referral to order.

Geoff: 30%. 

Petteri: 70%.

Geoff: That's ridiculous. That's insanely-

Petteri: Yeah, it's ridiculous.

Geoff: ... that's ... I was going to say ... I knew it was going to be high, otherwise you wouldn't brag about it, but 70% conversion rate per referral is insane. 

Petteri: 70%, and that tells about how committed our users are. That is supported ... Our long-term retention rates are also two to three times higher than any other variables. 

Geoff: Congrats on the process. I think any last thoughts here, it sounds like we've covered the broad gamut. I like that we started from a very holistic approach and all the different skills that come to bring the Oura ring into place from the hardware to the design, from the business side, the distribution side, the use case side, down to what I think were some of the interesting insights, then to the advantages to the form factor. 

I think, again, it seems silly, knowing a little bit more about the specific hardware state that people are focused on the form so much that it makes the function really hard to use. Again, a watch that you need to charge a couple of times a day or at least once a day makes it very, very unwieldy for sleep tracking or for continuous tracking. 

So, I appreciate the good work you guys are doing and really I think, being a part of what I see is part of the future. In the future there will be a continuous dashboard of human biometrics just as we have like an activity monitor for computers, we have the report on our house, the report on our car. The most valuable, most complicated machinery that we all will ever own, which is our bodies, we have very, very little data on. And it seems silly to me that no one is building or very few people or organizations like yourself are building the right tools, the right technologies there. 

I want to say, "keep up the good work there," and we want to keep in touch and support, if we can. 

Petteri: Thank you, thank you. It's really what is exactly driving us. We just don't want to accept what is there in the current paradigm, but we want to go also deeper into understanding in the context of what is the meaning of sleep? What is the meaning of the lymphatic system that cleanses the brain during the nigh? How the sleep stages are correlating with that cleansing system? So, all the body functions that we have a certain kind of method or something to measure that currently but still we haven't understood it so far. So, we want to dig deeper into the understanding that how, in a unique level for each individual, how we can empower them by learning about their own body reactions in the context of their own lifestyle, their own daily choices and different protocols they have. 

Geoff: Well said. We'll leave at that. Thank you so much Petteri.

Petteri: Yeah, thank you, thank you very much. It was great.

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HVMN Co-founders Michael Brandt and Geoffrey Woo