Episode 27: David Rabin MD, PhD, Psychiatrist & Neuroscientist

Han Tran Body Clock Podcast

Listen on: Apple | Google Play | Spotify | TuneIn

David Rabin MD, PhD is the chief innovation officer, co-founder and co-inventor at Apollo Neuroscience Inc. His work focuses on developing technology to change the way that we approach patient care more effectively.

Transcript

Dr. Sohaib Imitaz: Hey, guys. Welcome to another episode of the Body Clock podcast. Today, I’m excited to have Dr. David Rabin on our show. He is a psychiatrist as well as a neuroscientist, and he is the co-founder of Apollo Neuroscience. Quite an exciting and emerging technology dealing with stress and resilience and helping you perform at your optimum state. So I’m going to let David explain a bit more about his background and how he got involved with what he’s doing. And I look forward to listening about what he has to say. Hey, David.

Dr. David Rabin: Hey, how are you? Thank you so much for having me.

Dr. Sohaib Imitaz: I’m good. I’m glad you could come on.

Dr. David Rabin: Yeah, me too. I think we have a lot of synergy in this space. Yeah. As you said a second ago, my background is in psychiatry and neuroscience. I’ve been focusing my research for just over 10 years now on chronic stress on the body and the effects. I originally started out looking at the effects on the cellular and molecular parts of the nervous system in dementia and aging blindness disorders and then realized that I was much more interested in working with people on the whole.

And so I transitioned into psychiatry where I focused mostly with people who have tumors and trauma disorders, like PTSD, and addiction disorders, and any other disorder that’s worsened by chronic stress, which often includes things like chronic pain and insomnia, depression, anxiety, and these kinds of things.

Dr. Sohaib Imitaz: So it seems like you spend quite a lot of time really getting the depth of all these kinds of debilitating chronic processes that people suffer from. So you’re quite an expert in that. So whilst you were doing that, did you always have an interest in technology as well?

Dr. David Rabin: Yeah, I think I always saw an opportunity for technology to change the way that we approach patient care more effectively. I think, you know, as we were talking about earlier, as physicians, we focus a lot on the biological processes of the body that have been studied for the last hundred years but we don’t spend a lot of time looking at the ways that we can more effectively understand those processes.

We kind of focus on this is what we know and this is how it is. But ultimately, what I think wearable technology has brought to the table is an opportunity to. And I realize that I think, you know when Fitbit they came out and I don’t know you’re familiar with BodyMedia, which is one of the first wearable companies. I think it was the first for tracking where metrics actually came out of Pittsburgh, where we’re located.

And we have a lot of heritage of wearable technology here to identify not just activity and health, but also emotional states. And so I always had an interest in that and just using that technology to sort to understand not only what’s going on from our patients’ mouths when we see them in the office, but more importantly, I think what’s going on in their day to day lives at home. And there’s a huge barrier in health care that we’ve been witnessing.

I think not just in the US, but around the world where, you know, our patients come in and they’ll tell us. And this is really common in psychiatry. You ask your patients how they’re doing and they tell you about the day and they’ll tell you about the week, you know. They came to visit. But they’re not particularly great at remembering what happened the other 6 or 8 weeks or 12 weeks before, you know, between their last appointments.

And so wearable technology really provides us and it’s not there yet, but it can have the opportunity to provide us with an incredible amount of information about what our patients are doing on a daily basis at home so we can more effectively manage their care.

Dr. Sohaib Imitaz: So I think that would really help transform health and for the normal individual. So you talk about stress. So the best way of measuring stress, would you say that’s heart rate variability?

Dr. David Rabin: That’s a great question. You know, I think there’s a lot of different ways to measure stress. And I think we’re still learning about what the body looks like under stress. I think one of the most important things that we learned in medical school- to fall back to that, we didn’t study in enough detail but is the autonomic nervous system and sort of understanding the balance between the sympathetic fight or flight or freeze response system with the parasympathetic rest and digest and create and reproduce and sleep system.

And those two systems are sort of a dynamic interplay in the body, in the brain. And when we understand what those systems do in response to stress and the response to safety, it starts to shed a lot of insight into what we can predict people’s bodies look like under stress. Hari variability is a really interesting measure that actually was discovered in the 1950s and 60s with Hari variability biofeedback.

Hari variability in and of itself is really just the rate of change of your heartbeat over time. So it’s really looking at the amount that your heart rate is shifting when you’re exposed to stress and how quickly it shifts when you’re exposed to stress. If it should go up quickly, your blood pressure should go quickly or respiration to go up quickly. And the purpose of that is to get you out of that situation.

And in turn, when you’re in those sympathetic responses, your heart rate variability is low because your heart rate is very high and doesn’t really matter that you’re able to adapt and switch quickly, you just need to get out. And so under stress, Hari variability is typically low and that’s an indication as well that your parasympathetic nervous system, the rest in digesting and create system, the reproduction system, and the system is essential for doing everything from managing your gut microflora to your emotional health is totally suppressed.

So when you’re under these high stress states, because your body is not supposed to be worried about any of the things like reproduction or creativity when you’re running from a bear. And so ultimately, what really chronic stress is it’s these little situation times that result in sympathetic activity that is increased and parasympathetic activity that decreased all the time.

And what happens is all the things that the parasympathetic system is important for governing stop working well. So your ability to regulate your sleep, your digestion, your immunity, your recovery, your ability to transition between stress and not stress dates, wakefulness- we say all those things start to dysfunction under chronic stress situations when the sympathetic nervous system is overactive.

And so we can see that because people who have chronic stress or conditions related to chronic stress like PTSD and depression anxiety tend to all have low heart rate variability, which is a sign that their sympathetic nervous system up all the time. And so what we found through seeing patients and through, you know, doing thorough literature review is that ultimately it is a pretty strong consensus activity like meditation, mindfulness, yoga, deep breathing, massage, really excellent psychotherapy, and things of that nature boost heart rate variability and reduce symptoms at the moment during the session in these conditions or in patient- people of chronic stress.

And so there’s been these really strong links between activities that boost Hari variability and help them sort of reset the nervous system and help reduce symptoms and improve attention and emotion regulation and mood regulation and circadian rhythm regulations. I think it’s a very important topic that you guys talk about a lot. And so that is sort of the basis for all of the work that we do is looking at how do we help people who are constantly in a threatened state achieve a more natural safe state more effectively so that they can more effectively engage in their own healing process.

Dr. Sohaib Imitaz: So would you say that it’s shown to have a massive impact scheduling such activities to relax and, you know, meditate in your day to day life when you are in a threatened state for maybe, you know, deadlines working too hard or even, you know, if you’re going through some type of traumatic situation or financial situation or maybe something like a breakup, do you feel an activity such as meditating or yoga can help counteract that and improve your heart rate variability?

Dr. David Rabin: Yeah, that’s another great question. I think you’re absolutely right about that. Those activities can help improve your heart rate variability and improve balance between the sympathetic and parasympathetic sides of the nervous system, which over the long term if you practice meditation or mindfulness or yoga or deep breathing or biofeedback or any of these techniques, you will over time become more resilient to stress.

Meaning that you will recover more quickly from stress. When the threat is gone, you won’t be continuously thinking about the threat for minutes, hours, days, months later, you’ll be able to quickly adapt back to a safe environment and to feel safer so that you can get back to your regular life maintenance work. So absolutely. Meditation and mindfulness and all these techniques can help very well.

I think the major barrier for people adopting these techniques is that they can take thousands of hours of practice or really become proficient. And so when you’re somebody who’s already sick or already suffering from chronic stress because your life is hard, you know, what are the chances that you’re going to want to take out 30 minutes a day to truly calm your mind and enter a meditative state to help boost your nervous system balance in what we’ll refer to sometimes as homeostatic capacity. A lot of these folks just can’t do it.

They can’t do it because they don’t feel safe enough anywhere in their lives to be able to allow themselves to enter those states. And so that kind of gets into Apollo. And the whole idea of Apollo is based on the theory of music and the way music affects the body, and people will often use music or sound meditation- sound therapy- to help them transition between stressed out and meditative states more effectively.

And we’ve seen that it’s very well studied phenomena logically. And so that was a big inspiration for us knowing that things like sound, like massage, as well can sort of help facilitate the stage without requiring as much effort on the part of the user.

Dr. Sohaib Imitaz: So I’m looking at Apollo. You said it kind of improves your calm, improves focus, improves physical recovery for athletes and sportspeople, increases cognitive performance under stress, reduces blood pressure, and improves HIV. So I mean, it seems to really be impacting a lot of your, you know, processes in the body and really helping you be a lot more focused and calm. So how does it work? So you talked about music. So you have a background in music as well?

Dr. David Rabin: I do. I do. Way back. I trained originally when I was a kid. As a kid, you know, I played the piano and trumpet. But then more recently, I’ve just been a music enthusiast, but I’ve had a lot of very powerful experiences with sound, whereas I felt distinctly different from experiencing different sound environments.

Dr. Sohaib Imitaz: So then are you using what you’ve studied in neuroscience and psychiatry and applying kind of your musical background? Is it certain vibrations that are being used in your technology to help people feel this way?

Dr. David Rabin: Yes. So that’s exactly what we’ve done. So Apollo, the technology. Apollo, which we developed at the University of Pittsburgh, is sort of this synergy of all of these different Eastern techniques like mindfulness and meditation and sound and music healing and the things that we learn from our music backgrounds and our own experiences and then combine with our Western medicine-what we learned from treating patients, who are severely ill with Western medicine techniques and seeing the failure in response and rate.

That kind of thing. And what we came up with, ultimately, was Apollo, which is a wearable technology that is a little bit smaller than a 1-inch by 1-inch pod that you could wear on your ankle or your wrist or really any other part of the body that it that you can attach it to. And it vibrates at very specific frequencies that we understood, from the literature and from the music space, changed the body in reliable ways.

And so the basis of this comes from a long history of literature, looking at different vibrations and other kinds of stimuli that we experience in different ways other than vibration, like sound, and vision lights, and things like that. And touch. And looking at when what happened to the nervous system, when you deliver intense and high-frequency simulation versus what has been said when you deliver slow and gentle, soothing stimulation.

And there is a lot of evidence to suggest that if you delivered slow and soothing stimulation, the parasympathetic nervous system activity goes up and people see somewhat a slight increase in the measures of that, like heart rate variability. And similarly, if you have a fast and loud stimulation, it provides the opposite response where the sympathetic nervous system goes up. But people don’t want to listen to music all the time.

You have to be able to have conversations and give talks and be dynamic and be able to interact fluidly in your social environment. So having earbuds or earphones can be disrupting and invasive. And so what we said was, can we get the same effect by literally taking all of these core sound frequencies and then synthesizing them into vibrations in a frequency range that you can feel rather than hear.

And so what we found, ultimately, through our first double-blind, randomized placebo-controlled clinical trials at the University of Pittsburgh is that for the first time in the history of science, we’re actually able to show that, reliably, we can shift biometrics in the body with these vibration frequencies and not with other vibration frequencies.

So the Apollo vibration frequency, the way they’re specifically layered, seems to create a coherent state or a cardio-respiratory resonance, saying the body’s similar to meditation and mindfulness, where your heart rate and your breathing enter sort of asynchrony such that your sense that you feel more present and your heart variability goes up and you’re more able to adapt in certain situations and you improve your performance under stressful task because you’re more focused and present in the moment.

And all of these benefits are the same exact benefits you would get from being a regular mindfulness practitioner. But with Apollo, they happen within two minutes. So the idea was to create something that facilitates the transition between states because that’s one of the things that people who have chronic stress struggle with the most.

Dr. Sohaib Imitaz: So it sounds like it fits quite perfectly because it lowers the barrier of practice, which helps people get so good at these practices. So you can instantly start getting, you know, getting the same effect. It’s quite a time efficient as well. It seems great. At Owaves, we’re kind of a lot about time efficiency and helping people plan.

Anything that saves time and helps people improve their performance or be more well or kind of, you know, stop the progression of a mental illness or stop people feeling anxious or depressed, which a lot of students do. It’s a win-win. Because at the moment, in the United States- to be fair, globally- students are going through some of the most the worst cases of mental health and stress due to, you know, trying to catch up with what life throws at them. So this seems like a pretty cool device that really could help people. And as you said, the software is central to this, isn’t it? It’s the app.

Dr. David Rabin: Yeah, and thank you for bringing that up. The software is absolutely central to this because the software utilizes all the benefits that we have as a society. We learned from wearable technology that we can start to understand just from a 3D accelerometer or from other biometrics, like a heart monitor or anything else, body temperature, et cetera, even from the usage of your phone, that there are certain patterns of behavior and body function that correspond to optimal performance versus stress state.

And so we see that there are certain times when your body is going to go to these. And this is the focus of your show. I think it’s really relevant. Your body goes through rhythms, right? Your body is not the same at all times of the day. There is a rhythm and a pattern that the body follows in its natural state or in any state or that it wants to follow to facilitate this certain time that you naturally rest.

In a certain time, you naturally perform, and then when you eat, and etc., and all of these things and how your body’s functioning at different times throughout the day based on it will have a direct impact on how you respond to stress and when your focus is at its peak. And so by understanding from wearable technology and just from your cell phone use what your rhythm look like of your behavior.

We can start to understand what your baseline looks like and what your body looks like when you’re performing at your best and what your body looks like when you’re performing at your worst. And then we can start to predict, for example, when you’re going to start performing at your worst and then turn on automatically to help facilitate those transition state so that you don’t wind up getting to a place where you didn’t want to go.

You’re already calm and clear-headed before you get into that position. And I think that has much more of an impact when we talk about people with severe mental illness, because those folks often times have just not been taught how to effectively adapt to stress and their coping strategies are usually more poor and they’re not able to emotionally identify as well either. And so for folks like that, having a sort of almost like an emotion prosthetic that helps listen to your body, understand and identify emotions, safe for you to then help you help guide you.

Sort of the future of where all of this goes. And by learning about your behavior, we can optimally tune and tailor these personalized therapies to your body. So I think one thing that I wanted to bring up that I don’t know if I mentioned earlier, but I think it’s really critical to all of this is this idea that we don’t talk about our society very much, and particularly in medicine, which is a change in and of itself is a skill.

And we as humans, part of the reason that we are in the status of the world that we’re in is because we possess inherently in our genes the ability to adapt to changing environmental stimuli and internal stimuli extremely effectively. And that in that adaptation, that adaptability will be called resilience. It’s something that you can train yourself to be better at. Every single person in the world has it built into their genes when they’re born. It’s not something that’s unique to some people or others. It’s a skill that all of us have built-in.

It’s just if you choose to value that skill and practice it, you become really good at adapting and really good at being resilient. And stress doesn’t faze you the same way as it faces other people who haven’t trained as much in or value the skill of adaptation. And so what Apollo is really doing- you don’t press a button and it magically takes you into another state-is it helps facilitate the ability to switch states more effectively so that if you are not trained in switching or adaptation, well, then it helps you more effectively feel safe enough to actually be able to transition successfully.

And so that can be from stress, not stressed or not stressed to stress or from weight to sleep, sleep to wake. Meditation is not meditation, etc. And so those are the kinds of things that where Apollo is really functioning out. And that’s at the core, which is really at the core of the autonomic nervous system because the most fundamentally important feature of the autonomic nervous system in terms of change adaptation or change coping is activity in the parasympathetic nervous system and a balance in the nervous system that helps facilitate your ability to adapt.

So by training that nervous system, you’re effectively over time by doing activities, whether it’s Apollo or whether it’s meditation or mindfulness or any of the things we talked about, all of the things over time or gradually condition the nervous system to be more balanced on the whole.

Dr. Sohaib Imitaz: So this system, is it sensing your states or are you personally realizing that you’re about to do this and then you kind of trigger, you know, the vibrations to stop or? And how does the wearable work? Is it attached to you? Is it something you hold?

Dr. David Rabin: So the wearable attached to you- the most common places that people wear it to get the best effect are actually on the ankle or the wrist. Most people like wearing it on the ankle because it’s less intrusive and the effects are actually much better. Which is very interesting. And so that’s become the new favorite location. Basically, the software is interesting because it evolves over time by interacting with you.

And so the first version of the software- and we’ll be releasing a commercial version of this in August- the first version of the software will be, you know, a very simple learning algorithm that will understand your schedule when you use certain frequencies, whether they got the effect that you wanted based on your interactions with the app and the device and starting to understand what works best for you at different times of day based on what you’re using and what we can tell that you like based on certain accelerometer responses and that kind of thing.

And particularly, I think that’s really relevant with sleep and a lot of people use this to help the sleep latency or effectively decrease the time it takes to go from wide awake to falling asleep. And so the initial version will have this sort of these basic algorithms that help understand that kind of thing. And then we will also intake data from Apple health kit and other wearables to interface with Apple health kit and Android health kit and plus type devices.

So other wearables will be able to interface with the apps that you can see how your biometrics are changing over time. With respect to Apollo use, which I think is really interesting, we see our effects within two minutes. So within two minutes you can look at your app and you can see, “Hey, my hurry variability is up and my heart rate is, you know, 10 points posted, arresting, etc.

And so we can interface with lots of different wearable technology for health tracking and fitness as well as commercial technology. I think that will grow over time as we continue to learn about our users and, you know because a lot of this I think is important to bring up. What I mentioned earlier is a lot of this area is really the wild, Wild West of wearable health care. And we don’t necessarily understand what our users’ bodies are going to look like all the time.

It’s never been studied before or it has been studied very minimally. And so, you know, part of what this will be is a big learning experience for us, where we teach our software about each individual user using deep learning and machine learning algorithms sort of help tailor that response more and more over time.

So the more you use it, the closer it will get to getting you to exactly where you want to be at all times. And down the road, it will also be biometrically reactive. So it can predict when your heart rate’s changing and your heart rate variability change, you can use that to predict emotional state distress state to help turn the device on preemptively.

Dr. Sohaib Imitaz: So it is becoming increasingly personalized. And can you see, kind of top athletes- LeBron James- you know, these types of people using this device quite soon?

Dr. David Rabin: We hope so. We have a lot of teams and trainers in the professional space testing it in the US. And I believe we have a device actually over at Manchester United. It was one of the folks over there.

Dr. Sohaib Imitaz: That’s where I am. I’m in Manchester.

Dr. David Rabin: Oh, there you go. Yeah.

Dr. Sohaib Imitaz: Okay. So someone’s using it.

Dr. David Rabin: Yes. One of the main folks there who helps organize training and strength conditioning routines to those guys and helps them improve their performance and recovery is testing it from a conference that we met earlier this year, the Sports Biometrics Conference, and we have a number of special teams on the country testing it. We have some folks at USC, we have some folks at different Francisco Giants.

What else? Pittsburgh Steelers, and a number of others. And I think the main thing for athletes that they are really interested in is, and I think this is what’s particularly fascinating, athletes have been training for having resilience for a really long time because they’re constantly under stress. And that stress, you know, over time, stress subsides and they get used to their high performing environment, but especially when there are new members that join a team or a ball club of any kind.

You know, the first 100 times you perform in front of fifty thousand people is a pretty nerve-wracking experience. And similarly, when your games or your practices end at 10 or 11 p.m. and you have to get to bed so that you can wake up for a 7 a.m. training the next day, you want to make sure that you’re falling asleep within an hour of that game ending without using alcohol or drugs or whatever.

And most of the time, these guys struggle mentally to do that, particularly when they travel into one of the main reasons that these folks are interested is because when they’re traveling and pre-game, and even during training, they want to make sure that they’re able to recover as best as they can during the in-between times when they have a limited amount of time for rest because it has been shown-I think you guys talk a lot about this as well-that sleep is the single biggest factor in terms of how well you recover.

Dr. Sohaib Imitaz: We focus on sleep being the kind of fundamental and with circadian rhythms. So that sounds pretty cool. So it can really help people improve shifting from states, you know, from a stressed state to sleep. And that’s very important for athletes. But what about entrepreneurs and innovators?

And you know, these top chief executives, I mean, similar to them, they’re facing a lot of different stimuli throughout the day. They have to react quickly, make quick decisions. So they need to kind of a period of, you know, switching off. So I guess this will be useful for them as well.

Dr. David Rabin: Yeah, I mean, that’s a great point. You know, being an entrepreneur and physician myself, I can tell you that we basically never stop working. And when we do finally stop working, you want to be able to relax and eat and get to sleep as quickly as you can so that you can go and do it again the next day.

And there’s a huge group of people who are living that kind of life, not only in the entrepreneurship world but also in you know, the regular industry around the world. And so one of the main focus for us is how do we, you know, -we don’t want to be the company that just tracks your employees health and tells you to give them different recommendations about what to do or to take time during times- we really want to provide something that makes people feel better and improves performance because people feel better.

That’s really what this comes down to. And so that’s what we see in some of our studies of the eight clinical trials that are underway right now. And we just actually started and I think it’s important you bring up burnout because especially in medical students in the US, the burnout slash depression rates are somewhere around 25 to 30 percent across all medical students. And there’s, I think, one doctor commits suicide in the US every day.

So in a year, that’s two medical school classes that we’re losing to burnout and suicide and depression and untreated mental illness every year. And that’s really, you know, when we with a shortage of medical care, specifically primary care, we have in the US, it’s just something that we can’t have. And so being able to provide folks like this with something that helps them adapt to stress more effectively and get the sleep they need to recover is so critical.

We’re starting a study right now actually at the University of Pittsburgh with the entire neurosurgery residency program where we’re looking at all Apollos and wearable biometric devices. And they’re going to then basically track their performance recovery and biometrics over the course of a month. And we’ll have an opportunity to see, you know, how well are we actually helping these extreme high performers in what is arguably one of the most extreme environments, as you know, is in their position.

And really, you know, when they’re working 100 to 120 hour weeks, how we help them recover as best they can so they feel that the best the next day? And that seems to be working very well in the household. I know I used it when I was in my part of my training in the hospital where I work and see patients and it works incredibly well. It helped me manage my stress. So we’re very optimistic about how that study is going to go. And it’s looking like that will kick off in the next couple of months.

Dr. Sohaib Imitaz: Sounds very novel and exciting. And I mean, the statistics are quite horrific about, you know, the stress loads and that’s only going to increase unless we do something about it. So this seems like a very-

Dr. David Rabin: It’s even worse in residents.

Dr. Sohaib Imitaz: Yeah. It even worse in residency, right? And I guess if you can start using these things early it helps and kind of adopting to, you know, what can help you be less stressed. So kind of augmenting that experience.

Dr. David Rabin: It’s like starting meditation early. The sooner you can start meditating, the better. It’s just that most of us don’t have the time, especially doctors and so. Yeah. And so how do you manage, you know, the fact that you need something that’s going to go with you and give you the same benefit, but then gradually allow you to become better at meditating over time because it helps you be more accustomed to those states on a regular basis.

Dr. Sohaib Imitaz: So touching upon that, how does your day look like? How do you plan your day? What’s a typical day? How do you kind of, you know, live a healthy lifestyle or do you live a healthy lifestyle? It’s so busy being a physician and an entrepreneur.

Dr. David Rabin: Yeah. I mean, I won’t beat around the bush, it is a constant challenge. You know, I think it’s also critical to understand how we look at challenge in our society. I don’t know what it’s like in England. In the US, it’s very much that when you’re challenged, it’s like, “Oh, no, this is another opportunity for failure. I might as well not try.” And then, you know, another way to look at a challenge, I think it really shaped the way that I structure my life, especially the way I’ve been shifting in the last couple of years, is that you know, I was very busy.

I didn’t have time to work out and didn’t have time to meditate and doing any of these things for a very long time. And, you know, I would do like two five-minute meditation day and that was it. And, you know, since then, I’ve lost two years by changing my approach to challenge and looking at challenge as not a way to, you know, exploit my weaknesses and to make myself feel bad or to fail, but really as an opportunity for growth and understanding that, you know, the reason that this challenge is facing me is because if I try to do this, I will get better at it. And I’m not good enough at it right now.

So if I practice, I can work at it and I can change the way that I approach these kinds of things. And that gradually over time, adopting a mindset really helped me. And now I work, I wake up at about 5:30 every morning and have a chia and like, almond milk or coconut milk, you know, high protein meal. And then we’ll do either like an hour of yoga, or an hour of lifting, or cardio, and then go to work and then usually I’m at work until late.

Come back, try to eat dinner around 6:30 to 8:00, sometime around there. Then try to go to bed by 10:00 and wind down at the end of the night. Not do work. Not doing work after 10:00. Not checking your email after 10:00 or after eight o’clock. And making sure whatever that time is and you making sure that you set a time where you aren’t engaging with work type things in your thoughts or in your behavior is a really important structure point as well.

Dr. Sohaib Imitaz: It seems that you maintain your circadian rhythm quite well, you know, waking up quite early and sleeping at a good time. Well, you’re right. So how I look at it at times, what I really struggle with, is a lot of trade-offs, right? Because so now we’re generating so much information like day by day, there are so many things coming out about technology and health.

And if you’re, you know, at the forefront of this field or you’re interested in this field to just keep up to date. It’s like a full-time job. You know, Twitter. What’s happening? And we’re more connected. So it’s always like you want to switch up before bed to, you know, increase your deep sleep in your REM sleep and be rested for the next day to improve your performance but then you’re like, “Am I missing out on something? Is an opportunity that’s arisen?”

Especially being someone in training or the students, you know? Sometimes it helps, you know, if you’re on top of something like Twitter or LinkedIn, where, you know, people are posting, you know, new information and kind of opportunities and then, you know, they go pretty quickly. So it’s about you grasping that time. But then if you’re right, neglecting that, then sometimes you’re thinking, you know, have I missed out on something?

So I think we’re almost always in this struggle of FOMO, fear of missing out and, you know, prioritizing our own health and being healthy. And that’s what the crux of it is. But as you rightly have explained so well that you have to get on top of the stress and have these healthy habits or the stress increases over time. So we all got a threshold that, you know. Do we need a break after, you know, can we handle stress for, you know, a period of time and then we’ll break down?

Dr. David Rabin: I mean, that’s a good question. I think, you know, it depends on the, you know, the frequency and the amount of the stress and how resilient you are coming into it. I think, you know, that’s what resilience training is really for. You know, and parasympathetic nervous system balance, you know. All of the stuff we’re talking about.

I think what you really just brought up, I think the key point of all of this is, yes, we could be searching for job opportunities and going out and meeting people, networking all the time and always doing work. And that’s what a lot of us do. But ultimately, we’re not performing at our best when we’re out in those situations, we’re strung out. And so, you know, for us to make the most of those experiences, you’re going to sometimes have to add structure to your life and set limits with yourself and say, “No, you know, I’m not going to go out right now.

I’m going to take this time for myself to take a break.” And I think that the break thing is really important. We focus a lot on powering through for, you know, hundreds of hours, weeks and weeks and weeks at a time. And, you know, taking these vacations and vacations are great, but we should be taking breaks every day. You know, and that’s really what optimizing recovery is all about.

It’s about the understanding that breaks are something you need on a regular basis to give your mind and your body a rest so that you can recover so that you can focus and be at your peak the next day and or even later that same day. And so making sure that you structure breaks in as often as you structure everything else in your life is really important to ensure that you maintain a peak level of performance on a regular basis.

Dr. Sohaib Imitaz: That’s great advice and that’s something I’ve been really incorporating into my life. But also, having said that, I feel like- just speaking from a personal perspective- I was going to ask you further for me, I like varying my breaks. So I’d like to plan different activities to make sure, you know, I’m a quite innovative person.

I get bored quite easily. So I make sure that I’m doing, you know, say you’re going to a comedy night, but then you’re switching that over with a different break, you know, going to tennis with some friends. Is it better to kind of change things up or repetition is best?

Dr. David Rabin: Yeah, it is a great question. I mean, I think so. So repetition is important for training. So there has to be certain aspects of your routine, your structure that are repeated, because when you repeat, you create new synaptic formations in the brain that create easier pathways of neurological flow, of information flow.

So effectively, the simplest idea is that every time you get stressed out, you the first thought that goes your head is I need to have an ice cream cone, because when I was a kid that always made me feel better. And so when you’re an adult, you do the same thing and this is ingrained in your mind. And every time you start to feel any bit of anxiety, you start to go, you go find ice cream. And the response to that would be, OK, you know, to be able to overcome this.

You could go to a psychologist, psychiatrist, and take medicine. But the truth of the matter is that all you have to do is you have to just retrain your behavior and your thought process to say no to the ice cream when that impulse comes to your mind. And then over time, that’s no longer the first thought that comes to your mind. The other activity that you put in place and so that repetition is critically important.

However, I think the behavior in of itself, the variety, is also important. And so and that’s again where the balance comes in, right? It’s all about doing whatever you need to do to help you feel balanced. And, you know, one of the best ways to achieve balance is to train your body, to be able to manage change and an adaptation more effectively. So by shifting your routine a little bit and shifting activities that you necessarily do one night versus the next, you can also increase your training in terms of your ability to adapt to changing situations more effectively.

So you have to repeat that, right? And so it is a constant balance of changing your behavior and getting to a point where you end with. And that’s really where Apollo comes into that facilitates behavior change by providing a bottom-up stimulus about your nervous system in advance, as opposed to telling somebody, “Hey, do an activity that balances your nervous system and then you’ll get behavior change.” But this is sort of saying, “OK, we’re going to balance your nervous system so makes it easier to engage and set healthy activity.”

And then the behavior change will come naturally over time as you continue to use this technology. And that’s, in fact, what we see. So however you do it, it doesn’t really seem to matter that much as long as you’re engaging in some sort of autonomic balancing activities on a routine that is relatively repeatable so that you can retrain your body.

Dr. Sohaib Imitaz: So how often should you be recovering? So should you plan things daily to have a break or have like small breaks and then have what, you know, most people on the weekend they go all out or can we be working seven days a week? And then if we work more smartly and plan breaks better or which model works?

Dr. David Rabin: Yeah, I mean, that’s a great question, I think. And that’s where some of the personalization of that comes in because everybody has a different schedule and everybody has a different life situation. And so you kind of have to figure out how you’re going to fit that structure of balance into your life or balancing activities. And, you know, and again, that’s part of why we came up with Apollo is giving other people don’t have the ability or the skills to necessarily plan that in advance and to really stick to it. But ultimately, that’s a big challenge for a lot of people, is how do you fit this into your life? Like when I have to do the personalization work?

What is the structure and the schedule actually look like? And for a lot of people, it doesn’t really look very good and even people who are extremely focused and resilient and good planners. And so, you know, it really comes down to, again, as practicing those skills of making a structure for yourself regardless of what that is and sticking to it. And that structure will take shape over time.

It’s not going to be the same structure forever. It can be the structure for right now then. And you can gradually ease into that structure and then evolve that structure over time to personalize to your needs and how you see your body changing as you’re working. If what you’re doing is not working, try something else. You know, it has to be a dynamic thing. And that’s, again, part of improving our response to change. It’s not about setting one thing forever like, this is my diet for the rest of my life. It’s not about that.

It’s about, you know, figuring out what do I need to do right now for my health. And to give you an example of my own life, I’m a very distract-able person. We’re probably very similar. I have a lot of interests. And sometimes it’s difficult for me to focus. And so what I actually have done is I’ve tried to adapt my break to my schedule, which is atypical, I think, for most people. And so maybe it’s more common now. But basically what I do is I just work through a certain point to where I know that I feel like I’m kind of overwhelmed or kind of pushing myself too hard. And I recognize what that feeling feels like, which could be depending on the work.

It could be a half-hour. It could be an hour. It could be two hours or longer. But when I get to that point, I know what that feels like. I recognize that I’m starting to be less productive and my mind is wandering. And then I’ll go and take a break, come back fresh. And my brain could be anything like, listen to music for 15 minutes or like a 15-minute meditation or a walk. I think, you know, we definitely do not walk enough. And that is something that is definitely a fantastic way to clear your mind and come back fresh.

Dr. Sohaib Imitaz: That’s some really good activities and using your intuition and letting your body feedback to you, which is something everyone can do, which is a great thing for especially students to do. And I think I would agree with you because we were trained sometimes worked past our breaking points, but in reality.

Dr. David Rabin: Right.

Dr. Sohaib Imitaz: Productivity decreases. So I’ve started doing that as well. Like I know when I can focus on I’m in the zone and the flow state and I’m going and then I right now, I just I wouldn’t be wasting my time. I need a break. I need to get out. And over time. As you learn, you can plan, you know, after about two weeks, you need to do say, you know, meet up with a lot of friends or whatever.

You kind of work that out. But what I’m interested in is, do you think with data, as we accumulate data, will we be able to figure out maybe an average of a week, in a given week, how many hours would be optimum or within a threshold or like confidence intervals of how many hours we need to plan to socialize? You know, for example, we have the seven fruits and vegetables.

It’s kind of quite quantified. Do you think we will get to a point where we will work out for, you know, best performance or best happiness or, you know, these kinds of feelings? There might be, you know, say if the recommendations are seven hours a week, then we can, you know? If one day we don’t have much time to kind of fit that in, we can kind of compensate in another day? Do you see that happening?

Dr. David Rabin: Yeah, I definitely see that happening. And I think that we’re not very yet, but I think that over the next five years or so we will become significantly more adept at interpreting the data that’s coming in from these wearable technologies to start to make predictions about these kinds of things.

I think that we’re not quite there yet. And I think the main reason is because the reliability of the sensors on most of these wearables is not quite there yet to be able to give us all the information that we want to make those kinds of assessments. But we’re getting there. You know, I think that definitely on the way. But I also want to say that one of the major sort of goal points of all this work is that, you know, wearables are a tool and your phone is a tool.

And all of your technology that you have access is a tool and similarly, your own skill sets that you’re born with are tools as well. And so I think one of the main points of all of this work is what we’re really doing is we’re trying to improve. And this is really also what Apollo is about. By meditating and practicing mindfulness or using Apollo, what you are effectively doing is you’re drawing your attention back to your body, which is the quiet and present listening part of your consciousness that we don’t really talk about very much.

We have this other part of our consciousness which we spend most people probably don’t like 90 plus percent of the time in which is active, noisy thinking part of our consciousness. That’s all we’re trying to find, the next thing to do or think about. And that’s a really important part. But what’s equally important is balancing the noisy part with the quiet part and the quiet part of the part that listens not just to our environment to make better decisions, but also to listen to our bodies and start to understand over time what you were talking about earlier, which is, “Hey, maybe I’m reaching a point where I’m not performing at my best anymore.

I should take a break.” And then you don’t need to have those things scheduled in. So over time. I think you know, equally, as we see wearables evolve, we’re also going to see to some extent human consciousness or human awareness and self-awareness evolve because people through wearable technology ideally are not going to become dependent on the tool.

They’re going to start to use the tool to then accentuate their ability to learn about themselves and become better through listening. Listening, being a skill, just like adaptation or anything else. The more you practice listening and the more you practice quieting your mind and bouncing to any activity, the better you get at it.

Dr. Sohaib Imitaz: Which is really important because we’re losing patients in this day and age and we think it’s a waste of time if we’re not doing something. And I think the fightback will be products like Apollo, which equip people to kind of concentrate on this part of their consciousness as well, you know, bring back these practices that were instilled in people, you know, a century ago. But now you can look at it as a double-edged sword.

Technology is taking us away. Now we can use technology to bring us towards, you know, a more kind of restful, bright, calm, focused state, which I’ll be honest, even myself, I struggle sometimes and obviously being trained in lifestyle medicine. I know how important it is with the studies, but it’s just you know, nowadays we’re so connected, right? I’m guessing.

The start of medical school, we were given a statistic that-you can correct me if I’m wrong- I remember our professor or head of the medical school said, “You can only make the human mind or the human brain can only make three hundred successful social connections at one time, right?

Dr. David Rabin: I think it might be closer to 150. But yeah.

Dr. Sohaib Imitaz: It’s probably 150. It’s been about 10 years ago now. And then out of that, the close relationships is decreased further. I don’t remember the exact number, but now, being on all these, you know, we connected to so many people, we just can’t keep up and remember names even.

Dr. David Rabin: Yeah, you’re absolutely right. That is a huge, huge thing. And again, I think that’s one of the biggest challenges, right, is teaching us to listen better. You know, I think one of my biggest and first struggles for myself that I had to overcome was when I was in training.

I was anxious. And, you know, anxiety for me was racing thoughts about work and I had trouble settling down. And really, really not an uncommon thing for us as trainees, but, you know, feeling just sort of, you know, on edge a lot of the time. And, you know, we’re constantly under supervision. And it was you know, this is a very stressful, competitive process. And for me, what I found was that anxiety and how worried it was directly correlated with my ability to remember things. So it was inversely proportionate. So the more anxious that I was, the worse my memory was. And I said, “OK, I’m spending all this time worrying about remembering things that I can.

Then, you know, regurgitate onto an exam or worried about things that I need to explain to my attending physicians in the O.R. when they’re asking me a question. And I’m so worried about it that I might even able to remember what I’m trying to remember.” And so what I practiced overtime was knowing that you know. And really just spending time again learning to listen to yourself again. And listen to your body and work towards a point of understanding where you get why, it’s important to remember the thing that you’re trying to remember and you fit it into a larger paradigm in your mind about the way that the body works and the way the mind works or whatever it is you’re doing, the way that your industry works. And so you start to build a greater picture.

That’s not just about, you know, me diagnosing a patient, sending that patient home with a prescription, I’m actually trying to figure out how to provide this person better care in whatever way I can. It’s not necessarily going to be the way that I was told or the way that’s written in the book. It might be something completely different. But again, you know, it’s just the practice of balance and practicing allowing myself to you know, give myself more attention.

You know, I think one of the things we don’t focus on our society a lot is, is the four pillars, which are a critical aspect of ancient Buddhism and Hinduism and many tribal cultures in the world. And even I think at the core of Christianity and Judaism and Islam, which is the first pillar being gratitude. The second pillar being forgiveness and the third pillar being compassion.

And a fourth really being self-love. And the whole goal of which is that the pillars form the foundation of trust in yourself. And so being able to practice and, you know, focusing on just practicing those things, those emotions, those feelings of gratitude towards yourself for everything that you did and just getting you here today, the simple things right now, forgiving yourself, the things you did wrong because everybody makes mistakes and being compassion for yourself, the things you’re going to do wrong in the future.

Understanding that, you know, we all struggle and you’re just doing the best you can. And we’re gonna make mistakes, but you’re going to learn from them and move on. And all of that kind of forms is this construct of self-love where you can actually appreciate yourself for who you are and what you’re doing. And that’s at the core of really all of this is being kind to yourself.

And by being kind to yourself and not looking at your body or your mind or any part of yourself as deficient or dysfunctional, you’re able to be compassionate and sort of share this healing experience with your body. That in a lot of ways I think we mistreat and we don’t see it as a fundamentally interconnected part of who we are.

Dr. Sohaib Imitaz: I think that would really hit home with a lot of our listeners. And you’ve raised some really good points there, which we tend to ignore. And that’s really good for especially young listeners who often think they have to be continuously, you know, blaming themselves if they’re failing at something. So a note of thanks for sharing that. You’ve got the two. So it’s good you’re putting the care in the human and the human aspects, but then we’re using technology machines to help us as well. And it’s that kind of combination.

Dr. David Rabin: Right.

Dr. Sohaib Imitaz: And now I feel like I think people have learned a lot from what you’ve talked about. And I’m really excited about, you know, trialing Apollo. And thanks for that.

Dr. David Rabin: No problem.

Dr. Sohaib Imitaz: And because you were showcasing it at CBS 2019, the Consumer Electronics Show, which always has the movers and shakers in the games and the coolest products. So a lot of respect for you and for what you’re doing.

Dr. David Rabin: Thank you.

Dr. Sohaib Imitaz: And I’m quite impressed by the technology. And I am a big technology fan, so it’s right up my street. And from that, I was wondering, is there anything else you’d like to share for our listeners or web listeners could follow you or follow Apollo or anything else you’d like to share?

Dr. David Rabin: I think we went through quite a bit. That was a really great conversation. I think I will share that if any of your listeners are interested in Apollo, finding out more information about Apollo neuroscience, our company or the products that we’re putting out in August or if you like, the beta tests. You can sign up at Apolloneuro.com and then you can also reach me directly through the web site or on Twitter at @DaveRabin.

Dr. Sohaib Imitaz: Thanks, Dave. I mean, I’m sure a lot of people will be interested in this technology. And I’m excited to see this on quite a few influencers using this as well. You know, sports stars. As you said, Manchester United seems to be ahead of the game in terms of looking at technology. And I think it’s something that a lot of people can utilize in the correct way. And a lot of people, I think from this podcast and I’ve probably learned a lot that, you know, unaware often how you need to focus on stress.

Thanks for being on the show. And I mean, you’re in line with Owaves philosophy of, you know, balancing your life well and planning and kind of developing these successful habits. So I’d like to say thanks. And I’m sure we can collaborate on quite a few things in the future.

Dr. David Rabin: Yeah, me too, and I really appreciate your time and thank you for having me. This is great.

Dr. Sohaib Imitaz: Thank you.