How To Improve Your Heart Rate Variability (HRV) - Dr Leah Lagos

1. 0:00 – 3:42

   The History of HRV

   1. CWChris Williamson0:00

      What's the history of HRV? Who, who discovered it?

   2. LLDr Leah Lagos0:03

      You know, it's really interesting. It originated being a metric that doctors looked at before babies were born to predict the vitality of the, uh, of the unborn baby, that they would be healthy upon birth. And then in time, doctors began using it as a metric of cardiovascular health and other conditions. Uh, HRV is very much associated with clinical conditions from fibromyalgia to irritable bowel syndrome, to depression, to anxiety. And then a cohort, a, a small subset of people, including myself, came along and said, "Well, what about people that aren't afflicted by a condition but just wanted to get better?" And, and that question has been the last 17 years of my research and practice.

   3. CWChris Williamson0:52

      Wow. So I think a lot of people listening will be familiar with HRV, what it is, and sort of the, the, the fundamentals. But just give us a 30,000-foot overview recap.

   4. LLDr Leah Lagos1:03

      Sure. So HRV has to do with the variability in between each heartbeat. And essentially, the short simple answer, without getting too technical, and I think that's one of the things the public has to understand, people get lost in the science, Kris, is, is that we are looking for bigger numbers from greater health and resilience. But everybody has a range. And, and so the scientific definition, uh, has to do with the oscillatory variability in between each heartbeat, um, and measured in milliseconds. And that's the technical d- definition. What we'll talk about today is HRV in terms of RSA, resonant sinus arrhythmia. And it's so much easier to understand and grasp as a user, because you can look at with all sorts of different wearables that are out now, the peak to trough. So when you inhale, your heart rate goes up, and when you exhale, it goes down. And that phenomenon is known as resonant sinus arrhythmia. And ultimately, we want that variation to be as big and beautiful as possible, almost like ocean-like waves. But that's not exactly what happens in life. We get stuck. There are stressors. And, and we can talk about the different variables in time, but we want to optimize those oscillations to be resilient, adaptable, flexible, um, marked by agility, to, to kind of respond as we need and acclimate flexibly.

   5. CWChris Williamson2:36

      Is that what you mean by autonomic flexibility?

   6. LLDr Leah Lagos2:39

      It does. It does. And people think about stress in terms of, am I stressed or am I not? (laughs) But what we really should be talking about is your agility in handling it. How long does it last? Are you able to let it go when it happens? How long does it take you? Are there specific stressors that take you longer? And you begin to look at HRV, and we can dive into this e- as deeply as you want, but as a metric that gives you insights about yourself. So of course, we can train HRV, and I'll take you through my protocol for doing that, which is in my book, Heart Breath Mind. But, but I want the world to understand, HRV is a measure of who they are, what amplifies them, what takes away from their natural gifts, and it's, it's a metric that people can calibrate with breathing, but also with study and research on, on what kind of leads to these changes inter- inter day.

   7. CWChris Williamson3:41

      I

2. 3:42 – 6:57

   Why HRV Lowers During Stress

   1. CWChris Williamson3:42

      have never heard anybody explain the adaptive reason for why HRV lowers when we are stressed. There must be an advantage that is given to the user for having a lower HRV under sympathetic arousal.

   2. LLDr Leah Lagos3:58

      Mm-hmm.

   3. CWChris Williamson3:59

      What is that?

   4. LLDr Leah Lagos4:00

      It's likely associated with the reptilian response of immobilization. Our body immobilizes even in prehistoric days to conserve energy. And while the reptilian response served a function and can serve a function in certain stress situations, usually it doesn't, and it stays longer than we need. (laughs) So ...

   5. CWChris Williamson4:25

      That's so interesting. So ...

   6. LLDr Leah Lagos4:26

      Mm-hmm.

   7. CWChris Williamson4:28

      Y- your hypothesis is that when we were reptiles, we would need to... But what ... Surely, surely a high HRV, if we needed to, uh, lay out in the sun and warm ourselves on a rock, surely that would have allowed us to regain more energy than a low HRV. No?

   8. LLDr Leah Lagos4:49

      That would. Lying, lying on a rock and being in the sun, c- sunshine, the light exposure, is, is what could enhance HRV. But the autonomic nervous system, during times of stress, wants to conserve energy, and, um, and what it tends to do is fragment what I call autonomic bandwidth. So if you have an HRV, Kris, let's say, just you measure with your Oura Ring or, or other wearables, and there are many, and you have a range of 42 to 75, you begin to look at what's happening on different days to understand what's, what's reducing your HRV.

   9. CWChris Williamson5:29

      Mm-hmm.

   10. LLDr Leah Lagos5:30

       And maybe it's getting too late. Maybe it's a conflict with a, a, a good friend. Um, but what you're asking me is how could this have been adaptive for us. Yes. Um, and my hypothesis would be, in, in terms of trying to conserve energy and, and somehow keep the body safe in that way. However, we're in such a dynamic world, that if, if we're a fraction of our- ourselves, and, and the flexibility to respond is reduced, it doesn't work out that way.

   11. CWChris Williamson6:03

       Because we ruminate on the stressor for so long that we actually extend the stressor for a good amount of time.

   12. LLDr Leah Lagos6:10

       Yes. And that, for most people, is beyond conscious control, so the idea of just let it go is, is great, great idea, but then how do you do it? And I would argue that letting go is much more a physiological construct that, that can be taught through processes such as heart rate variability biofeedback training than, than just ... and I'm a psychologist by trade ... than, than just cognitive techniques. But first, you have to teach the autonomic nervous system how to let go.

   13. CWChris Williamson6:45

       Right. So you're suggesting that we go bottom up from the body to the mind as opposed to top down from the mind saying, "Hey calm down. You're being too stressed."

   14. LLDr Leah Lagos6:52

       Yes.

   15. CWChris Williamson6:52

       "Why can't you just let go of this thing which often makes you more stressed?"

   16. LLDr Leah Lagos6:55

       That's a-

   17. CWChris Williamson6:55

       So the other qu- th- th- the other question

3. 6:57 – 11:11

   What Determines HRV Range?

   1. CWChris Williamson6:57

      that I have, what determines our range? You've mentioned that we have a range within which we sit. I know that one of your prescriptions will be, your goal is to get to the top end of your range, so therefore comparing your HRV with somebody else's is kind of pointless.

   2. LLDr Leah Lagos7:11

      Same.

   3. CWChris Williamson7:11

      Unfortunately, I'm in, I'm in a, a Whoop group with some pro athletes, some cricketers, and some of their HRVs are in the 200s. So I- I'm always gonna be ...

   4. LLDr Leah Lagos7:21

      Mm-hmm.

   5. CWChris Williamson7:22

      ... bottom of the pile, uh, around them. But what is it that determines our range?

   6. LLDr Leah Lagos7:29

      There are a multitude of factors. There are biological, um, pieces to this and, and low HRV, um, a- i- in some cases can indicate a clinical condition, and, um, and I've had that happen with clients where we've uncovered and properly gotten treatment and then, and then worked on amplifying HRV as they went through, through other treatments. But it also can be chronic stress that's not properly managed. It can be a host of different pieces. There are also people that are more sensitive in this world, and there are people that feel deeply, they connect quickly. I call them physiologically gifted, that in stressful moments, their heart rate reactivity may jump 30 beats, whereas someone else may jump 10. And that's not conscious, and that's not something that talk therapy is going to change, but they can increase the precision of their, their response under stress by having a stronger what's called, um, uh, baroreflex gain. Through this process, the baroreceptors control heart rate and blood pressure, and we gain control over that reactivity in the moment. It's it- it just calms. And, um, with that said, there are many, many different reasons people have different levels of HRV. I had one person, it took us three sessions. I mean, questions after questions. I got it. They were drinking 19 cups of coffee a day. (laughs) So sometimes the variables, Chris, are internal, sometimes they're medical, and sometimes they're external. A big variable that people think about consciously that having a few glasses of alcohol, they know it impacts them, but they don't really have a sense of how sensitive their nervous system is or how long it lasts, but you can measure that. And so, factors like sleep, alcohol use, lack of exercise, chronic stress can certainly dampen HRV, but they're not the only reasons.

   7. CWChris Williamson9:33

      What does low HRV feel like experientially if it's, uh, acute? Let's say that you could just throw low HRV at someone that's listening now. What would that feel like in their body and their mind?

   8. LLDr Leah Lagos9:50

      Someone can't identify low HRV i- if, if that's their general baseline state. But some people can and we, and we actually sometimes train this, um, from, from my clinic with clients that are athletes on being able to recognize when, when they have a lower HRV than a higher HRV when they wake up before they look at their scores, just to develop their sense of somatic awareness and, and being just aware of what their body is telling them. Um, some people will say when their, their HRV is on the lower end of the range that they feel more myopic, meaning their mind gets stuck more, more irritable, they're less able to control their reactivity, and they speed up faster. But it's, it's really different for each person. And what's so fascinating is there's no one-size-fits-all, uh, composite HRV, this is exactly how you'll feel in low HRV versus high HRV. It's about really understanding the person, helping them be aware of what it feels like for them at the lower HRV and what it feels like at higher HRV, and then understanding the factors that they can control (laughs) , um, to continue to amplify their HRV.

   9. CWChris Williamson11:10

      Talk to me about

4. 11:11 – 15:52

   The Link Between HRV & Brain Function

   1. CWChris Williamson11:11

      the relationship between HRV autonomic flexibility and the brain and brain function.

   2. LLDr Leah Lagos11:18

      So we used to think of heart rate variability just as a metric of the autonomic nervous system's resilience to flexibly respond, which means if I need to amp up and run across the street, I can. This isn't, this isn't associated with relaxation or just being calm. It's acclimating or adapting flexibly to the needs of the moment. But then after I've run across the street and, and dealt with a s- a, a specific need that caused me to run across the street, that I can return back to baseline quickly. And, and so for many years, HRV research really honed in and focused on HRV as a measure of adaptability and resilience. In the last 10 to 15 years, uh, myself and several other researchers have focused on heart rate variability's impact on the brain.And sure enough, this concept of oscillation, if we think of resonant sinus arrhythmia as an oscillation, when you inhale, your heart rate goes up, when you exhale, it goes down. And we want these oscillations to be as big as possible. We also want that oscillatory ability in our i- in our mind, right? To be able to focus on something deeply and let it go. It's a different style of oscillatory, uh, functioning, but conceptually, the ability to oscillate is what I call cognitive dexterity. And we're beginning to understand that heart rate variability is also indicative of someone's cognitive dexterity as well. Meaning, that someone can flexibly alter between, uh, kind of deeply dive into, diving into a subject matter and then zooming out to consider contextual details, or they're able to, to consider a lot of information and have a pause before they react. So, there are different types of, of dexterity, but what can be really useful is, is the ability specifically, and it's the first one that I work on with people that want the kind of cognitive benefits associated with HRV is inhibition. So, Chris, if there is something, and ev- everyone, when you really dive deeply and someone's being authentic and open, everyone has a place in their life they wish they had a little more control over before they act. (laughs) And i- it could be work, it could be partnership, it, it could also be in a sports performance domain. But ultimately, to have the ability to screen out negative thoughts and consider their desired behavior before they respond becomes a part of the cognitive process that they do gain control over, and this process, HRV impacts the prefrontal lobe specifically.

   3. CWChris Williamson14:14

      Wow. What about... So, I, I understand that HRV is a metric which, which is, uh, both acute and chronic or systemic. It's, uh, an indicator of where you're at now, and it's also an indicator of your sort of overall capacity, autonomic flexibility, probably health and fitness as well, uh, stress response, stuff like that. What is the relationship between heart health and HRV? Do healthier hearts always have a higher be-, quote-unquote "better" HRV?

   4. LLDr Leah Lagos14:46

      Yes. In fact, there's a, uh, a wealth of research that, that suggests that low HRV is indic- is correlated with cardiovascular conditions. So, we want that, that heart to have those large, abundant oscillations, um, that, that variability is essentially associated with longevity and, and a longer life. So, when I, when I see people go through, um, in my clinic, 12-week training, many people stay for years after. They say it's, it's not just a change of heart, but a change of life. And, and we go through this process, but in the first 12 weeks, we often see the heart rate, independent of physical activity, drop five beats. And so, let's say your baseline heart rate is generally 65. It, it's now at 60. There is improved cardiovascular efficiency, and, and certainly that has implications for, uh, heart health and longevity.

5. 15:52 – 24:31

   Is it Beneficial to Hack Your HRV?

   1. LLDr Leah Lagos15:52

   2. CWChris Williamson15:52

      How do you think about the difference between sort of hacking HRV in the moment so that you get the state change and long-term duration impact on HRV, the trait change over time? Is there a difference between hacking and improving, or do all of the hacks that improve in the short term result in improvements in the long term?

   3. LLDr Leah Lagos16:14

      There... It's such a good question, and I, I, I, I really am so glad you asked because people don't understand that there are two different very distinct pathways for using HRV and, and focusing on HRV for different outcomes. So, the first one is going through a process such as HRV training, 10 to 12 weeks, to increase heart rate variability at baseline, meaning without even breathing. And why would you do that? What, what does it matter? Well, first of all, you want an autonomic nervous system that without even any conscious intervention can flexibly respond to the world. So, people who are out and about, have lots of meetings, then go home to a family with, with lots of things happening will say, "I just have more energy (laughs) to, to manage. The sensory inputs of the world require less from that nervous system because the nervous system is optimized." Okay? So, that's one, which is optimizing the baseline. How do we do that with the resonant frequency breathing? And it, it really takes a minimum of 10 weeks, 15 minutes a day, twice a day, breathing at resonant frequency, which I'll describe a little bit later. But what that does, Chris, is by week four, you have increased baroreflex gain, meaning baroreflex controls heart rate and blood pressure, and you've increased the mechanisms, the precision by which it senses and responds. It's just more precise. And I say to my clients, is, let's say you're, you're a Volvo coming into my clinic. There's... Everything's going well, you get to where you need to go, but, but now you've, you've really increased to being more of a sports car, where you can accelerate and decelerate just very quickly with, without expended, more expended energy. So, that is the baseline piece. And then within the 10 weeks, you continue to strengthen what's called baroreflex gain, and what happens is that the parasympathetic and the sympathetic nervous system...And in stressful situations, the sympathetic activation occurs. But now, you're parasympathetic. You're parasympathetic dominant at baseline, and it comes quicker to bring down the sympathetic. The sensing is faster, and it allows you to let go. And this all happens underneath, you're not conscious of it. But you would just say to me, you know, let's say, Chris, one of... Can you give me a stressor? Something just...

   4. CWChris Williamson18:44

      Emails.

   5. LLDr Leah Lagos18:45

      Emails. And what about emails?

   6. CWChris Williamson18:47

      When there's lots of them and I need to reply.

   7. LLDr Leah Lagos18:49

      Lots of them. And so maybe you come in and you say, "You know, the abundance of emails in... Every day is an eight out of 10 stressor." And as you go through the process, the emails don't change. (laughs)

   8. CWChris Williamson19:03

      Mm-hmm.

   9. LLDr Leah Lagos19:03

      The emails have maybe even increased, but your reactivity to them, the feeling of stress towards them goes down a few numbers. And that has to do with the nervous system becoming more precise in your responding. Meaning, you can amp up, but you can let go faster. And re- I call it return to baseline. So, that is the baseline piece. You go through this process to increase your flexibility, agility, adaptability without doing anything. It's a nervous system that is just more precise. And that's what the HRV training can do. One, improving baseline. Two, is what I call HRV hacking, and using wearables to calibrate your elite self. So you start to collect data, "Okay, on Tuesday I was a 42 HRV on my, on my wearable, but on Sunday I was a 65. What's the difference?" And you begin to target the variables and then define the algorithm through your own tracking to get a sense of what really helps calibrate you. And what's so fascinating is it's different for everybody. So when you, when you really get to know somebody and look at the way they live their life, the way alcohol may impact you may be completely different from your neighbor. You may be someone that running three miles a day really activates your parasympathetic nervous system in a beautiful way that shows up in your HRV calculation. So, but if you do it too many days, it drops it. So you start to really get a sense of, "Who am I from a physiological perspective?"

   10. CWChris Williamson20:47

       Talk to me about the resonance breathing, how this works, the sort of pushing at the right time on the bike pedal.

   11. LLDr Leah Lagos20:54

       Yes. So, this process came about to me, um, many years ago in grad school at Rutgers University. Paul Lear, who teaches at UMDNJ, was giving a presentation about his work with Evgenia Vashilo and Bronya Vashilo that he brought from Russia. They were working with cosmonauts in Russia when they discovered something called resonant sinus arrhythmia. And it- it essentially is a frequency that activates the entire nervous system. It's... And different what's called vagal afferent pathways, from the brain, to the heart, to the digestive tract. And when you activate this frequency, which is a specific frequency in the body, the numeric is 0.1 hertz, you activate multiple pathways at once, allowing them to tighten or strengthen the homeostatic regulatory mechanisms. Okay. Short, um, kind of short, succinct way, he was using this at Rutgers and with the Vasilos to treat a multitude of health conditions with incredible outcomes; depression, PTSD, fibromyalgia, asthma. And so I-I went up to Dr. Lear and I said, "Have you used this with athletes?" I am interested in elite performance, and that question led (laughs) to the last two decades of my research and practice. And what we found is that specifically for athletes, this allows them to gain control over anxiety and being able to perform at what I call their full autonomic bandwidth, or their elite self. And-And so the HRV training takes approximately 10 weeks, meeting once per week and identifying a rate of breathing that optimizes those beautiful heart rate oscillations. I have you practice that 15 minutes twice a day. The first four weeks, we work to maximize your baseline heart rate variability and I look for what's called the baroreflex gain, the indication around week four that your homeostatic mechanisms that control how you respond in the moment, how you anticipate a stressful moment, and how you recover from a stressor are going to increase, and that's the first sign. And then sessions five through 10, I walk you through my protocol for managing stress more in the moment and being able to oscillate from a sympathetic to a parasympathetic state and becoming aware of when you're in each of those states. So for people, let's say, at the Olympics, they want to be able to create that parasympathetic state on demand in a certain number of breaths. We do that. (laughs) A decision-maker for the UN will want to make sure that he or she is in a parasympathetic, open, agile, receptive state where they can be very focused or contextually driven, and they will want to learn how to reliably enter what you could call a flow state, but I would scientifically call a parasympathetic state. So I tailor the training based on the needs of the individual, but it is some modulation of physiological states to then control behavioral outcomes and even how they feel.

6. 24:31 – 30:22

   Finding Your Ideal Breath Rate

   1. LLDr Leah Lagos24:31

   2. CWChris Williamson24:31

      Okay. So-As far as I'm aware about your process, there is a particular breath rate between 5-point-something and 6-point-something?

   3. LLDr Leah Lagos24:41

      Yeah. So it's, it's generally between five breaths per minute and 6.5 breaths per minute.

   4. CWChris Williamson24:47

      Cool.

   5. LLDr Leah Lagos24:48

      Yes.

   6. CWChris Williamson24:48

      So, there is a particular rate, which is indivi- uh, uh, it's individual for each person.

   7. LLDr Leah Lagos24:53

      Okay.

   8. CWChris Williamson24:53

      When you find that, that helps based on the rate at which your heart beats and the way that it beats, the breathing in and the breathing out at that particular pace can help to amplify or, getting it wrong, to make worse your HRV. You're suggesting 15 minutes in the morning and 15 minutes in the evening, so twice a day, and the first four weeks is you trying to basically dial in what is that particular breath rate. And then we sort of move forward from there.

   9. LLDr Leah Lagos25:21

      So, so almost. Uh, that, that was great, and, and, and I love that explanation. So generally in the first session, we identify resonant frequency, that rate between 5 to 6.5 s- uh, breaths per minute. And, um, then we do a little, a little extra fixing on the side and helping to, to breathe from the abdomen on the breath.

   10. CWChris Williamson25:47

       Sure.

   11. LLDr Leah Lagos25:47

       Um, and also then learning to be able to inhibit other thoughts. And so there are pieces of this that I've, I tailor in, and I talk a little bit, uh, about in my book, but to activate the prefrontal lobe. And one of the pieces, since we're talking about HRV and the brain a bit today, is to make sure to use the pacer that's set to your resonant frequency. If you close your eyes or listen to music, you won't have the same cognitive effects. When you look at a pacer, matching your breathing to the pacer, y- it's a two-for-one a little bit because you're optimizing oxygen and blood flow all over the body, especially to the prefrontal lobe while training attention. So it's maximizing the, the cognitive enhancements.

   12. CWChris Williamson26:36

       A pacer is just some sort of cue, maybe on a screen, something like that?

   13. LLDr Leah Lagos26:41

       Right. And there's several different ones on the iPhone and the Android. If you just type in breath pacer, you can find the one you prefer. Some are just a line going up and down, some are balls that expand and contract. I have an, um, an app on a Elite HRV that walks you through my 10-week protocol. Y- y- you're welcome to use that if you like. There's many. But that watching the pacer as you do your practice 15 minutes twice a day does make a difference in terms of the cognitive impact of the training.

   14. CWChris Williamson27:10

       Okay. So you have this 15 minutes twice a day.

   15. LLDr Leah Lagos27:14

       Mm-hmm.

   16. CWChris Williamson27:14

       Is the assumption from you methodologically that those 15 minutes sessions will begin to bleed into your breath rate outside of that session-

   17. LLDr Leah Lagos27:26

       Yeah.

   18. CWChris Williamson27:27

       ... getting closer to that? How long does it take? Because I breathe at whatever rate I breathe at, s- s- 6.8 breaths per minute throughout the day on average. Uh, how long does it take to do two 15-minute sessions a day to basically reprogram my breath rate? That seems like a very big change to come from only 30 minutes a day.

   19. LLDr Leah Lagos27:46

       So it does, and you're absolutely right. It does become your habit. But what I'm really targeting is training your heart. So, so that the rhythms, the resonant frequency rhythms are going to be different when you breathe, let's say that first week at resonant frequency versus just your natural baseline. But I want the rhythms from your resonant frequency to be your baseline. And the heart is a muscle.

   20. CWChris Williamson28:11

       Breath rhythms or, or heart rhythms?

   21. LLDr Leah Lagos28:13

       Heart rhythms.

   22. CWChris Williamson28:15

       Okay. So you're training the heart more than you're training the breath during these 15-minute sessions. Is that right?

   23. LLDr Leah Lagos28:21

       Correct. And subsequently, you train the breath after seven to eight weeks. But first and foremost, you train the heart. And by week four, I start to see the heart pattern that we, that I teach at, at Breathing at Resonant Frequency to begin occurring just at their baseline.

   24. CWChris Williamson28:41

       That's interesting.

   25. LLDr Leah Lagos28:42

       Mm-hmm.

   26. CWChris Williamson28:42

       So how long or how much work is required after going through your protocol of 10, 12 weeks, how much work is ma- is required to maintain those gains afterward? If I stop after 10 weeks, do I just go back to normal?

   27. LLDr Leah Lagos28:58

       Doesn't matter. Right. So, n- you have to, you still have to do some breathing, not the, not the same level. And what I recommend is to breathe three to four times a week, at least for 15 minutes. So it's, it's kind of like calf raises in a sense, Chris. And once you get to a certain level of, of the muscle you wanted to develop, you don't have to push as hard to maintain it, but you do have to exercise it.

   28. CWChris Williamson29:27

       Mm-hmm.

   29. LLDr Leah Lagos29:27

       Uh, people, it's, it's not a perfect algorithm. Uh, people will say they are fine with twice a week. Other people will say, "I just need to do once a day, five days a week." Other times, I'll have people that will come back and just say, "You know, the cognitive impact, the, the screen door effect, where I can screen out what's not important and really focus on what is, is kind of waning after nine months. I wanna just do a surge for another 10 weeks." And we do. So, so if you notice the benefits minimizing, then, then you up it. And sometimes, it's less. Maybe it's two weeks of going back to every day 15 minutes, and you're feeling great again, and then you titrate. So you don't have to breathe for the rest of your life for 15 minutes twice a day. But you do have to do some breathing. And I would just base it on how you're feeling and what you're needing to maintain.

7. 30:22 – 35:07

   How We Should Breathe Throughout the Day

   1. LLDr Leah Lagos30:22

   2. CWChris Williamson30:22

      W- how should we be breathing throughout the day outside, when we take it off the cushion, so to speak? What is your advice to your elite performance clients on what they should be doing and what they learn in week, whatever it was, six to 10 or eight to 10?

   3. LLDr Leah Lagos30:36

      Yes, I love that question. I believe if we had everyone really understanding the powerful impacts of breathing, not only on how we feel, but how we make decisions and how we behave, we'd have a very different world. And there are ways to use the breathing to enhance health, and so, particularly in moments that bring someone anxiety, and then taking what I call a power five, focusing just on that feeling of the crisp, fresh air through the inhale, and then letting go of the fear or the anxiety on the exhale to reset. And they can take those small intervals as needed. But there are also kind of fun ways to use this to enhance functioning in other aspects of one's life. Uh, parents might use this in terms of with their own children and, and being able to flexibly, flexibly respond to multiple children asking many needs at a time, and before responding, taking a power of five or doing it with their kids (laughs) all together. And, and we should talk about that. Physiological connectivity is real, and it's really amazing. Um, but, um, finding moments that, that you either want to have more control over how you're responding and, and be able to create a desired response, or enhancing cognitive functioning, mental clarity-

   4. CWChris Williamson32:01

      Mm-hmm.

   5. LLDr Leah Lagos32:01

      ... objectivity for decision-making.

   6. CWChris Williamson32:03

      Well, let's, let's go into that. Explain to me, uh, g- give me a couple of protocols and also, I think importantly, the cues of how people know to do the protocol. Um, w- what are some of your favorites? What are the ones that give the most benefit?

   7. LLDr Leah Lagos32:17

      Sure. So, many athletes, professional athletes, whether NBA or PGA Tour, will notice their mind racing. And it, it can be even something that, something great that happens, a birdie (laughs) on the golf course, but their mind races. The sympathetic arousal sets in, and, and their mind is racing. And so as they're walking from, uh, hole to hole, they're practicing their breathing, counting four in, six out, to clear the mind and also return the body to their baseline self. It's not-

   8. CWChris Williamson32:52

      Four in.

   9. LLDr Leah Lagos32:53

      One.

   10. CWChris Williamson32:53

       Six out.

   11. LLDr Leah Lagos32:54

       Correct. And what's interesting about adding the counting, Chris, is you can't count and think at the same time. They require the same part of the brain. So for many people, the counting with the breath, and this is not for the 15-minute twice-a-day practice, that's too much, but this is for, uh, kind of epic, e- epic-of-time uses to use the counting while, while they're taking a few breaths to quickly enter their desired baseline state.

   12. CWChris Williamson33:23

       Yeah, I guess anyone that's tried to do breath counting during meditation knows that you lose the count when you also lose your focus. It's very difficult to keep on top of that as you're going in and out. It's like playing music over the top of a sound that you don't want to hear. You can kind of really only hear one of them, the loudest sound at one time. Okay, um, what about... So, four in, six out, longer on the exhale.

   13. LLDr Leah Lagos33:47

       Mm-hmm.

   14. CWChris Williamson33:47

       What are some cues-

   15. LLDr Leah Lagos33:49

       Mm-hmm.

   16. CWChris Williamson33:50

       ... that you like to give people to remind them, "Hey, this is something that you need to pay attention to. This is something that you haven't done yet today"?

   17. LLDr Leah Lagos33:57

       So you... Uh, for some people, they love being able to use this on demand if they have a racing mind or a heart rate that speeds up. We'll identify physiological responses that would necessitate using, let's say, the power of five to return to baseline. There are other people that, that just want to use this during the day to keep them calibrated without any specific need and still do things like set their phone and to, to vibrate at three different points during the day, just so they can have a quick reminder to take five resonant breaths and recalibrate. In other instances, I like to pair it with habits for people, let's say eating. So before, (laughs) before sitting down to have breakfast or lunch or dinner, um, they, they take a moment to take five breaths. And this doesn't have to be eating, but it can be some other regular activity so that, so that this becomes a way not just to bookends at the start and end of e- every day, but a way to stay calibrated and open and engaged with the world without kind of the energetic expenses of the world coming at them.

8. 35:07 – 39:08

   Impact of Nasal Breathing on HRV

   1. LLDr Leah Lagos35:07

   2. CWChris Williamson35:07

      Nasal breathing. Ever since James Nestor wrote, uh, Breath, a fantastic book, he came on the show to talk about it. Uh, nasal breathing's kind of another hot new girl in school at the moment. What has your research showed about the impact of nasal breathing on HRV, and what do you see as being the best, uh, facial strategy when it comes to maximizing HRV training through breath?

   3. LLDr Leah Lagos35:34

      Oh, that's... So, it's interesting, and I've had many clients who've read James Nestor's book, and, and I have so much deference for his work. Um, and, and we evaluate. And I've had a few instances where the nasal breathing has shown over the, what I call the pursed-lips breathing, where you inhale through the nose, but exhale through the mouth, maximize their HRV. But in most instances, that's not what I've seen. And, and in more instances than not, the inhale through the nose and the exhale through the na- the mouth leads to increases in HRV i- when we test it in the moment. Um, I've also had people specifically say, "Well, I feel better one way or another," and, and I'm going to defer to the person. I don't believe, Chris, that there is a one-size-fits-all, and I, I very much honor when someone says, "This makes me feel this way."... then, then I'm going to defer to it, and we're going to work with it. So what's interesting, I don't have my clients take a pause at the top of their breath before they exhale, but every once in a while, I'll say, someone will say, "I need that pause." So, so we incorporate it. And, and there's just nuances for everyone's nervous system. So just succinctly, to answer your question, I have not seen, uh, that the nasal breathing produces HRV gains that are, um, more than the inhale through the nose and the exhale through the mouth. There is something about the inhaling through the nose and the exhaling through the mouth that increases what's called peak expiratory flow and leads to cardiovascular effects. So my endurance athletes, including my golfers on the tour, will say, "Doc, at week seven, my training hasn't changed, and I'm just not tired on hole eight anymore. What's happening?" And, um, that I haven't found to happen with the nasal breathing, but we certainly could explore it more.

   4. CWChris Williamson37:38

      Who are some of the clients that you work with? What, w- what are some of the illustrious heights that they've got to?

   5. LLDr Leah Lagos37:48

      (laughs) I have, I have worked with NBA coaches that, um, have, have done extremely well, um, in the NBA. I've worked with hedge fund owners, PGA Tour players, the Masters, Olympians that PR'd. And what I love about HRV and the training of this process is that it helps any individual maximize their elite self. And, and so, it, it's not s- it's not sports-specific or situation-specific. If you are an incredible... And I've worked with, uh, one of the top dancers at Martha Graham, and, and she had incredible experience going through this training and, and being able to reduce performance anxiety, and, and have one of, what she called, her best performances on stage. But what I love about this is, it takes anyone and any talent, and allows them to remove the anxiety or the fear, and then consistently be able to stay at a bandwidth of, of, of their maximum talent and abilities, and, and to be able to inhibit other factors that would detract from it.

   6. CWChris Williamson39:06

      So

9. 39:08 – 44:30

   Is This More Beneficial Than VO2 Max?

   1. CWChris Williamson39:08

      the, the big question that I've had since learning about your work, I have a friend, Yousef, who went through your, uh, protocol at the start of this year. And a question that both of us had in the back of our mind is, what is the relative effect of simply training VO2 max, i.e., increasing your fitness, versus resonant breathing practices?

   2. LLDr Leah Lagos39:32

      Mm-hmm. They work beautifully together, and that's why you see athletes with these incredible HRV scores. And I wouldn't say one is better than the other, but what the HRV does that the VO2 max does not is developing a reflex that kicks in on its own, unconsciously, to help you modulate stress.

   3. CWChris Williamson39:57

      Right. What do you see as the role, then, of VO2 max training? Um, uh, uh, also, what about the role of low and slow versus VO2 max? I'm sure, even if this isn't your area of expertise, you must have an awful lot of insight into this, 'cause your clients are going to come to you, and they're gonna say, "Doctor, do you need me to stay in zone two for 45 minutes a day, three times a week, or would you rather me try and get up to maximal, uh, sort of 90% plus heart rates for 10 minutes twice a week?" Wh- wh- what do you know? What's your insight when it comes to fitness training for HRV improvements? What does the research say?

   4. LLDr Leah Lagos40:36

      That this enhances recovery, and, and it allows for the heart rate to stay lower for activities during-

   5. CWChris Williamson40:46

      No, no, no, no, no. So i- i- in terms of protocols of training, if somebody was to do a physical training, uh, protocol-

   6. LLDr Leah Lagos40:53

      Mm-hmm.

   7. CWChris Williamson40:53

      ... what do you tend to suggest to your clients? Are you saying, "I want you to focus more on zone two. I want you to focus more on your VO2 max work."? Wha- from a physical perspective, what do you, what do you tend to advise?

   8. LLDr Leah Lagos41:03

      That's, that's not a specifically an area of training that I incorporate.

   9. CWChris Williamson41:08

      Mm-hmm.

   10. LLDr Leah Lagos41:08

       Sometimes I'll work with athletic trainers, and we'll compare data, and-

   11. CWChris Williamson41:12

       Mm-hmm.

   12. LLDr Leah Lagos41:12

       ... and our goal is to collaboratively kind of integrate for a specific outcome. Um...

   13. CWChris Williamson41:20

       Have you ever... Uh, uh, are there any learnings that you've taken away from that? Are there any, uh, particular protocols that you've found where you go, "Wow, this seems to reliably improve HRV from a training perspective"?

   14. LLDr Leah Lagos41:33

       Mm-hmm. That's a great question. I, I've had some... I'll, I'll tell you some trainings, yes, uh, some kind of unexpected, um, data collections and, and so forth. So, um, sometimes I will see that running, for specific individuals for a specific distance, has an incredible impact on their HRV. Not all. And, and sometimes, it's, it's... S- I've seen that with swimming as well. And, um, the amount, the distance run is really interesting, because for one person, it's three miles, and for another, it's six. And, a- and, and, and finding what distance and what frequency, and measuring it with HRV, um, can be really insightful. The kind of unexpected ones, uh, I've seen acupuncture improve HRV. I've also, and this is kind of a funny one, but, um, I've seen two people, actors-... that don't know each other, come from energy healing, and, and they show up at my office, and, and on both of those occasions, and, and throughout their training, I, I kept saying what was happening. And it didn't improve their baseline, but when they came directly from that session, I could see in the moment that their HRV was uniquely higher than normal and their parasympathetic state more easy to access. Um, there... I've also seen people take supplements that augment HRV.

   15. CWChris Williamson43:11

       What are some of those?

   16. LLDr Leah Lagos43:12

       Uh, I have no affiliation with it, but LYMA. LYMA is a supplement that, uh, has a scientific formula to-

   17. CWChris Williamson43:23

       L-Y-M-A?

   18. LLDr Leah Lagos43:25

       Correct. To, uh, to optimize... It has antioxidant effects, anti-anxiety effects, and to improve sleep. Um, people take it for various reasons. It's... And again, I have no affiliation with it, but I had enough clients tell me about it, and we measured it, and, and I measured also their sleep, (laughs) um, a- as related to HRV, and we saw improvements in both. So it's interesting.

   19. CWChris Williamson43:49

       Maeve, is it a supplement or is it a laser that you put on your skin?

   20. LLDr Leah Lagos43:52

       That's separate, but I can also tell you a funny story about, uh, light exposure, which is applicable, um, that I've had people use different lasers, I've, I've had people use the Varilux lamp and put it next to their computers, and I've, I have many times, more times than not, also seen how that impacts HRV. So what's interesting is to use HRV as a metric to determine the effectiveness of an intervention.

   21. CWChris Williamson44:22

       Mm-hmm.

   22. LLDr Leah Lagos44:22

       And it's making changes on your autonomic nervous system, HRV will reflect it, and, and it's a reliable measure.

10. 44:30 – 48:13

    What People Get Wrong With HRV

    1. LLDr Leah Lagos44:30

    2. CWChris Williamson44:30

       Talk to me about what people get wrong when it comes to measuring HRV. There's a million ways to do it, there's lots of different wearables. What are the worst and the pitfalls, and what are the best ways to do it?

    3. LLDr Leah Lagos44:42

       Nocturnal HRV is a fairly reliable way to measure heart rate variability, 'cause there's generally less movement at night and less variables impacting you. But of course, a measurement after a lot of drinking or eating late or specific stressors are going to skew that. I've had people have foot twitches, and then their HRV is not reliable, and so it's not perfect. And if you see abnormal numbers, there's... Generally, there's something happening with the wearable or there's a specific behavior occurring in the moment to make it an aberration, and there's no need to panic. You just... You want to collect data. And I always say, "All data is good data." (laughs) It leads to, to understanding. Um, the Oura ring can be really helpful for tracking HRV, uh,

    4. NANarrator45:35

       Mm-hmm.

    5. LLDr Leah Lagos45:35

       ... Elite HRV Pad, uh, sensor, a CorSense polar for measuring HRV in the moment is also helpful. But when you're walking or talking, your heart rate variability is going to change. And so one of the things people will see, increases in HRV on Oura, and they don't understand it's movement-related. Even at night, if they had a really restless night of sleep or were up and down to help children or go to the bathroom, their HRV, HRV reading is going to be skewed.

    6. CWChris Williamson46:07

       Mm-hmm. Yeah. That's, that's one of the things that I learned. Uh, Joel Jameson has been on the show, Bry- uh, Br- Brian Mackenzie also been on the show. Um, you know, both of those guys are talking about one of the challenges you have when wearing a lot of wearables, that throughout the night, they take these snapshots, but these s- snapshots are dependent on what's sleeping position are you in, are you awake or are you not? And unless you have something which is continuous... Whatever happened to that CorSense thing that, that you guys had?

    7. LLDr Leah Lagos46:37

       It's a question I had to call Jason Moore and ask, because it was very good, and the way to use it was to take it as soon as you woke up in the morning, and then you could reliably (laughs) measure your HRV across time.

    8. CWChris Williamson46:47

       Mm-hmm.

    9. LLDr Leah Lagos46:47

       And, uh, and I, I have to, I have to give him a call. I don't know if they, they ran out or, but-

    10. CWChris Williamson46:54

        Yeah. For the, for the people that don't know, there was a, a fingertip HRV-

    11. LLDr Leah Lagos47:00

        Mm-hmm.

    12. CWChris Williamson47:00

        ... sensor thing that you guys were, like, quite highly affiliated with, at least for... Uh, this is one of our suggested, uh, measurement devices. And, um, yeah, I thought that was a great idea. I couldn't get it in the UK, and then by the time that I moved to the US, it had stopped, uh, shipping. So I think you guys suggest polar straps and a, a, uh, a few other bits and pieces.

    13. LLDr Leah Lagos47:19

        So polar is great, and, and has fairly high scientific reliability, such that you can even publish research off of it. And, um, it allows you to capture HRV in the moment as well as at sleep, uh, at night. So you have that optionality. So I'm a, I'm a big fan of the polar. You can also download it to your phone. And so I've used it with coaches and, and specifically NBA players to be able to get a sense of where they're at right before a game. Are they in a sympathetic or parasympathetic state? And then we play games, like how to bring your heart rate down by five beats in two breaths. Can you do it in one breath? Can you do it in half a breath? And so, uh, so, it's, it's a very simple way to increase HRV and, and also to allow someone to enter into a competition in, in an ideal performance state.

    14. CWChris Williamson48:12

        Are

11. 48:13 – 51:51

    Recommended Vagal Practices

    1. CWChris Williamson48:13

       there any other vagal practices-

    2. LLDr Leah Lagos48:16

       Mm-hmm.

    3. CWChris Williamson48:17

       ... that you recommend or that you like?

    4. LLDr Leah Lagos48:21

       There... It, it's interesting. There are a host. There's something that... There are different places in New York and California, I don't know how popular it is all over the world, sound baths. And, and you go into, uh...... training center or a spa, and, and they use different instruments to produce different sounds. The vibrations are really fascinating because they do activate the parasympathetic nervous system, and of course, I've collected the data on that. (laughs) And, and it does persist for some people for beyond the moment, um, with the... But what I really think people should understand is before trying to add all of these different interventions to increase vagal tone, or, uh, to get into a parasympathetic state, or even to increase parasympathetic state at baseline, is to understand thyself and measure what really helps to calibrate their most elite self, what amplifies and also detracts from them, and then what their goal is. And you can even do things like, "Well, how many days of the week am I in my top 25% of HRV?" So if your best days are Saturday and Sunday, but you're training, competing, making decisions Monday through Friday, we have a, we have-

    5. CWChris Williamson49:47

       Mm, mismatch.

    6. LLDr Leah Lagos49:48

       ... a frequency problem. Right. Um, and, and so that would be the where I would start for most people, and then after they have a sense of their HRV range and the variables that amplify and detract, then committing to 10 weeks or 10 to 12 weeks of the HRV training, breathing 15 minutes twice a day at their resonant frequency. The reliability is really important. You're training the biggest muscle in your body, your heart, but without the training that stimulates the baroreflex at that certain algorithm, you don't get the result. If you do exactly what I've asked, the 10 weeks, twice a day, 15 minutes, it works. But I've tried, uh, uh, you know, I've had people call me from India, "Kris, can I, doc, can I work with you for 10 days?" It doesn't work like that.

    7. CWChris Williamson50:35

       Hm.

    8. LLDr Leah Lagos50:35

       It's the chronic stimulation of the baroreflex at this rate, 15 minutes twice a day, 10 weeks, to reliably increase baroreflex gain, and, and really gain control over the modulatory mechanisms of how you anticipate, respond, and recover from stress.

    9. CWChris Williamson50:54

       Is there such a thing as a non-responder to resonance breathing?

    10. LLDr Leah Lagos51:01

        Yes, but at first, and then it becomes a bit of detective work to understand why. And so if someone is not responding to the resonant frequency breathing, then we begin to talk about what's happening in their life, whether it is a, a, a chronic almost paralyzing state of stress, um, it's a lack of recovery, it's over-training, and, and then we address it. And, um, after we take away that variable, then HRV training works across ages, uh, around the world, and, and it's just a commitment to time and disciplined breathing at resonant frequency that produces the results.

12. 51:51 – 55:00

    Common Pitfalls in HRV Training

    1. CWChris Williamson51:51

       What are the most common pitfalls when someone does their HRV training? Let's say that someone thinks that they're a non-responder, and they're going through the checklist of particular things. Is it that they've got their frequency wrong, they've detected it wrong, and they're trying to breathe at the wrong rates? Is it... What, what are the, uh, common errors?

    2. LLDr Leah Lagos52:09

       It's, it's funny. It may surp- it may surprise most people. It's not breathing at the wrong rate. Even if you breathe .2 seconds off, you're still going to have salutary health positive benefits. It's the trying so hard, that, "I have to make this perfect. I have to make this time meaningful," that they don't actually let go in the moment, and they put so much pressure on themselves that they, they minimize the impact of the training. So... And I've seen that happen a few times, and, and then what I'll say is, "I want you to make this your spa time or playful, and, and I, I want you to be playful about your breathing, light, gentle." And the more, and it, it, it's really true, the more you can enjoy it, the more the benefits will find you.

    3. CWChris Williamson52:59

       Isn't it interesting we're trying to go bottom-up to teach our nervous system that this is safe, that you are okay as you are, that you can deal with this, to expand that, uh, autonomic flexibility so that the brain then is, is given the room to be able to make better decisions? And in the process of trying to do bottom-up training, a top-down problem comes in.

    4. LLDr Leah Lagos53:24

       (laughs) It happens.

    5. CWChris Williamson53:24

       Yeah. How funny?

    6. LLDr Leah Lagos53:26

       Yeah, yeah. The other condition I've seen interfere with the immediate effects of HRV is PTSD. And, and so if you take someone who has just experienced a traumatic event, their body is in such a startle state, it takes time, but don't give up. The HRV biofeedback can work for you. It can work for anybody that's gone through a source of trauma. It's, it's just sticking with it and being persistent, and sometimes in those cases, I'll pair a memory of feeling safe. It's not the memory, the cognitive, it's the feeling. And so it's really interesting. You can, you can help someone access physiological imprints. For many people, men too, leaders of huge corporations, software companies, uh, banks. Uh, I mean, one of the most potent times people have felt safe or a sense of connection is holding their child for their first time, men as well as w- women, and, and recreating a, a feeling of safety, going back to an imprint that exists, connecting to it on the inhale, and letting go o- of the rest of the world. So if you're feeling stuck, I would, I would also add connecting to a time in your life you felt really safe, connected, or a sense of love, and letting go of trying so hard. And, and persisting with the practice, it, it does help everybody. It just, sometimes it takes just a little more time to start.

13. 55:00 – 55:44

    Where to Find Leah

    1. LLDr Leah Lagos55:00

    2. CWChris Williamson55:00

       Hell, yeah.

    3. LLDr Leah Lagos55:00

       (laughs)

    4. CWChris Williamson55:01

       Dr. Leah Lagos, ladies and gentlemen. Where should people go? They wanna find out more of this. They're gonna follow the program.

    5. LLDr Leah Lagos55:06

       So my program for heart rate variability biofeedback is in the book, Heart, Breath, Mind. It's on Amazon. It's Barnes & Noble. It's at local distributors around the world. Um, and if you want to also connect with me, my website is drleah, L-E-A-H, lagos, L-A-G-O-S .com.

    6. CWChris Williamson55:30

       Damn right. Leah, I appreciate you. Thank you for today.

    7. LLDr Leah Lagos55:33

       Thank you, Kris. Such a pleasure.

    8. CWChris Williamson55:34

       If you enjoyed that episode, you will love a selection of the best clips from the podcast over the last couple of months, and it's available right here. Go on, give 'em a watch.

Episode duration: 55:45