by Steward Levy R.Ph, MBA

One of the most researched and evidence-based tools available for managing health and performance is Heart Rate Variability (HRV) biofeedback training. HRV biofeedback training teaches employees how to self-regulate their emotions which has been shown in over 200 studies to reduce symptoms of stress while improving mental, emotional, and physical health. Case study results with healthcare workers, manufacturing workers, and teachers have shown increased productivity and teamwork, reduced turnover, reduced absenteeism, improved worker safety, and reduced healthcare costs [1].

HRV biofeedback from devices and apps provides visible evidence that our emotions have a subsequent impact on our heart rhythms, which change in real-time, as we shift from stressful emotions to positive emotional states. Coherent heart rhythm patterns facilitate higher brain function for a greater sense of well-being and a positive outlook follows resulting in improved relationships, communication, and creativity. Incoherent heart rhythm patterns inhibit higher brain centers and impair mental decision-making, exacerbate fear, and can affect physical health.

HRV monitoring – Daytime vs. Night time 

The most popular devices that measure HRV while you sleep are Oura, Whoop, Garmin, CardioMood, Apple, Withings, and Biostrap. All of these devices also support daytime measurements and biofeedback with the exception of CardioMood. Devices and Mobile Apps that are focused on real-time HRV biofeedback include, HeartMath, EliteHRV, HRV4Biofeedback, Sensie, Oxa Life, and Lief.

There are different applications when measuring HRV during sleep and during the day. One study found that HRV during sleep is generally higher than HRV during the day, possibly due to decreased activity and external stimuli during sleep [2]. Another study found that daytime HRV measurements can vary depending on the time of day they are taken, with HRV almost twice as high around midnight than at mid-morning in younger people [3].

Measuring HRV during sleep can provide insight into the body’s state during rest and can be useful for identifying sleep-related disorders such as obstructive sleep apnea [4]. On the other hand, measuring HRV during the day can provide insight into managing the body’s response to stress, help with self-regulation to addictive situations, help manage trauma, and can be useful for assessing overall cardiovascular health [5].

Overall, measuring HRV can provide valuable biofeedback, and the choice of when to measure HRV depends on the specific emotional health program goals. Since biofeedback requires training rather than treatment, it can be used to help people change and develop new sustainable lifestyle management skills. This is an important opportunity for employees to work with a health coach who is trained in HRV biofeedback and to have a portal to capture the various biofeedback devices. To be successful, employees must play an active role during the training and learn to practice on their own. Employers should also ask their mental health providers if HRV biofeedback is being utilized to improve well-being and to measure outcomes on their programs.

Stewart Levy R.Ph, MBA. is the CEO and founder of HealthWell Corporation a population health management company focused on the prevention, management, and implementation of evidence-based wellbeing solutions. HealthWell Corporation provides clinical services including health screenings, workshops, digital health tools, and software solutions to help employers improve employee health and manage healthcare costs. Clients include Leading Employers, Insurance Companies, Healthcare Systems, Retail Clinics, and Occupational Health Clinic Providers.



Heart Math Institute –