Review: Pulsetto

In the interest of full disclosure, I’m suspicious of wellness gadgets. Can a single piece of Bluetooth technology really improve my sleep, boost my mood, lower my anxiety level, and increase my resilience to stress? Pulsetto is the latest nondrug health wearable promising to do just that, by using ultra-low radio frequency energy to stimulate the vagus nerve in the neck.

To test these bold claims, I used the Pulsetto neckband for over a month, to see what impact it would have on my health and general well-being.

Yes, I’m coming into this review with a sense of skepticism (would you want your review journalists any other way?), but with so many potential benefits on offer, and “no prior mindfulness or meditation experience required,” if it can help this cynic, just imagine how much it could benefit someone actively looking for help?

Photograph: Pulsetto

The Pulsetto stimulates the vagus nerve, which is the main thoroughfare for your parasympathetic nervous system. This is the calm, restful end of the nervous system, responsible for body functions like immunity, digestion, heart rate, and mood. It’s the opposite of the sympathetic nervous system, which triggers fight-or-flight responses to stressful situations.

Pulsetto claims that vagus nerve stimulation, or VNS, can essentially kick-start your parasympathetic nervous system, helping you to reduce stress in the body.

Now, VNS isn’t new. Anyone who has ever been told to “take a deep breath” during a stressful situation is being prescribed one simple method for stimulating the vagus nerve. Other low-tech, tried-and-tested options include getting a foot rub, meditating, practising yoga, taking a cold shower, and even singing.

VNS has also been used by medical professionals for years, first as a treatment for epilepsy in the 1990s, as pain management for chronic cluster headache sufferers, and as a potential help for people suffering from long-term depression.

According to the Royal College of Psychiatrists in the UK, there are two types of VNS. The first involves having a battery and stimulator implanted under the skin, with a wire connected directly to the vagus nerve. The other is transcutaneous VNS (tVNS), where the vagus nerve is stimulated by holding a device against the neck where the nerve is. It's this tVNS that is the technology behind Pulsetto.

It's worth mentioning that the Pulsetto isn’t the only tVNS product available. Nurosym is a €699 ($870) device that uses an earpiece instead of a neck band to target the vagus nerve, while GammaCore, from £237 ($295), is a handheld device specifically designed for those who suffer from cluster headaches and migraines. This gizmo is also available by prescription from the NHS in the UK.

Another important bit of info: The Royal College of Psychiatrists states that “there is growing positive research supporting the use of implanted VNS for people who have had depression for a long time. However [due to problems with ‘blind’ trials], there is very little evidence to support the use of tVNS for treating depression.”

Photograph: Pulsetto

The Pulsetto is extremely easy to use, with a clear, icon-driven app that makes it perfectly clear what you’re supposed to be doing. In the box there’s a charging cable, plastic neckband, and tube of electrode gel. This is the same gloop used during ultrasound examinations, and it helps to ensure the best possible connection to your skin. The 60-gram tube goes a long way, and a 250-gram replacement costs just £3 ($3.75).

Once your neck is sufficiently lubed, it’s simply a case of turning the Pulsetto on, placing it around your neck, waiting for it to connect to the app (iOS and Android), and choosing your treatment. You can opt for sessions targeting stress, anxiety, sleep, burnout, or pain management, each lasting from four to 20 minutes. You can adjust the intensity of the session, and there’s feedback opportunities at regular intervals. Over time you can compare sessions and discover which intensity worked best for you.

What does a Pulsetto session feel like? It’s a little like a nervous twitch, with the stimulation causing an odd, but not painful, fizzy, pulsating feeling in my neck. It’s not a million miles away from a painless bout of pins and needles, or, for that matter, the sensation of licking a 9-volt battery. (Oh, please, we’ve all done it.)

As a typically sized (English) male, I had no problems with the fit of the Pulsetto, but when I asked a petite 5'6" friend to try, she found the neckband far too big for her neck. The contact points on the Pulsetto just didn’t touch her skin in the same way, and even with the intensity turned up she could feel very little. I checked the device, and it was already at its smallest circumference—so pencil neck jibes aside, it’s an issue worth flagging.

Most sessions last just a few minutes, with “pain management” being the longest at 20. Given how similar each of the sessions are—between 4 and 6 on an intensity scale from 1 to 9—choosing stress, anxiety, sleep, etc. seems like a clever placebo, given that the device only really does one thing. It’s akin to choosing a generic drug like paracetamol or ibuprofen specifically for back pain, simply because there’s a picture of a person with a bad back on the box.

Photograph: Pulsetto

Aside from the daily pressures of self-employment, parenthood, London life, and the escalating cost of living, I wouldn’t consider myself to be overly stressed, pressured, or strung out. I also don’t have a history of mental health issues. Compared to some, I may well be a fireball of pent-up neurosis, but the point is, I’m not actively worried or looking for help with stress. But that doesn’t mean I wouldn't benefit from a bit of calm.

Extracting myself from the bustle of life for a few minutes of Pulsetto time each day was a treat. It’s what apps such as Apple's Breathe have been prescribing for years—the benefit of a moment to chill with some deep breathing and enforced relaxation.

During the first few sessions with Pulsetto I couldn’t really tell you what, if anything, it was doing for me. I soon got used to the buzzing in my neck, but I didn’t come away from a session feeling any different. I wasn’t sure what I was looking for, but I certainly wasn’t finding it. I was, however, enjoying the stolen moments of peace and quiet regardless of the device itself.

Impatiently, I soon started to experiment with the intensity level, and I found the difference between levels 5 and 7 to be quite significant. Anything above 7 was too much for me, but at the higher rates I did at least start to feel some effects.

I didn’t suddenly turn into the Dude, but the feeling reminded me of experiments with CBD oil. Annoyingly, I intensely dislike the effects that CBD oil has on my mind and body, making me feel dizzy, with undertones of nausea. Dizziness is one of the common Pulsetto side effects, alongside local pain, muscle twitching, headaches, and tingling.

After a session—admittedly the ones at the higher intensities—it would often take a few minutes to feel normal again. Yes, the more I used Pulsetto, the more I got used to the post-pulse wooziness, but I could never marry these feelings with those of being less stressed or anxious. Maybe I need to work on myself more.

But is it working? Apparently stimulating the vagus nerve regularly for three to four weeks can also lead to a drop in heart rate and an increase in HRV (heart rate variability). According to the people at Whoop, my HRV (as a 45-year-old man) should be between 35 and 60. According to my Apple Watch health data, I hover around the 38-40 mark. Healthy enough, but no athlete. So the question remains, without altering my routine, would the Pulsetto improve my HRV?

Sadly not. Over a month or so (hands up, I did miss a few days here and there), there was no upward trend in my HRV data, which continued to fluctuate slightly as it is supposed to. Whoop suggests that minimizing alcohol, getting more sleep, and working out more can also increase HRV, but I wasn’t about to add any sadistic variables to this test.

According to Pulsetto, “80 percent of customers see a substantial improvement in their stress and anxiety levels after 3 to 4 weeks. The time necessary to see a difference varies from person to person and might range from 1 to 2 days to 4 to 6 weeks.” Well, this wasn’t the case for me.

After my initial misgivings I genuinely wanted Pulsetto to change my life. I wanted regular daily use to drop my heart rate and raise my HRV. I wanted to exude calm and radiate wellness. No such luck. If I were wracked with anxiety and desperately in need of a better night’s sleep, I’m pretty sure investing time in myself would go a long way to helping. While adding the Pulsetto into this mix might well assist to some small degree, in this particular instance, after a month of testing, I can’t help but feel that a foot rub could do the same.

Then there is the bigger issue at play here. The over-prescription of drugs is a serious matter, with time-pressured doctors (certainly in the UK) often quick to prescribe blood-pressure pills for the easy win, rather than suggesting patients should eat better and exercise more. And despite not being drug based, Pulsetto isn’t really any better, offering a supposed quick fix to the symptoms of stress, sleep issues, and anxiety, without ever addressing the root cause of the problem.