If you’re leery of sleeping pills and haven’t fared well with cognitive behavioral therapy, maybe it’s time to think outside the box. There are quite a few alternative treatments for insomnia. Among the least known is Cranial Electrotherapy Stimulation, or CES.
The “electro” in CES might give pause, recalling cruel shock treatments that characters in movies like One Flew Over the Cuckoo’s Nest were forced to undergo. As practiced today, that form of treatment–Electroconvulsive Therapy–delivers 800 to 1,000 milliamperes (mA) of current to the brain, inducing seizures to relieve severe mental illness.
In contrast, CES is a treatment you administer on your own with a device that delivers 1 to 4 mA of current to the brain. The sensation it produces ranges from a slight pulsing at contact points on the earlobes or the head to nothing at all. But proponents claim this tiny amount of transdermal electricity has the power to relieve anxiety, depression and insomnia. In June the FDA announced it would soon grant approval of CES for the treatment of these disorders with fewer restrictions and reclassify CES devices as belonging in the same risk category as acupuncture needles and power wheelchairs.
What Does CES Do to the Brain?
The claim is that CES can relieve insomnia, but so far there are only theories about how it works. Studies suggest that CES alters electrical activity in the brain, deactivating neurons in the cerebral cortex and down-regulating activity in other parts of the brain. Alpha waves, associated with relaxation and focus, are slowed and become more prominent.
Other mechanisms of action have also been proposed. CES may 1) promote the release of endorphins and other neurotransmitters that inhibit arousal and agitation, or 2) stimulate peripheral nerves, triggering processes that calm the brain. The particulars are not known, but any or all of these actions could give relief to people with insomnia.
How Safe Are the Devices?
The FDA’s reclassification announcement suggests that the risks associated with CES devices such as the Fisher Wallace Stimulator and the CES Ultra are low. Of 57 service members recruited to participate in a randomized controlled trial of the effects of CES on insomnia, one subject in the active treatment group complained of a headache and another reported sleeping worse after a single session.
Fisher Wallace states that 1 in 500 users experiences a mild headache and 1 in 250 experiences an increase in wakefulness immediately following treatment sessions. I haven’t been able independently to confirm these figures. But Kirsch and Nichols, reviewing studies of CES in an article in The Psychiatric Clinics of North America, note that “adverse effects are rare (<1%), mild, and self-limiting, consisting mainly of skin irritation under the electrodes and headaches.”
How Well Does CES Work as an Insomnia Remedy?
Now we’re on shakier ground. Of 18 studies of the treatment’s effects on mood and level of arousal, only 2 were rigorous enough to be included in a meta-analysis conducted by Klawansky et al. in 1995. These researchers concluded that CES was better than sham treatment only for anxiety—and not for insomnia. (But . . . insomnia and anxiety are closely related, so you may be heartened by this result.)
Scientists who study sleep and insomnia remedies haven’t shown much interest in CES. In the study of service members cited above, subjects received 5 treatments or 5 sham treatments. Male subjects, more numerous than females, reported sleeping nearly an hour more after the first and fourth sessions of active treatment. Female subjects did not. Overall, the results were “encouraging but not decisive,” identifying a “nearly significant” increase in total sleep time among all subjects after the third treatment. “Nearly significant” is not a slam dunk.
The results of older studies are mixed, suggesting that CES may help people with insomnia fall asleep more quickly and sleep more efficiently. Clinicians offer mostly favorable reports of CES on the Internet, but nothing more decisive is known about its effects on insomnia.
Liz, a librarian I interviewed for my book, wrote to ask about the Fisher Wallace Stimulator and said she thought it might be worth a try, given the company’s 60-day money back guarantee. I can’t vouch for it personally. But for people with treatment-resistant insomnia, it’s worth consideration.
If you have tried a CES device or try one out in the future, please share your experience here.