If you have chronic insomnia, you may have developed anxiety about sleep. I had lots of sleep-related anxiety until I went through sleep restriction. Once my sleep stabilized, the anxiety disappeared.
If you go through cognitive behavioral therapy for insomnia (CBT-I), your therapist may address sleep-related anxiety by challenging some of your ideas and beliefs about sleep. This approach works for some insomniacs, research shows. But others remain anxious at the approach of bedtime and look for alternative treatments.
Studies have shown that cranial electrotherapy stimulation (CES) is modestly effective at controlling anxiety. It’s not endorsed as an insomnia treatment by the American Academy of Sleep Medicine. But it’s FDA approved and widely used in the armed forces for anxiety, PTSD, insomnia, and depression. Here’s more about it.
What CES Is and Does
CES is a treatment you administer on your own with a device that sends mild, pulsed, alternating electrical current to the brain via electrodes placed on the earlobes. When the device is turned on, most people feel nothing at all (a few report feeling a slight pulsing at contact points on the earlobes).
The electrical pulses trigger changes in the brain. When UCLA researchers used a functional MRI scanner to look inside the brains of people undergoing CES, they found evidence of two things:
- Decreased neural activity in three areas of the brain: the frontal, parietal, and posterior midline regions.
- Altered connectivity in the default mode network (DMN). The DMN is a network comprising several areas of the brain that are active during restful alertness, daydreaming, thinking about self or others, remembering the past, and planning for the future. It’s activated by default, when your attention is not focused on performing a task or on some aspect of the outside world.
Why CES Might Help
A device that decreases neural activity might be useful for people with insomnia, which is associated with hyperarousal. Or, by introducing high- or low-frequency cortical “noise,” CES may change activity in the cerebral cortex in helpful ways. It might produce an increase in alpha activity (associated with relaxation), as other studies have shown.
CES may also achieve its effects by altering communication between the nodes of the DMN. Studies of people with depression and anxiety have detected abnormalities in these connectivity networks—abnormalities whose effects may be lessened with CES. Changes in the DMN may help people disengage from worry and rumination and/or focus on things outside themselves.
Safety and Effectiveness of CES
Studies of CES suggest that devices such as Alpha-Stim, the Fisher Wallace Stimulator, and CES Ultra are quite safe. The FDA reclassified the devices two years ago. Now they’re in the same risk category as acupuncture needles and power wheelchairs. Adverse effects from CES—such as headaches and skin irritation under the electrodes—are rare.
As for effectiveness, while several controlled trials of CES have been conducted, the only consistent result obtained is that compared with sham treatment, CES was effective in reducing anxiety.
In a recent survey of veterans and service members using CES devices, 67% of the 145 who answered all the questions reported improvement in anxiety; 63%, improvement in PTSD; 65%, improvement in insomnia; and 54%, improvement in depression. But many of the respondents were also using medication for symptom mitigation, so it’s hard to know how much of the benefit was due to the CES device and how much, to medication.
If you try using a CES device (or if you tried one in the past), please comment on whether it helps.