Anxiety, PTSD, insomnia, & depression respond to treatment with CESIf 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:

  1. Decreased neural activity in three areas of the brain: the frontal, parietal, and posterior midline regions.
  2. 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.

Posted by Lois Maharg, The Savvy Insomniac

Lois Maharg has worked with language for many years. She taught ESL, coauthored two textbooks, and then became a reporter, writing about health, education, government, Latino affairs, and food. Her lifelong struggle with insomnia and interest in investigative reporting motivated her to write a book, The Savvy Insomniac: A Personal Journey through Science to Better Sleep. She now freelances as an editor and copy writer at On the Mark Editing.


  1. After reading this post, I figured I had nothing to lose, as many of these companies offer a thirty day money back guarantee. I went with the CES Ultra through the company Elixa. I saw no change in my insomnia, but I was very impressed with the company’s customer service. The company shipped my device the same day I ordered it. I received it relatively quick, as they are in the US. I also received my refund (minus a 15% restocking fee) about three days after I dropped the package in the mail.



    1. Hello,

      Thanks for your review of this CES device and your comments about the company’s customer service. Too bad you got no relief for your insomnia—but at least you weren’t stuck paying for a useless device.



  2. These CES devices are not the same in how they stimulate and I keep looking for an article comparing the various products.

    My housemate is a veteran with mental health issues and PTSD. They got the Alpha-stim at the local VA clinic. He had a few treatments with quite negative results: his symptoms increased substantially rather than be reduced.

    I am looking for info that may help me feel comfortable with either the CES-ultra or the Fisher-Wallace stimulator. He doesn’t do well with most drugs either.



    1. Hello Donna,

      I’m sorry to hear about your housemate’s predicament. Also sorry that the Alpha-Stim didn’t help. If I could offer help on the PTSD and mental health issues I certainly would.

      But short of the following article, ( written by an MD (which you may already have seen), I don’t know of any articles comparing commercial CES devices and their effects on various mental health issues. It’s not a topic I would probably write about, either, since there’s just not enough evidence that CES devices typically help with insomnia, which is the focus of my blog, or anxiety.

      I don’t think there’s any way of knowing how your housemate will fare with these devices short of actually trying them out. At least the Fisher-Wallace stimulator comes with a money-back guarantee.

      Good luck finding something that works.



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