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Frequently Asked Questions
About CES (cranial electrical stimulation)
Q. What is CES?
CES, or cranial electrotherapy stimulation, is a non-pharmacologic
approach using gentle electrical impulses for the prevention and treatment
of depression, anxiety, and insomnia.
Q. How does it work?
The exact physiological mechanism by which CES works is not fully
understood and is still the subject of research study. It is hypothesized,
however, that CES acts by indirectly stimulating brain tissue in the
hypothalamic area, causing the brain to manufacture various neurohormones
and restoring them to pre-stress homeostasis.
Q. Is CES safe?
CES has an unblemished safety record. A broad reading of published
literature on the subject shows no negative effects or major
contraindications from its use, either in the U.S. or in other parts of
the world. The National Research Council has deemed CES a non-significant
risk modality.
The unit's sole source of current is a common nine volt battery. Its
intensity is limited to 1.5 milliamps—no more than is required to run a
small toy or a penlight. Even when turned to maximum intensity, it is not
harmful. It is suggested, however, that until you become fully acclimated
to the unit, you maintain the amplitude at a lower setting.
Q. How is the current transmitted?
The CES Ultra is powered by a nine volt battery. It utilizes pre-gelled
electrodes that sit below each ear and snap on or attach to the end of a
lead-wire that plugs into the jack of the unit. Another option is
ear-clips fitted with felt or conductive rubber electrodes which attach to
each earlobe.
Q. What is it like?
Most people find CES a pleasurable experience. The most you will ever feel
is a gentle tingling sensation with the higher frequencies and a
light-headedness with frequencies less than one hertz. If the sensation
proves too strong, you can simply reduce it by a simple turn of the knob.
Increasing or decreasing the amplitude does not impair the efficacy
of the treatment. Research shows CES to operate effectively at both lower
and higher levels of stimulation as well as below the sensate threshold. A
common approach is to turn the amplitude to the point of sensation, turn
it down slightly below that point, and leave it there for the remainder of
the session. Your own comfort level always dictates the amplitude.
Q. Is CES user-friendly?
Most CES units are easy to employ: (1.) Attach either the electrodes or
the ear-clips. (2.) Insert the lead-wire into the jack. (3.) Turn the unit
on. (4.) Set the timer and amplitude.
Q. Does CES work for everyone?
Nothing works for everyone. But CES is effective for most people.
Q. What immediate results can I expect?
Most people experience a response almost immediately after treatment,
others, after several days. This relaxed but alert state will usually
remain for an average of 12 to 72 hours after the first few sessions. With
regular use it is possible for the patient to habituate to this preferred
state of consciousness.
Q. How does CES affect sleep?
CES is positively indicated in the treatment of insomnia. Sleep patterns
begin to normalize within the first day or two, with less and shorter
periods of awakening during the night, faster onset of sleep after going
to bed, and a greater feeling of being rested upon awakening in the
morning. CES users often report an increase in vivid dreaming, resulting
from compensation for lost REM sleep. As sleep patterns normalize-within
the next two or three nights—it should become less frequent.
Q. What additional long-range changes should I expect?
Depression and mood swings become less frequent, as do irrational anger,
irritability, and poor impulse control. Mental confusion due to stress
begins to subside. The ability to focus and concentrate on work becomes
easier and more efficient. Cognitive processing is visibly enhanced. As
concentration and memory improve, recalling information and learning in an
accelerated manner return to normal pre-stress levels.
Q. When should CES be used?
CES may be used on waking in the morning and/or on going to bed at night
and/or during the day in particular situations. It can be used both as an
adjunct to meditation each morning or during stressor moments occurring
unexpectedly in the course of a day—those times when you "lose it." Using
the unit in those situations—even for as little as ten minutes—can help
curb that anxiety. In addition to activating actual bio-electrical
changes, it serves as a reminder that you can be with yourself in a
different way—a positive affirmation that you have the power to change
your emotional state and are willing to create the time and the space to
do so. Ultimately, each person finds for themselves how to best
incorporate CES into their daily routine.
Q. Where can it be used?
Most CES units are portable, allowing its use just about anywhere and
under a variety of circumstances, except those noted under the
contraindications. You can use it at home while watching TV, doing the
dishes, or at the office while poring over a report. But CES should be
treated as more than an aside—one more task, squeezed in between others.
It is an important reminder of the need for inner quiet. Though you need
not interrupt your usual activity for CES, its results are generally
enhanced by setting aside a special time for its use alone.
Q. What is the suggested length and frequency of treatment?
The recommended usage is 30-45 minutes once or twice daily for the first
month. Once symptoms are reduced or eliminated entirely, the frequency may
be reduced to two or three times weekly. Individuals undergoing
psychiatric treatment or suffering from severe anxiety and extremes of
compulsive behavior often benefit from more frequent and prolonged
application.
When symptoms of depression or anxiety have lessened or disappeared,
it is important to have continuous access to the unit as a tool for
relapse prevention on an as-needed basis. It is helpful that you work
closely with your physician/healthcare professional to determine the role
CES plays in your overall treatment program.
Q. What is the difference between the two CES Ultra frequencies?
The CES Ultra has two different electrical frequencies: 100 Hz and 0.35
Hz. The frequency of choice is the 100 Hz which has the largest body of
evidence as to efficacy. It may be used while engaging in other
activities, providing a gentle and calming tingling sensation.
The 0.35 Hz setting operates at a lesser amplitude, generating very
little actual sensation, but with a more subtle impact. The 100 Hz has so
far proved to be the most effective configuration. Micro-frequencies, such
as the 0.35 Hz, should be used after having first tried the 100 Hz and
primarily when meditating or in a resting state.
Q. Are there any contraindications for its use?
There are no known contraindications for use of CES. There are, however,
circumstances in which its safety has not been tested. CES should not be
used without on-going clinical supervision by severe depressives,
epileptics, those known to be pregnant, or by individuals with implanted
electronic devices such as cardiac pacemakers or insulin pumps. The
induced relaxation response, resulting from use of CES does not in any way
impair reaction time. It is recommended, however, that CES not be used
while operating dangerous or complex equipment or while driving.
Less than three percent of CES users report a slight headache. This
is usually alleviated by simply down turning the current. If the headache
recurs during ordinary use, cease using the unit and consult with your
physician.
As with the use of any medical device, the physician/licensed
practitioner should be informed of any medication or neurotransmitter
blockers the patient is taking as well as the employment of cardiac
pacemakers or other electronic devices as mentioned above.
CES is not a substitute for professional counseling, meditation, or
constructive relationships. Used in conjunction with those efforts, CES
assists you in attaining a balanced emotional state.
Q. What is the history of CES?
Research on what is now referred to as CES began in the former Soviet
Union during the 1950's, its primary focus being the treatment of sleep
disorders, hence its initial designation as "electro-sleep." Treatment of
insomnia was soon overshadowed, however, by psychiatric application for
depression and anxiety. Since then, it has been referred to by many other
names, the most popular being "transcranial electrotherapy" (TCET) and "neuroelectric
therapy" (NET).
East European nations soon picked up CES as a treatment modality,
and its use spread worldwide. By the late 1960's, animal studies of CES
had begun in the United States at the University of Tennessee and what is
now the University of Wisconsin Medical school. These were soon followed
by human clinical trials at the University of Texas Medical school in San
Antonio and the University of Wisconsin Medical School. More studies
followed.
CES has been an international treatment modality for more than 50
years. Thousands of people worldwide continue to receive its benefits. The
most extensive work on CES is presently being conducted at the Pavlov
Institute in St. Petersburg, Russia. But by no means is its use restricted
to that part of the world. Current estimates are that there are between
50-100,000 units in use globally.
Q. What research is there as to its effectiveness?
There are approximately 1,000 articles on CES therapy many of which are
listed in four reviews put out by the Foreign Service Bulletin of the
United States Library of Congress. This is in addition to the wealth of
physiological and bio-engineering data on electro-sleep and
electro-anesthesia, including 18 experimental animal studies. Human
research studies on CES currently number more than 100. Its efficacy has
been clinically confirmed through 28 established psychometric tests s,
computerized EEGs and topographical brain-mapping. Meta-analyses yielding
positive results from the use of CES have been conducted at the University
of Tulsa and at the Harvard University School of Public Health.
Q. What is the current legal status of CES?
CES is an over-the-counter device, available without a prescription and
with few restrictions everywhere in the world except for the United
States. There it may be secured only on the order of a licensed health
care practitioner (M.D., N.D., D.O., PhD. Psychologist, or Chiropractor,
depending on a given state's regulations).
Q. Why haven't I heard more about CES?
CES has been a relative unknown and under-deployed technology due to the
fundamental Western bias on behalf of pharmaceuticals. Within the last ten
years, we have come to better understand the connection between brain
function, neurotransmitters, and electrical stimulation. As our knowledge
of this area grows and new research findings emerge, so too will the
popularity and increased usage of CES.
Q. What distinguishes the CES Ultra from other CES units?
The most significant research on CES is based on the traditional 100Hz; a
much smaller portion on micro frequencies—those less than one Hz. The CES
Ultra is currently the only unit on the market featuring both. Other units
may claim to carry the 100Hz. but do not have an accurate rendition of the
configuration on which most of the research is based.
There are also certain "underground" instruments on the market, many
of which can be found on the internet. Contrary to their oft-stated
anecdotal claims, most have no scientific evidence behind them. Many are
nothing more than low-cost pulse generators of dubious quality, and have
not been fully evaluated for either efficacy or safety. They are not
registered with the FDA. Often billing themselves as "for research
purposes only," they do not have permission to present themselves as
"medical devices" or make any medical claims.
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