FAQ...Everything you wanted to know about CES
Q. What is the history of CES?
A. At least two millennium ago, physicians used electric eels to relieve pain. Experimentation with low intensity electrical stimulation of the brain was first reported by Drs. Leduc and Rouxeau of France in 1902. Research on using what is now referred to as cranial electrotherapy stimulation (CES) for treatment of anxiety began in the Soviet Union during the 1950's, its primary focus being the treatment of sleep disorders, hence its initial designation as "electrosleep." Treatment of insomnia was soon overshadowed, however, by psychiatric application for depresion 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 Universiity 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 oif Wisconsin Medical School. More studies have followed. At present, the number of human studies stands at one hundred and three.
CES has been an international treatment modality for more than fifty years. Thousands of people worldwide continue to receive its benefits. The most extensive work on continues in Russia at the Pavlov Institute in St. Petersburg. But by no means is its use restricted to Eastern Europe. Current estimates are that there are between 50- 100,000 units in use globally. From a broad reading of published literature, no negative effects or major cotraindications have been found from the use of CES to date, either in the U.S. or other parts of the world.
Q. Who could benefit most from the Use of CES?
A. First and foremost, those suffering from stress in the form of depression, anxiety, and insomnia who seek an effective non-pharmacologic alternative. Secondly, those suffering from illnesses where stress constitutes a prime symptom..
Accoring to the American Academy of Family Physicians, stress-related problems account for 80-85% of all visits to medical offices. Research indicates that 80-85% of all diseases are caused by stress which plays a major role in aggravating up to 90% of all illnesses and some part in the development of every disease, from cancer to the common cold.
It has been estimated that 80% of the populace of the United States react to life adjustment problems with the "flight" or "fight" anxiety reaction. And that a similar percentage of our hospitals are filled with persons who have channeled anxiety released energies into their bodies resulting in psychogenic illnesses.
Among those illnesses are: substance abuse withdrawal syndome (alcohol, street drugs, nicotine, prescription drugs), chronic fatigue syndrome including fybromyalgia, pre-menstrual syndrome, attention deficit disorder and hyperactivity, migraine and tension headaches, TMJ, chronic pain, pre-competitive and performance anxiety, panic disorders, tic dolereaux, bruxism, stress induced asthma, hives, gastrointestinal disorders, ulcers or gastritis, and irritable bowel syndrome.
We would underscore, however, that CES is not a cure for these illnesses and does not represent itself as such. But by successfully addressing the anxiety, depression, and insomnia underlying these disorders, it can play a major role in the healing process.
Q. Is CES then only for the "sick" and the "stressed-out ?"
A. You don't have to be "sick" or "stressed-out" to use CES and realize its benefits. CES is a life-enhancing instrument of potential value to everyone. Its uses are wide ranging. Some people use it as an adjunct to meditation practice each morning. Others during peak stressor moments that hit unexpectedly in the course of a day. Who hasn't experienced those times when we are about to "lose it?" Putting the unit on in these situations even just briefly--perhaps for as little as five or ten minutes-- can help curb that anxiety and serve as a reminder that one needs to be with oneseself in a different way. It also represents a significant affirmation to self that one has the power within to change ones mental state and that you are willing to take active steps to create the time and the space to do so.
Many use CES as an assist to their creative work or in high stress situations. CES quiets the mind, making it especially helpful in preparing for examinations or as an accelerated learning tool, such as when memorizing blocks of marterial. For the athlete readying for competition, it helps create the state of relaxed awareness helping them enter the zone of maximum performance. Each person finds for themselves how to best incorporate CES into their daily routine
Q. Can CES be used As a Sleep Aid?
A. The 100 Hz unit can be used at bedtime. But the .5 Hz (Alpha stim) because of iits more dramatic and immediate impact needs to be employed differently.
Because of the increased alertness resulting almost immediately from its use, some patients may find it difficult to fall asleep immediately after a treatment. Accordingly it is recommended that the Alpha-Stim CES aplication be done at least three hours before going to bed. But by no means does it mean that it is contraindicated for insomnia!
One thing CES users often report is an increase in vivid dreaming. This results from compensation for lost REM sleep. As your sleep pattern begins to normalize--within the next two or three nights--it should become less frequent.
Q. Will CES work for everyone?
A. No. But it is known to be effective for most people.
Q. What Can I expect ?
A. Most people will experience a relaxation response almost immediately after treatement begins (with the Alpha-Stim), and within days with the 100 Hz unit. Immediately after an Alpha-Stim CES treatment, patients usually report feeling relaxed and sometimes inebriated for the first few minutes. This is a pleasant and very comfortable sensation. After several minutes to hours, the light-headed feelings usually disappear, the relaxed state remains and a profound sense of alertness is achieved. This relaxed/alert state will usually remain for an average of 12 to 72 hours after the first few treatments. With regular use it is possible for the patient to habituate to this preferred state of cnsciousness. Some patients describe the Alpha-Stim experience as analogous to having a type A mind in a type B body.
During the treatment some people will notice a subjective change in their body weight. You might feel heavier at first and then lighter, or you may simply feel lighter initially. You could feel slightly worse during the heavy cycle, and this feeling could last for days unless extra treatment time is given. Therefore it is important to continue the treatment for a few extra minutes if you should feel heavier at the end of the alloted time, even if it has already been twenty minutes or more. Continue for at least two minutes after you feel lighter. Although this is quite common, not everyone will be aware of these weight perception changes.
Q. What Long range Changes should I expect?
A. Sleep patterns should 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 the following morning. Depression and mood swings become less, as does irrational anger, irritability, and poor impulse control. By the second week, cognitive processing is visibly enhanced. Mental confusion due to stress begins to subside as the ability to focus and concentrate on work becomes easier and more efficient. The ability to recall information and accelerate learning also begins to return to normal pre-stress levels as concentration and memory improve.
Q. What is the suggested length and frequency of treatment?
A. For the 100Hz unit the recommended usage is 30-45 minutes once or twice daily for the first month after which the frequency may be reduced to two or three trimes weekly once symptoms are reduced or eliminated entirely. The .5 Hz (Alpha Stim) recommended usage is three times a week for twenty to forty minutes, although there are some who will benefit from a more frequent daily treatment. There are also some who will achieve the full benefits from within ten minutes. Some dentists use it instead of nitrous oxide during dental procedures. that last for hours .
You yourself determine how to best incorporate CES into your daily routine. It can be used on waking in the morning and/or on going to bed at night and/or in response to stress situations. Individuals undergoing psychiatric treatment or rehabilitation for substance abuse often benefit from more frequent and prolonged application.
Those suffering from severe anxiety and extremes of compulsive or addictive behavior may find it necessary to use it more frequently, perhaps several times daily. When symptoms of depression or anxiety have lessened or disappeared, it is still imprtant to have access to the unit as a tool for relapse prevention on aan as-needed basis. It is helpful to work in close conjunction with your physician/healthcare professional to determine the role CES plays in your overall treatment program.
Q. Can you Overuse the Unit?/ Are there any adverse Effects from doing So?
A. You can't really overuse it. There have been no reported adverse effects from more frequent use. The objective of CES is to return neurotransmitter activity to pre-stress homeostasis. Once attained, CES has no additional effect. Serving as a training wheels of sorts, CES helps you reprogram yourself. Rather than learning to rely on the unit, you learn instead how to refine and expand the art of self-regulation CES teaches you to become more sensitively atuned to yourself and better understand your body and its needs.
Along the way, the knowing part of you will inform you in somewhat subtle fashion when CES is needed and when it is to be put aside. You alone will become the determinant of use, as regards both frequency and duration.
During its usage, you will experience periods of relative calm and a sense of control. You may even succumb to a bit of self-congratulations. Seemingly, your CES unit appears destined for the bottom of a drawer. Life being what it is, however, just as you are ready to celebrate for successfully negotiating your personal terrain with skill and dignity--- Voila! New challenges appear from nowhere,--a veritable curveball from hell. CES can help move you through those difficult transitions. Keep it handy. Incorporate it into your daily regimen.
The continuing use of the unit allows for further refinement of stress management skills at newer and higher levels of complexity.
Q. Is CES difficult to use? /How much technical skill does it take?
A. Most CES units are user friendly. After having put on either the electrodes or the earclips and inserted the leadwire into the jack, it's all very simple. CES units either feature an on-off knob that also controls the amplitude (turning it to the right increases the camount of current) as in the 100 Hz devices. Or a button that turns the unit on and a side wheel that increases the amplitude (The Alpha Stim in addition displays the amount of micro-current being used from 1-6, each numeral representing hundreds of microamperes).
With the frequency set at .5 Hz, start with a low current and gradually increase it. If the current is too high, the patient may experience a stinging at the electrodes, dizziness or nausea. If any of these symptoms occur, simply reduce the current and the symptoms will shortly subside. After a minute or two, try increasing the current again, but always keep it at a comfortable level. It's ok to feel the current providing it is not uncomfortable.
Q. How does CES work?
A. As is the case with numerous medications, including aspirin, the exact physiological mechanism by which CES works is not fully understood and is still the subject of research study. It is hypothesized that CES acts by direct stimulation of the brain in the hypothalmic area with specific electronic frequencies. Such stimulation causes the brain to manufacture various neurohormones that effect ones moods and emotions as well as ones cognitive capabilities
back to a level of pre-stress hoemeostasis. For a more detailed hypothesis see "The Biolectrical mechanism" under Research.
A. How is the current transmitted?
Q. The 100Hz unit (Healthpax, CES 100Hz, Mindpeace) utilizes pre-gelled electrodes that snap on or attach to the end of leadwire that plugs into jack of the unit. The Brain Tuner (BT-5 and 6) employs a stethoscope shaped device that sits beneath the ears.
The .5 Hz unit (Alpha Stim) uses gold "ear clip" with tab electrodes that adhere to the clips. Saturate electrodes with saline solution. Apply them to the superior aspect of the earlobes as close to the jaw as possible.
Q. Under What Circumstances is CES Best Used?
A. CES units generally come with a buit-in belt-clip alowing you full freedom of movement. This allows you to use it just about anywhere and under any circumstances, except those noted under the contraindications. You can do it at home while watching TV or at the office while doing your paperwork. Though of course you wouldn't go out jogging with it on. But CES is more than an aside. It is also a reminder of the need to create quiet space of quieting down and rerouting all that mental traffic in your head. You don't want to contribute further to it by including CES as one more thing to do, squeezed in between.....and .....Though you need not interrupt your usual activity for CES, its results are enhanced by setting aside a special time for its use alone.
Q. How safe is CES?
A. CES has an unblemished safety record. For a more deatiled analysis of that record see "safety" under the research section.
Cranial electrotherapy stimulators are generally limited to less than one milliampere (mA) of current. The Alpha-Stim 100 is an example of a CES device that employs very low intensity electrical current pulses (up to 600 microamperes) for the treatment of anxiety. To put this into perspective, it takes one-half of an ampere to light an ordinary 60 watt light bulb. To truly compare the work done per second by these two different currents, we must multiply the currents by the respective voltages that drive them. The product current x voltage is a measure of the rate of generation of energy, and is referred to as the power output. By definition, when a device outputs 1 ampere of current with a 1 volt driving force, the power output of the device is 1 watt. Therefore for the Alpha-Stim 100, the maximum output is (600/1,000,000)amperes x 9 volts = 0.0054 watts, or about 11,000 times less power than the light bulb. Many people do not even feel this amount of current.
This is current amplitude similar to that in the human body. The sole source of the current is a tiny nine volt battery. Because the current is alternating, it sends bipolar current between the electrodes instead of unidirectionally, as would be the case with direct current. Hence there is a net cellular polarization of zero to the user. This is a safety factor of major importance.
Q. Is CES Discomforting?
A. CES is not to be confused with either ECT (electro convulsive therapy) or aversion therapy both of which are based on discomfort. With CES you should experience no discomfort whatsoever. The most that will ever be felt is a mild tingling sensation. If at any time the sensation proves too strong, the amplitude may be reduced by a simple turnof the knob or twist of the dial.
Research shows CES to operate effectively at both lower and higher levels of stimulation as well as below the sensate threshold. accordingly, the patients may turn the amplitude to the point of sensation; then turn it down slightly below that point leaving it there during the session. She may also increase or decrease the amplitude at will without impairing the efficacy of the treatment. The patient's own comfort always dictates the setting of the treatment.
Q. What is the Relationship Between CES to Nutrition?
A. There is a synergistic reationship between nutrients and CES. If one thinks of a car battery with six cells, two of which are dead, it can be eseen that two things are helpful or even necessary to bring it back to normal functioning: One must add both water and a trickle charge of electricity. The brain may be similar, in that while CES adds the trickle charge, in the absence of the necessary nutritional elements (water), the charge will have only a limited effect. The brain uses amino acids as precursors or building blocks with which to build the neurohormones. Witrhout these amino acids present in the bloodstream in adequate amounts, CES has limited value. On the other hand, the precursors, if present, can be uptaken and put into service as neurotransmitters much more rapidly if CES (the trickle charge) is also added.
Think of the brain as a car battery, some cells of which may not be fully functioning. To achieve that end one needs both water and the trickle charge--This is analogous to the brain, amino acids and the CES.
The brain uses amino acids as the raw materials, the building blocks or precursors with which to bilid its neurotransmitters. It is necessary for these amino acids to be present in the bloodstream in adequate amounts for the maximum impact/benefit of CES to be realized. These precursors, if present will be taken up and synthesized into neurohormones much more effectively when CES is added. these neurotransmitter precursor amino acids can be taken orally as food supplements. To experience an even more dramatic impact of CES it should be done in conjunction with amno acid supplements, especially in those areas in which one is deficient. testing having determined the nature of the neurotransmitter deficiency and supplementing with specific amino acids known to be precursors to them.
Q. Are there any Contraindications?
A. There are no known contraindications for use of CES. However, there are circumstances in which its safety has not been tested. Accordingly, CES should not be used without on-going clinical supervision by severe depressives and those known to be epilectic, pregnant, or those using implanted electronic devices such as cardiac pacemakers or insulin pumps.
There have, however, been instances where under such supervision CES has been employed successfully as in the treatment of pregnant drug addicts and cases where CES has been shown to reduce both the frequency and severity of seizures.
Because of the feeling of induced relaxation that results while using CES, though, this relaxation response does not in any way impair reaction time, it is recommended that CES not be used while operating dangerous or complex equipment or while driving.
CES treatment may result indirectly in increased bloodflow to the brain. Hence its possible contraindication in recent hemorrhagic stroke or subarachnoid bleed patients. This same effect can cause brief increased blood flow beneath the elecrtrodes behind the ears. This redness should not be cause for concern. This is an extremely rare occurrence. It is not a burn response and will go away shortly after the CES treatment is finished if it occurs at all.
Perhaps three persons out of one hundred report a slight headache when using CES. This is usually alleviated by simply turning the current down. If the headache should recur 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 pacemaers or other electronic devices as mentioned above.
Q. What research is there as to the safety and effectiveness of CES?
A. 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 electroslep and electroanesthesia in animals. As of this writing there are more than 100 research studies on CES in humans and 18 experimental animal studies. The efficacy of CES has been clinically confirmed through the use of 28 different psychometric tests. The significance of CES research for treating anxiety has also been reconfirmed through meta-analyses conducted at the University of Texas and at the Department of Health Policy and Management , Harvard School of Public Health. The full body of research can be accessed at this website.
Q. Why haven't I heard more about it?
A. Because of the fundamental bias on behalf of pharmaceuticals in Western medicine and the poltical and economic power of the Drug cartels and the influence they wield over public policy.
Q. What is the current legal status of CES?
A. CES is an over-the-counter device, available without a prescription and with few restrictions everywhere in the world but the United States. In the United States, it's quite a different matter. Two years ago, the FDA issues a PMA (Pre-market approval) call-up order. This required all manufacturers of CES to submit a pre-market approval application for review by the agency for a final determination as to safety and efficacy. Those manufacturers who did not submit an application would be forced to cease manufacture and distribution of their product. Because this is an an extremely difficult and costly process, many CES manufacturers have been effectively forced out of business or forced to relocate overseas.
Electromedical Products, Int'l, Inc. (EPII), manufacturers of the Alpha-Stim, stand alone, having submitted a comprehensive PMA. Though mandated by law to submit that application to a review panel for final evaluation, Agency bureaucrats have refused to do so, alleging the application to be deficient in certain key respects. In truth, the application meets all the stated specifications and is comprehensive both in its scope and its attention to detail.
It is not legally within the authority of the bureaucrats to make judgements which by law are reserved to a panel of scientific and medical experts. The Agency has nonetheless taken this upon itself. Numerous appeals have been made to force them to comply eith the law. A final decision is still pending.
Because the Alpha-Stim has been approved by the FDA for treatment of pain, it can still be sold for that purpose. The argument with the Agency has to do with the right to make claims for anxiety and the right to include the earclps for CES application. The Alpha-Stim is currently available to any licensed health care professional or to any individual in the United States by prescription (easily obtained by treating the Alpha-Stim as a micro-TENS device) with the earclips and with instructions as to CES use.
Health Directions, manufacturer of the "Healthpax," and Life Balance International, manufacturer of the "LBI-2000" have both ceased operations.
CES Labs no longer manufactures or distributes the "CES 100Hz."
The only other true CES instruments on the market are the Brain Tuner (BT-5 and 6), available through Transformational Technologies, Tools for Exploration, and Tools and Techniques. Lower cost generic units also available through them include The Mindpeace (100Hz), Current Source (.5Hz), and the Force( .5Hz and 100Hz combination). They are now based overseas in Malaysia. All these devices are low cost pulse generators that make no medical claims and are available for "research" purposes either directly from the manufacturer or through the above distributors.
The Alpha-Stim 100 is by far the single best unit on the market. It is the Rolls- Royce of the field. It provides dual application for both CES (employing earclips) and pain (employing probes). Built to exacting specifications, it has easy-to-use controls, features one button operation, plus two additional frequency settings (1.5Hz and 100Hz), an LCD readout and timer, and a full five year warranty.
Its originator, Dr. Daniel Kirsch is one of the pioneers in microcurrent electrical therapy.
Q. Where can I get more information on these products ?
A. By phone through the CES information hotline: 1-800-CESRX-4U (237-7948) or e-mail @ cestx@ix.netcom.com or on the Net at through links to this site
Michael Hutchinson, author of Megabrain: New Tools and Techniques for Brain Growth and Mind Expansion recounts his experience on the Alpha_Stim:
"The machine was turned on, and I felt a tingling sensation of tiny pinpricks in my earlobes, as a few microamps of biphasic square waves at a frequency of 0.5 Hz passed into my brain. The tingling was not strong enough to be unpleasant...the shift in consciousness was quick and unmistakable. My body immediately felt heavier, as if I was sinking down into myself. I realized I was becoming extremely relaxed, and all of a sudden, there I was. It was that feeling you get when all at once you blink your eyes and realize you're awake. Not that you had literally been sleeping, but you hadn't been paying attention as carefully as you might, you had been sleepwalking through your day, and now you're awake, and things are very, very clear. It was not a feeling of being in some stoned or otherworldly state, but rather a feeling of being exactly as you should be, at home in yourself--a feeling that your brain was operating correctly, efficiently, clearly.
...My body was no longer heavy, but very light, full of energy. The feeling was one of openness, clarity, as though I had been wearing sunglassess for weeks and had suddenly taken them off. It was no big thing. Nothing special, really, except I couldn't help but feel that this is the way we're supposed to be all the time."