Cranial Electrotherapy Stimulation (CES) in Soldiers with Insomnia: A Pilot Study


Name: Betty Garner

Rank: LTC

Organization: The Geneva Foundation

Performance Site: Landstuhl Regional Medical Center, Germany

Year Published: 2011

Abstract Status: Project Completed


Background: With millions of soldiers deployed overseas and/or mobilized to support the Global War on Terrorism (GWT), frequent deployments, personal/family stressors, or problems with obtaining adequate sleep can precipitate acute insomnia and lead to chronic insomnia. Insomnia is linked to impaired cognitive and immune functions, decreased quality of life, and increased accidents. Insomnia is well established in the general population both as a risk factor for and as a symptom post traumatic stress disorder, anxiety, and depression. Cognitive-behavioral therapies for insomnia (CBT-I) and medications are both efficacious treatments for the improvement of sleep. However, CBT-I is often time-consuming, requires trained clinicians, and is not readily accessible which would be difficult for soldiers deployed in war zones. Hypnotic drugs have undesirable side effects, are recommended primarily for a short term use, and are not ideal in a fast paced environment with unpredictable sleeping conditions. Thus, a treatment for insomnia that can easily be implemented and with minimal side effects is needed for deployed soldiers.To date, no studies have tested the use of cranial electrotherapy stimulation (CES), a safe and portable device, as a treatment for insomnia in soldiers returning from deployment and/or mobilized to support the GWT. 

Purpose: The primary aim of this pilot study is to test the feasibility and acceptability of CES, and secondary aims are to evaluate the extent of change in pre- and post-treatment sleep measures in soldiers with insomnia in a non-deployed environment to successfully guide future studies. Method: A convenience sample of 50 military personnel meeting the eligibility criteria will be randomized to assess the feasibility, acceptability, and effects of CES to placebo therapy. This study is a double-blind randomized controlled, parallel design with major assessments conducted at baseline (Time1), immediately after treatment (Time2), and at one month after treatment (Time3). Outcome Variables: Recruitment and retention numbers, insomnia severity, and sleep paremeters (e.g. time to fall asleep, sleep efficiency, and sleep quality, etc). Plan for 

Analysis: Descriptive statistics, paired t-test, and mixed analysis of variance using the repeated measures of general linear model. 

Relevance: The impact of insomnia on public health and the military healthcare system is enormous. This pilot study is a first step in a developing program of research with a goal of improving sleep for soldiers and families before, during, and after deployment.  Additional support for this on-going study will great enhance the continuity and success of this pilot study. A timely assessment and treatment is imperative in improving sleep ensuring fit and ready military personnel entrusted to military nurses and other healthcare providers.


Final Report is available on NTRL: