Interest in vagus nerve stimulation is growing, with claims it can ease stress, improve sleep and reduce inflammation. We ask the experts what the science says and try a wearable device.
It’s been called the body’s ‘superhighway’, but many of us have never heard of the vagus nerve. Its job is to send messages back and forth from the brain to major organs, which means it may influence everything from heart rate, breathing and digestion to mood and emotions.
And if the hype is to be believed, activating the vagus nerve may help turn down an overactive stress response and turn up the calming, restful part of the nervous system.
Vagus nerve stimulation has become a wellness buzzword, prompting social media hacks galore and an array of wearable (known as transcutaneous) vagus nerve stimulators (VNS). These use mild electrical pulses to stimulate the nerve and promise to relieve everything from chronic stress, anxiety and depression, to digestion problems, fatigue, inflammation and pain.
Since turning 60 I have noticed a rise in poor sleep, stress and anxiety. So, intrigued to find out more, I have been trying out Nurosym, one of the best researched devices with peer-reviewed studies into safety and efficacy. You clip an electrode onto your left ear (one of the places where an auricular branch of the vagus nerve runs close to the skin), which connects via a wire to a small hand-held controller that you use to turn up or down the intensity of each 30-minute daily session.
Vagus is the Latin name for ‘wandering’ and it’s an apt description for a nerve that starts in the brain and runs through the chest and abdomen, affecting many different organs on the way. It is a key part of what’s known as our autonomic nervous system, which – without us being aware of it – controls many bodily functions. This system is made up of two different parts: the sympathetic and parasympathetic.
"The two sides of the autonomic nervous system work in balance, a bit like a seesaw – reducing one increases the other," explains Professor Hamish McAllister-Williams of the Translational and Clinical Research Institute at Newcastle University.
"More sympathetic activity prepares you for 'fight or flight' so you can respond fast to stressful situations and perform at your best. But if your stress response goes into overdrive, it can cause mental and physical problems. That’s when you would want to boost the parasympathetic side, which prepares you for 'rest and digest' so your body can calm down and recover.
"The vagus nerve makes up a large proportion of the parasympathetic nervous system and that’s why stimulating it has been linked to helping with conditions such as anxiety, stress and depression.
"But it also seems to play a part in controlling inflammation, sensing when the body is releasing inflammatory markers and sending messages from the brain to turn off their production. That’s why VNS is also currently being investigated for a number of conditions that are associated with inflammation, including rheumatoid arthritis and inflammatory bowel disease."
Scientists have known about the importance of the vagus nerve for many years, and surgically implanting a pacemaker-like VNS device is a medically approved treatment for drug-resistant epilepsy and severe or treatment-resistant depression.
"What’s interesting is that irrespective of treating the underlying problem, implanted VNS seems to reduce inflammation which improves fatigue and people’s overall quality of life," says Professor McAllister-Williams.
Now scientists are trying to work out if wearable devices could have a similar effect. Currently, the TRICEPS trial at the University of Sheffield is testing whether transcutaneous VNS (tVNS) could improve arm weakness after a stroke.
Meanwhile, a team at the University of Leeds is studying whether it can help patients recover better after abdominal surgery. Other randomised controlled studies have shown improvements in insomnia and knee osteoarthritis, while a small study also found that tVNS could improve people’s ability to exercise.
Professor Mark Baker at Newcastle University is investigating it for Parkinson’s/walking problems and for fatigue post-Covid after it proved promising in Sjögren’s syndrome, an autoimmune condition.
Opinions vary. "The research is exciting, but some of the manufacturers’ claims are exaggerated and there isn’t any evidence that these devices have benefits in otherwise healthy people," cautions Dr Tiago da Silva Costa, at the VNS clinic for difficult-to-treat-depression at the Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.
"However, they seem to be very safe if you follow the instructions, and if you have anxiety, low mood or fatigue then it could be worth trying."
Professor McAllister-Williams points out that you need to use wearable devices consistently to get a response.
"Studies suggest the benefits may build up so there’s no point buying one, trying it for a couple of weeks and then giving up. Any benefits may also be down to the placebo effect, or it may be just simply sitting down calmly for 30 minutes while you’re wearing one of these devices may be enough to make you feel better and more relaxed."
Because I haven’t been sleeping well, I used Nurosym for 30 minutes a few hours before going to bed in order to help me unwind. It’s a little fiddly at first trying to get the wire shaped behind my ear and clipping the electrode onto the tragus, a small flap in front of my ear.
The sensation feels like a mild tingling – similar to a TENS machine – and you can very slowly adjust the intensity level.
I found that I didn’t feel much until around level 16 or 17 (out of 45), at which point I could definitely feel a noticeable, but not painful, prickling sensation.
Immediately after each session, my body did feel more relaxed and my restless monkey mind seemed to jump around less so I was able to fall asleep more easily than usual. I had to adjust the level each day, sometimes needing to turn it down because if it felt too intense it could make me feel jumpy.
The benefits so far have been subtle, though I’ve noticed that I have been waking up less often, and I’m not sure if it’s just because I’m stopping, relaxing, and doing something for myself for 30 minutes.
"Instead of self-medicating with alcohol – as many people who would benefit from vagus nerve stimulation do – practising ways to turn up the calming side of your parasympathetic nervous system can help," says consultant psychiatrist Dr David McLaughlan, clinical director of cleanslateclinic.co.uk
"Slow, deep belly breaths stimulate the vagus nerve," says Dr McLaughlan. "Try this 4-7-8 breathing technique. Breathe in through your nose for the count of four, hold your breath for the count of seven and then breath out of your mouth for the count of eight.
"Do this for two to three minutes to relax."
Mindful movements such as Tai Chi and yoga can encourage deep breathing and a sense of calm if practised regularly. Alternatively, try this 5-4-3-2-1 mindful exercise. Focus on five things you can see, four things you can touch, three things you can hear, two things you can smell and one thing you can taste, one after another.
This helps you to be more present and counter overthinking.
Cold water exposure activates the ‘diving reflex’, which calms your heart rate, but also stimulates the vagus nerve.
"If cold-water swimming isn’t your thing, try having a blast of cold water to start or end your shower," says Dr McLaughlan.
"Surprisingly, introducing more probiotics into your diet, such as sauerkraut and kimchi, which feed the good bacteria in your stomach, can also be helpful," Dr McLaughlan adds.
"The vagus nerve carries messages between the brain and gut and having a healthy gut microbiome can influence these signals and have positive effects on mood and inflammation."
Before you commit, check to see if a specific device has been tested in clinical studies. If you have a pre-existing condition, talk to your doctor before using any new devices.
Nurosym is EU certified as a safe non-invasive neuromodulation device. Studies show a 61% improvement in vagus nerve activity, a 40% improvement in postural tachycardia syndrome (when your heart rate increases very quickly after getting up from sitting or lying down), and a 32% improvement in memory. From £599.
Gammacore, which you hold against your neck, is available on the NHS for people suffering from cluster headaches. Ask your GP or pain clinic.
Government treatment regulator NICE says it can help with the frequency and intensity of cluster headache attacks, but you should only continue using it if your symptoms improve in the first three months.
Pulsetto FIT is worn around your neck, and it claims to offer calm in four minutes. It needs a connectivity gel, which can be messy, and there is criticism it lacks independent evidence.
One small study showed it improved self-reported symptoms of anxiety, depression and sleep disturbance. From £249.
Sona is worn in or behind the ear. It has a high-profile medical team behind it and offers a personalised programme that claims to aid sleep and reduce stress and pain. £695.
Health insurance for people over 50 that provides a quicker route to diagnosis and planned medical treatment in a private facility.
Underwritten by Bupa Insurance Limited.
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