How I used Vagus Nerve Stimulation (tVNS) for my Long COVID recovery
The vagus nerve is a key part of the parasympathetic branch of the autonomic nervous system, which plays a major role in Long COVID and ME/CFS. You can "train" it with an at-home device
I’m not a doctor, nor a scientist, and the following is not intended as medical advice. I’m just one person who has (mostly) recovered from a severe version of Long COVID and has done a ton of research, sharing my experience and learnings. Please always listen to your body, and always ask your medical providers what’s right for you (in particular when starting a new protocol, such as tVNS).
Today we’re going to dive into nervous system recovery and tools, starting off with tVNS, or Transcutaneous Vagus Nerve Stimulation. In my recovery framework, this is part of the pillar “Nervous System Reconditioning”.
If you already have a tVNS device and you’re looking for instructions on how to use it for Long COVID or ME/CFS recovery, you can find instructions at the bottom. If you’re looking for more information on what tVNS is, or how it might help your recovery, keep reading.
Why tVNS?
One of the major take aways from my learning and research over the last year is this: The autonomous nervous system plays a huge role in Long COVID and ME/CFS recovery. It is deeply connected to our organs, including heart and lung, and many of the typical Long COVID and ME/CFS symptoms. I’ll write about this in more depth soon, but for now I want to get into the practical advice, rather than keep going on about theory for months. Although I definitely could ;). You can check out some great resources here in the meantime.
There are lots of tools I used to help get my nervous system back into shape (see my overview). I’ll start with tVNS, because I’ve gotten quite a few specific questions about this.
What is tVNS?
Transcutaneous Vagus Nerve Stimulation (tVNS) is a non-invasive method of nerve stimulation, which you can do at home. It involves sending mild electrical impulses to the vagus nerve through the skin. The vagus nerve is a key part of the parasympathetic branch of the autonomic nervous system, and has been found to influence a wide range of bodily functions and organs. Research suggests that stimulating the vagus nerve can have therapeutic benefits for various health conditions, ranging as wide as depression and epilepsy.
Importantly, tVNS has also been shown to significantly improve Long COVID symptoms in a recent pilot study (Zheng, Simonian, Wang and Rosario, 2024).
My Experience with tVNS
I was pretty skeptical when I first came across tVNS. Firstly, I didn’t think my Long COVID was nervous system related, given that I had gotten several definitive cardiac and pulmonary diagnoses. The nervous system, on the other hand, had never even been mentioned by any of the doctors I had sought out for answers (including a Neurologist). Secondly, it didn’t seem likely that clipping some device to my ear could help with a condition so severe it had left me disabled. Eventually, however, I started understanding the connection of the autonomous nervous system to various organs, including lungs and heart. I revisited tVNS and how it works, and the doctor I eventually found who does understand Long COVID also recommended it. So I decided to try it out.
I ordered the device online, waited a few weeks until it arrived, and then started using it. I incorporated it into my daily recovery protocol. It is simple to use - you just clip it to your ear and turn it on for a few minutes a day. I used it every day and began seeing an effect over the first weeks. I noticed a slightly better overall condition on days when I used it, feeling slightly more stable, the symptoms maybe 1-2% better, versus when I was not using it (to be clear here, my long list of severe symptoms continued to be intense and debilitating. But in that stage, any 1% improvement was a notable relief). I kept using it, and I started seeing a gradual improvement over time.
It’s impossible to isolate effects, as I was doing and trying many different things at the same time (and I’m only an n = 1, obviously). However, understanding how the device works, it is clear that tVNS and the other tools (e.g. breathwork) are all using the same mechanism in the body— rebalancing and reconditioning the autonomous nervous system, which in turn impacts every major bodily function. So I think they’re all “pulling in the same direction”. I continue to use the device every day, along with the rest of my daily nervous system work and recovery protocol.
Affordability
This is probably a good moment to note that tVNS devices are, for now, relatively expensive (mine was ~US$300), which can be prohibitive to a lot of people (particularly if you’re unable to work due to the condition). What is really important to say here: You do not need a $300 device to recover. It can help, but other tools do the same thing, i.e. stimulate the vagus nerve, and recondition the nervous system. Many of those tools are free. I’ll write more about breathwork, in particular, soon (huge fan, and I’ve been diving a lot more deeply into that particular research the last months).
An honest review of my tVNS device
I’ll be honest here, I’m not the biggest fan of the particular brand of tVNS device I use (I purchased it from caputron.com and the brand on the device is vagus.net). I’m not sure I’d buy it again. But I also don’t have a better one to recommend at this point (please share if you do!). So here’s what I can tell you:
What I like
It’s effective— that’s obviously the most important part. It does the job. Yay!
It’s simple to use
It’s small and I can travel with it (now that I can leave the house again!)
What I don’t like
The battery life is disappointing. It requires charging every hour of use or so
It frequently fails, has display issues etc.
There’s a complete lack of instructions. If I hadn’t had my doctor’s pointers (see below), I wouldn’t have known what to do with it, and it might even have affected my health negatively (a huge risk given the severe state I was in at the time)
Overall, it feels bad quality for a $300 device, so if there’s a better one in the market I’d say get that one. But it works “well enough”. I hope that the manufacturer will continue to improve it.
How I used my tVNS device
Given the lack of manufacturer instructions, my protocol is based on trial and error, and what I have learned about the nervous system. I got some pointers by the excellent Dr. Carla Kuon at UCSF, too, when I first started using it (see my resources post for Dr. Kuon’s book, where she refers to tVNS as well). Sharing my protocol here because I’ve gotten a few specific questions, I know many of you aren’t sure how to use it either. Maybe it saves someone that trial and error :)
My tVNS protocol during Long COVID and ME/CFS recovery
Explanations below, in case you want more context
Important: Use the tVNS on the left ear (never the right ear! See below)
Clip the electrodes to the tragus (the little bump on the outside of your ear canal, towards the front)
Adjust the intensity so that you just feel a vibration. Make sure it’s not painful or uncomfortable. If it gets intense or painful even if turned down, I find that using more balm on the electrodes helps
Start with short sessions - one or two minutes a day, then gradually increase the duration as tolerated (I do 20 minutes now)
Max 20 minutes a day
Use it in combination with a calming activity, e.g. meditation or breathwork
Explanations
Why the left ear? Per instruction by Dr. Kuon, and here’s what I found for context: “Given that the right vagal nerve has efferent fibers to the heart, tVNS is safe to be performed only in the left ear” (Van Leusden et. al, 2015)
Why not turn it up to higher intensity? You’re trying to calm your nervous system, not put it on alert. Pain or discomfort can activate your sympathetic nervous system response (that’s the opposite of the goal)
Why calming activity? I use it while I do my breathwork or meditation every day, as those also stimulate the vagus nerve. I would personally not use it while being on your phone or laptop, having a conversation or watching TV etc. See above re avoiding a sympathetic nervous system response
Why max 20 minutes a day? This is also per Dr. Kuon’s instructions, I couldn’t find anything in the literature. My assumption: to avoid over-stimulating the vagus nerve and risk worsening the vagus nerve inflammation that’s common in Long COVID. Curious if anyone has more definitive knowledge here?
So overall, while it's important to note that mine is anecdotal evidence and may not apply to your body and condition, my personal experience with the tVNS device was positive, and I continue to use it. If you have the ability to invest in a device or get access to one, I’d recommend trying it.
I’m curious- for those of you also using tVNS, how has it worked for you? How have you been using it? Are you happy with your device?
For everyone else- would you try it? Any other questions I haven’t covered?
What else would you like to hear about next, either from this overview or otherwise?
All the best,
Nicole
I use the Sensate device, which sends vibrations through your chest. It’s very soothing. I wrote about it in one of my recovery tools posts. But I also saw this in YT recently:
https://youtu.be/og8UOYatAmg?feature=shared
I heard about stimulation through vibration before I knew there was also electrical stimulation. I'm not too keen on trying electrical because I have electromagnetic sensitivity (although this might be getting better).
I use the stress releaZer by Beurer. It works like the Sensate but it's way cheaper. It combines resonant breathing with vibration, relaxing music and binaural waves. I find it really helps me relax, and it helped my breathing a lot at a time where it was still very uneasy. I use it before I lay down to rest and before sleep.
I also have another device which can be used to stimulate the vagus nerve through vibration by putting it in the cymba conchae. I was told once that it makes sense to stimulate the vagus at different places, because you never know where it is most dysfunctional.