Objective To explore the effect of transcutaneous auricular vagus nerve stimulation (taVNS) combined with electro‑dry needling (EDN) on sleep, pain, anxiety, and depression in patients with cervical spondylosis. Methods According to the random number table method, 74 patients who met the inclusion criteria were divided into two groups (n=37): an experimental group (group T) and a control group (group C). All the patients were orally administered with analgesics. Group T received taVNS combined with two sessions of EDN over one week, while group C received sham stimulation combined with two sessions of EDN over the same period (there was a one‑week internal between the two EDN sessions; taVNS and sham stimulation were administered twice daily, 30 min each and continuously for one week). The Pittsburgh Sleep Quality Index (PSQI) scores, Hamilton Anxiety Scale (HAMA) scores, and Hamilton Depression Scale (HAMD) scores were recorded for assessment of sleep disturbances, anxiety, and depressive moods between the two groups before treatment (T0) and at post‑treatment 4 weeks (T2), 8 weeks (T3), and 12 weeks (T4). Their Visual Analog Scale (VAS) scores were recorded at T0, on post‑treatment 1 day (T1), T2, T3, and T4. Then, low frequency/high frequency (LF/HF) measurements in heart rate variability (HRV) were analyzed at T0 and T1. The usage of analgesics and occurrence of adverse reactions during hospitalization were also recorded. Results A total of 70 patients completed the study, including 35 in group T and 35 in group C. Compared with those at T0, both groups showed reduced PSQI, HAMA, and HAMD scores at T2, T3, and T4 (all P<0.05); VAS scores decreased at T1, T2, T3, and T4 (all P<0.05); and LF/HF decreased at T1 (all P<0.05). Group T had lower PSQI scores at T2, T3, and T4, lower LF/HF at T1, lower VAS scores at T1, T2, T3, and T4, as well as lower HAMA and HAMD scores at T2 and T3 than group C (all P<0.05). The dosage of etoricoxib used in group T was lower than that in group C (P<0.05). No statistical differences were observed in other indicators between the two groups (all P>0.05). Conclusions The combination of taVNS and EDN can improve sleep quality, alleviate pain, and reduce anxiety and depression in patients with cervical spondylosis, decrease the usage of analgesics during hospitalization, and modulate autonomic nervous function.