The combination of immersive virtual reality (VR) and slow breathing techniques helps promote bedtime relaxation and improves overall sleep quality in adolescents with and those without insomnia symptoms, new research shows.
Immersive technology holds "great potential to advance current treatments for sleep disorders," principal investigator Massimiliano de Zambotti, PhD, sleep neuroscientist with the Human Sleep Research Program, SRI International, Menlo Park, California, told Medscape Medical News.
"VR is a powerful distractor, which is important to contrast state of worry, rumination, cognitive intrusion that can interfere with the normal falling asleep and sleep processes," he noted.
The findings were presented at Virtual SLEEP 2020, the 34th annual meeting of the Associated Professional Sleep Societies.
Faster to Sleep
The study included 29 healthy high school students, 10 of whom had insomnia. The participants' sleep was assessed by polysomnography for 2 nights.
On the baseline (control) night, the participants engaged in 20 minutes of quiet activities, such as reading a book, before bedtime. On the intervention night, they performed 20 minutes of slow diaphragmatic breathing while experiencing a relaxing, immersive, VR environment. All participants were trained in the breathing technique in advance.
According to the investigators, compared with quiet reading, VR plus slow breathing led to an increase in perceived sleepiness and a decrease in level of alertness at bedtime (P < .05). There were no differences in those with and those without insomnia.
VR plus slow breathing also led to a significant drop in heart rate (roughly 5 bpm from before the intervention to after; P < .01). There was no significant change in heart rate with quiet reading, and again there were no group differences.
Participants also fell asleep an average of 6 minutes faster and experienced a 3% increase in sleep efficiency on the intervention night compared with the control night.
"Our intervention was designed to relax and/or distract participants from their surroundings, which is different from engaging in quiet activities like reading a book," study investigator Dilara Yuksel, PhD, a postdoctoral fellow at the Center for Health Sciences at SRI International, told Medscape Medical News.
Yuksel noted that the psychophysiologic pathways underlying the sleep-enhancing effects of immersive VR and slow breathing techniques need further investigation.
"We cannot say yet what exactly caused the relaxation effect ― was it the cognitive distraction via the VR or the downregulation of the nervous system function via the pace breathing?" Yuksel said.
"We are still in the early stage of using VR for sleep, and we really need to understand more about use and capability of VR technology," de Zambotti added.
Commenting on the research for Medscape Medical News, Lauren Goldman, MD, of the Sleep Disorders Center at the Cleveland Clinic, in Cleveland, Ohio, noted that the use of relaxation techniques to aid sleep onset is not new, but the addition of immersive VR is "relatively novel. VR gaming is becoming increasingly popular, so the idea of utilizing this modality to benefit a medical condition such as insomnia is very intriguing.
"Teens often struggle with insomnia and difficulty initiating sleep, which ultimately leads to insufficient sleep. This can affect their schooling, grades, and involvement in extracurricular activities. It can also impact mood, judgment, and overall mental health," said Goldman.
The finding that VR in combination with slow diaphragmatic breathing improves sleep onset latency and sleep efficiency is "fascinating," she said.
Goldman said the findings are "promising but preliminary. This intervention needs to be studied in a broader patient population in terms of age, comorbidities, and medication use. The long-term impact, in regards to efficacy and adverse outcomes, should also be further assessed. Use of virtual reality headsets has been linked to injuries, falls, eye strain, nausea, and dizziness.
"There is currently no FDA-approved medication for insomnia in those less than 18 years of age, so if further studies confirm long-term efficacy and safety of this intervention, it could have potential impact on management of patients with chronic insomnia," Goldman said.