The goal of this clinical trial is to evaluate the feasibility, acceptability, and preliminary effects of a virtual reality (VR) relaxation intervention among adults aged 25 to 50 with insomnia disorder. The main questions this study aims to address are: * Is a VR relaxation intervention feasible to implement and acceptable for individuals with insomnia? * Does the intervention reduce pre-sleep cognitive and somatic arousal? * Does the intervention improve sleep quality and sleep depth? * Can the intervention enhance overall sleep health and reduce symptoms of insomnia, anxiety, and depression? * Are these potential benefits maintained at a 3-month follow-up? Participants will be randomly assigned to either the intervention group or a waitlist control group. Researchers will compare outcomes between groups to evaluate the impact of the intervention. Participants will: * Complete online questionnaires at three time points (baseline, post-intervention, and 3-month follow-up) assessing sleep health, pre-sleep arousal, and symptoms of insomnia, anxiety, and depression * Take part in an in-person diagnostic interview at Université Laval to assess sleep and mental health status * Complete a daily online sleep diary for 8 weeks (2 weeks baseline, 4 weeks intervention, and 2 weeks post-intervention) * Engage in a 15-minute VR-guided meditation session each evening at home for 4 weeks * Wear a portable sleep monitor at home for 8 nights (4 nights baseline and 4 nights post-intervention) * Complete an acceptability questionnaire following the intervention
The objective of this study is to evaluate the feasibility and acceptability of a virtual-reality relaxation intervention for individuals with insomnia disorder, and to assess its effects on pre-sleep arousal, sleep quality, mental health, and sleep depth. The intervention is expected to lead to high feasibility and acceptability, a reduction in cognitive and somatic pre-sleep arousal, a decrease in sleep latency, wake after sleep onset, and number of awakenings, as well as an increase in sleep efficiency. Reductions in insomnia severity, anxiety symptoms, and depressive symptoms are also expected. In addition, variables derived from the Odds Ratio Product (ORP)-a validated index of sleep depth ranging from 0 (deep sleep) to 2.5 (wake)-will be computed. It is anticipated that the intervention will increase the total time spent in deep sleep (ORP 0-0.5) and decrease gamma power (\>35 Hz), alpha intrusion (i.e., the number of three-second epochs with alpha power \> 30 µV²), and the time required for sleep depth to recover following an awakening (ORP-9). An open-label, parallel-group, randomized controlled trial will be conducted to evaluate the feasibility, acceptability, and efficacy of the intervention. Thirty participants (15 women) aged 25 to 50 will be recruited following a diagnostic interview for insomnia (EDI-A) and psychiatric disorders (MINI). Insomnia severity (ISI), somatic and cognitive arousal (PSAS), and symptoms of anxiety (BAI) and depression (BDI-II) will be assessed using validated questionnaires. Participants will complete a daily sleep diary, and the Prodigy 2 Sleep Monitor, which enables home-based polysomnography (PSG), will be used to assess sleep quality and sleep depth. Feasibility outcomes (recruitment, retention, and adherence) and acceptability of the intervention, assessed through a self-reported questionnaire based on the Theoretical Framework of Acceptability, will complement the study measures. The virtual-reality intervention consists of a 15-minute guided meditation adapted for sleep and combined with slow breathing (\~6 breaths per minute) to promote immersive relaxation. Sessions will be performed in a seated position before bedtime, aligned with each participant's usual sleep schedule. The guided meditation, developed in collaboration with the McGill Mindfulness Research Lab, aims to enhance present-moment awareness and reduce negative sleep-related thoughts. The immersive environment was created in partnership with OVA, a Quebec-based company specializing in relaxing immersive environments, using visuals (starry night), ambient neutral soundscapes, and gender-neutral, accessible narration. Immersion will be delivered using a Meta Quest 3 headset configured to minimize exposure to blue light. After providing informed consent and completing the diagnostic interview, eligible participants will complete psychological questionnaires, a two-week sleep diary, and four nights of home PSG at baseline \[T1\]. Participants will then be randomly assigned to the intervention group or the waitlist control group. The intervention group will complete the daily VR intervention for four weeks, after which both groups will undergo a second assessment \[T2\]. The waitlist group will then receive the VR intervention for four weeks, followed by its own post-intervention assessment. A three-month follow-up assessment will be conducted for both groups to evaluate whether the effects of the intervention are sustained over time.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
30
A virtual reality (VR) intervention combining guided sleep-focused meditation and slow breathing will be used to provide an immersive relaxation experience. Each evening, participants will complete a 15-minute mindfulness meditation accompanied by visual animations designed to guide slow, paced breathing. The meditation content aims to cultivate present-moment awareness and facilitate the release of sleep-related negative thoughts and cognitive arousal. All sessions will be completed in a seated position before bedtime, aligned with each participant's typical sleep schedule. The immersive experience will be delivered using a Meta Quest 3 VR headset configured with a low-blue-light display mode.
Laval University
Québec, Quebec, Canada
RECRUITINGPre-Sleep Arousal
The Pre-Sleep Arousal Scale (PSAS) is a 16-item questionnaire that assesses symptoms of cognitive (e.g., racing thoughts, worry about not falling asleep) and somatic arousal (e.g., muscle tension, rapid heartbeat) experienced at bedtime. Participants rate the intensity of each symptom as they attempt to fall asleep using a five-point Likert scale ranging from 1 (not at all) to 5 (extremely). Higher scores on the scale indicate elevated levels of pre-sleep arousal.
Time frame: Baseline (Day 1), end of intervention (Week 4), and 12 weeks after end of intervention (Week 16).
Insomnia severity
The Insomnia Severity Index (ISI) is a self-administered questionnaire used to assess the severity of insomnia. The ISI consists of seven items that evaluate the nature, intensity, and consequences of insomnia over the past month. The dimensions assessed include difficulties initiating or maintaining sleep (sleep onset latency, nighttime awakenings, early morning awakenings), dissatisfaction with sleep, the impact of sleep difficulties on daytime functioning, and the level of distress caused by these problems. Each item is rated on a 5-point Likert scale from 0 (not at all) to 4 (extremely), yielding a total score ranging from 0 to 28. Interpretation thresholds are as follows: 0-7 (no clinically significant insomnia), 8-14 (subthreshold insomnia), 15-21 (moderate insomnia), and 22-28 (severe insomnia).
Time frame: Baseline (Day 1), end of intervention (Week 4), and 12 weeks after end of intervention (Week 16).
Anxiety
The Beck Anxiety Inventory (BAI) will be used to assess participants' anxiety symptoms. The BAI consists of 21 items rated on a Likert scale from 0 (Not at all) to 3 (Severely - It bothered me a lot). The total score is calculated by summing the responses to all 21 items (0-7 points are considered to reflect a minimal level of anxiety; scores of 8-15 indicate mild anxiety; scores of 16-25 reflect moderate anxiety; and scores of 26-63 indicate severe anxiety).
Time frame: Baseline (Day 1), end of intervention (Week 4), and 12 weeks after end of intervention (Week 16).
Depression
The Beck Depression Inventory - Second Edition (BDI-II) is a self-administered questionnaire designed to assess the severity of depressive symptoms. It consists of 21 items corresponding to various depressive symptoms, each rated on a four-point Likert scale from 0 (least severe) to 3 (most severe). The total score ranges from 0 to 63, with higher scores indicating greater severity of depressive symptoms.
Time frame: Baseline (Day 1), end of intervention (Week 4), and 12 weeks after end of intervention (Week 16).
Sleep health
The Ru-SATED scale is a self-report questionnaire that assesses six dimensions of sleep health. It evaluates regularity (i.e., going to bed and waking up at about the same time each day), satisfaction with sleep, alertness (i.e., the ability to stay awake without dozing off during the day), timing (i.e., typically being in bed between 2:00 and 4:00 a.m.), efficiency (i.e., spending less than 30 minutes awake per night), and sleep duration (i.e., sleeping between 7 and 9 hours per night). Each dimension is rated on a five-point Likert scale from 0 (never) to 4 (always). The total score, obtained by summing the scores across the six dimensions, ranges from 0 to 24, with higher scores indicating better sleep health.
Time frame: Baseline (Day 1), end of intervention (Week 4), and 12 weeks after end of intervention (Week 16).
Positive and negative emotions
The Positive and Negative Affect Schedule (PANAS) is a self-report questionnaire used to assess the intensity of affective states. The instrument consists of 20 adjectives, with 10 describing positive affect and 10 describing negative affect. Participants rate, on a five-point Likert scale ranging from 1 (very slightly or not at all) to 5 (extremely), the extent to which they experience each emotion. A high score on the positive affect subscale reflects a state of high energy and pleasurable emotions, while a high score on the negative affect subscale indicates subjective distress involving multiple negative emotions.
Time frame: Baseline (Day 1), end of intervention (Week 4), and 12 weeks after end of intervention (Week 16).
Sleep characters recorded by sleep diary
Participants will record sleep diaries each day duration the 4-week of intervention. Participants will complete 14-day sleep diaries at baseline before recruitment, end of intervention and 12 weeks after end of intervention. The following parameters extracted from the diary will be used for analysis: sleep latency (the time in minutes required to transition from wakefulness to sleep), number of awakenings (the count of nocturnal awakenings lasting more than 5 minutes), wake after sleep onset (the total time in minutes spent awake after initially falling asleep and before final awakening), and sleep efficiency (the proportion of total sleep time relative to time spent in bed).
Time frame: Baseline (Day 1), intervention (Weeks 1-4), end of intervention (Week 4), and 12 weeks after end of intervention (Week 16).
Sleep characters recorded by a portable sleep monitor
A portable sleep monitor (Prodigy 2 Sleep Monitor) will be used to collect objective measures of sleep quality. The following parameters recorded from the sleep monitor will be used for analysis: sleep latency (the time in minutes required to transition from wakefulness to sleep), number of awakenings (the count of nocturnal awakenings lasting more than 5 minutes), wake after sleep onset (the total time in minutes spent awake after initially falling asleep and before final awakening), and sleep efficiency (the proportion of total sleep time relative to time spent in bed).
Time frame: Four consecutive nights at baseline and four consecutive nights at the end of the intervention (Week 4).
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