VR Sickness: A New, Old Problem

Have you ever experienced dizziness, vertigo, or nausea while in a virtual reality experience? That’s VR sickness, and it’s a form of motion sickness. It is not a completely solved problem, and it affects people differently, but it all comes from the same root cause, and there are better and worse ways of dealing with it.

If you’ve experienced a sudden onset of VR sickness, it was most likely triggered by flying, sliding, or some other kind of movement in VR that caused a strong and sudden feeling of vertigo or dizziness. Or perhaps it was not sudden, and was more like a vague unease that crept up, leaving you nauseated and unwell.

Just like car sickness or sea sickness, people are differently sensitive. But the reason it happens is not a mystery; it all comes down to how the human body interprets and reacts to a particular kind of sensory mismatch.

Why Does It Happen?

The human body’s vestibular system is responsible for our sense of balance. It is in turn responsible for many boring, but important, tasks such as not falling over. To fulfill this responsibility, the brain interprets a mix of sensory information and uses it to build a sense of the body, its movements, and how it fits in to the world around it.

These sensory inputs come from the inner ear, the body, and the eyes. Usually these inputs are in agreement, or they disagree so politely that the brain can confidently make a ruling and carry on without bothering anyone. But what if there is a nontrivial conflict between those inputs, and the brain cannot make sense of whether it is moving or not? For example, if the eyes say the body is moving, but the joints and muscles and inner ear disagree? The result of that kind of conflict is to feel sick.

Common symptoms are dizziness, nausea, sweating, headache, and vomiting. These messy symptoms are purposeful, for the human body’s response to this particular kind of sensory mismatch is to assume it has ingested something poisonous, and go into a failure mode of “throw up, go lie down”. This is what is happening — to a greater or lesser degree — by those experiencing VR sickness.

How Can It Be Dealt With?

For those unlucky enough to be susceptible, there are three ways of dealing with VR sickness: avoidance, moderation, and adaptation. Fortunately, unlike being stuck at sea while seasick, one is typically in complete control of their engagement in a VR experience. Not all experiences will be an issue, and people are differently sensitive. One may be able to tolerate some things, but others not at all.

Most VR experiences include some kind of comfort rating, and offer different locomotion and interface options. Seated experiences tend to be more comfortable ones. Teleportation-type movement and snap turning also tend to be more comfortable for users. Smooth locomotion and smooth turning are more challenging. These options allow one to avoid some elements, and moderate others.

It is also possible to adapt, and here a bit of education will ease the process of getting one’s “VR legs”.

Adaptation Is Possible

Sailors eventually get their “sea legs” and adapt to an environment in which motion sensed by their bodies does not match what their eyes see. Astronauts residing on the ISS (International Space Station) have a similar experience: in microgravity, the inner ear does not provide useful information. As a result, astronauts’ brains eventually learn to rely primarily on visuals. (As it happens, after an extended period in microgravity, astronauts suffer serious sensory mismatch when returning to Earth. As Chris Hadfield described it in a talk I attended, “you’re smiling for the camera but you feel terrible.”)

I have some added insight into the adaptation process thanks to long experience with a disease that affects my vestibular system. In physiotherapy, I learned that the brain is highly plastic and in most cases can is able to re-learn the necessary lessons. But it’s best to know a bit about how exactly this process works.

While the brain is capable of re-learning how to deal with confusing sensory input to the vestibular system, this learning happens with a high degree of specificity. That means that if one practices a certain thing, such as looking left while moving forward, the brain only re-learns how to deal with that specific thing. One cannot practice a narrow activity and expect it to “carry over” in a general sense. One will only get better at the things one practices.

My advice to those attempting to gain their VR legs is to expose yourself to a mix of different activities in VR that challenge your sense of balance, and do so gently and in moderation, for short periods at a time. There is no good in forcing things and pushing too hard. When you bump up against your limits, immediately stop and re-center yourself, and try again. Then after a short while, give yourself a rest.

Vestibular physiotherapy and rehabilitation exercises are designed with this in mind, and the same principles apply.

Will VR Develop Past This?

In a way, modern VR development has already done much to eliminate many common triggers of VR sickness at a low level. High frame rates and highly accurate motion tracking aren’t just for providing good visuals and satisfying feedback. Display lag and subtly delayed visuals can cause feelings of illness, and these have been impressively addressed in the development of modern headsets. Smaller and lighter headsets also make for more secure and stable mounting to users’ heads; loose and wobbly headsets being also a path to visual mismatch.

The experiences coming from the VR applications themselves are another story, however. Some software titles are mindful of comfort level when it comes to their design of interfaces and experiences, while others seem to ignore comfort completely in favor of exploring novel gameplay. One thing that’s clear is that it is still early in this space.

In the meantime, if you find yourself suffering from VR sickness, the best most obvious thing to do is avoid applications and experiences that cause you to feel ill. Use others in moderation, and if you’re determined to adapt, then follow the guidelines I laid out earlier. Your stomach will thank you for it.

56 thoughts on “VR Sickness: A New, Old Problem

  1. I have been trying a Valve Index for a month, I had this distinct feeling while using the jetpack in No Man’s Sky.

    I think I should be able to adapt to it, it got easier already

    1. One solution to contain (because you can’t really stop it) your potential sickness is to move your body while you play. Move your arms, torso and legs if your avatar does the same. This will significantly reduce your discomfort.

    2. Dropping from high objects (3-5 seconds of drop time) playing Fall Out 4 using the power armor equipped with jet pack gives me the vertigo feeling even without VR. Given the “look before you leap nature” I always know when it’s gonna happen.

  2. i cannot play doom anymore :(

    but mostly i can handle first person video, handheld cameras, that sort of thing. but i have narrowed down one particular trigger…it was a helmet-cam video of a guy showing the limits off the winter tires on his bicycle. i was alright with a couple minutes of the video but then he hit a particularly smooth patch of ice and he went down. he was fine. i was not. i was miserable for hours after that. the visual effect of falling without the vestibular effect, in only about a second of video, was a huge trigger for me.

    i’m just highlighting something already in the article — these triggers can be studied and over time designers will learn to avoid most of them for most people. i guess.

    1. So you were fine playing it for a while? I always figured as the article alluded to with ‘sea-legs’ and talking of the brains plasticisty that you would get better at dealing with it the more often you used it.

      1. i don’t know, my experience may exactly match that description of improving with exposure…as a kid, i played FPS pretty constantly from like 11yo to 19yo…i probably “got over it” by the time i was 12, without ever really noticing it (i know wolf3d used to make me sick). but then as an adult i play, i don’t know, once every 6 months. i doubt i will ever play intensely enough now to get over that initial (re-) adjustment period period.

        1. Fair enough, seems perfectly reasonable to me to loose your acclimatization over time – though I expect its also a bit like ‘riding a bike’. You do sort of forget, but the brain was already prepared to relearn the bits you did easily.

          I know having played through awful stuttery lagfests in various games over the years you can get used to an awful lot of variation. Always bothers me to start with, and generally after I stop concentrating on it to do something else. But that sort of thing rarely bothers me really, maybe a few seconds of uncomfortable usually. It is only when I already feel like crap so I can’t tune out the flickers of the CFtubes or anything else that it really bothers me, and usually when I’m that bad upstairs the rest of me isn’t what you could describe as functional either…

          Perhaps try setting a framerate cap in the 20-30fps range and stepping it up – consistent response really aught to be less disconcerting, and that movie sort of FPS range is something we tend to be good at dealing with I’d think, lots of practice.

    2. My son has a rock climbing game on the Quest 2. I really like the game and have no sickness issues… Until I fall. Then it is an instant car sickness feeling that can take a couple hours to get over. I have gotten past it by closing my eyes as soon as I realize I’ve missed a grab or am falling for any reason. Wait until I hear the menu noises then reopen my eyes. I’ve played this game a lot and it hasn’t gotten any better for me but the “blindness” bandaid is helping.

    3. I’ve been playing first person shooters since childhood with no issues, but lately i find that when I watch csgo surf videos i’m overcome by nausea. I had heard about gaming sickness and just assumed it didn’t affect me.

    4. If you haven’t already turn off head bob with movement in games btw. Makes a massive difference for sickness for me. I used to be totally fine, got an inner ear infection then tried playing portal. nope nope nope

  3. I have a device that’s supposed to correct that. Back in the late 1990s a guy invented “virtual motion” which induces the feel of motion in your brain without visual or mechanical trickery. It has 3 electrodes, one on your forehead and one behind each ear on that little lumpy thing(called the mastoid process). The invention unfortunately was canned since they couldn’t get any manufacturers to buy it due to perceived safety issues but only after he sold 100 prototypes. As far as I’m aware, I may be the only person who still has one. It’s been long enough that the patent for it is about to expire so if someone wanted to reverse engineer it, we could solve this problem.

    1. This is called Galvanic Vestibular Stimulation, and it gets looked into periodically, but the problems with it are pretty hard to overcome. Specifically, each time a person puts on the device, there’s a particular level of current that they will respond to, and beyond that, a level of current they will find extremely painful. The problem is that the difference between these two levels is less than the variation in those same levels.

      Samsung showed off a pair of headphones they said would do this a few years ago at one of the shows (CES, maybe?), but then it never came to market. Around the same time there were videos of a university team that was working on the issue as well; they were looking at sending differential signals to the two sides of the head to create a variety of sensations. I don’t think that went anywhere either, though.

      I’m not confident this will get solved before more general nerve interfaces get solved, honestly.

  4. I do suffer from travel sickness as a car passenger, but only a very few games trigger it. Hands down worst offender is the N64 Cart version of Goldeneye. Has me lying down in a cold pukey sweat before I’m 5 mins into the game. I’ve tried it on and off over the years and it;s always the same. It’s commony reported on with regards VR sets (though not necessarily commonly suffered from) and so I have held off investing in that particular technology.

  5. Maybe VR isn’t for everyone? Some people may just never participate. Some people don’t fly when they travel. Some people don’t own cars. And still they get by, lead fulfilling lives, and don’t miss out on the things they don’t do.

    1. VR is for almost nobody. They’ve been trying to force these headsets for years and I think the percentage of people who just won’t ever wanna put that stuff on their face is in the high 90s. I work in VR.

      1. I think AR, which is basically just VR while retaining some view to the real outside world is definitely something we are likely to see for nearly everyone eventually (would be everyone if not for the complexities added by disabilities etc). But the blanking out the outside world entirely as VR does is I suspect something that will be great for some aspects of many jobs, and obviously the gamers, but is never going to be daily almost expected use for entirely everyone.

        The ‘metaverse’ type VR meeting spaces to me are kinda stupid, but have a core of good idea – remote more human gestures over long distances can be very useful. I just don’t see why it needs to be a VR experience, these people you are talking with can easily be overlaid on the world around you – even if it seems like they are ‘inside’ the wall – in many ways how is that different to the other side of a 2d screen… Just now they are perceived in 3d, can gesture more freely without going out of frame all the time etc.

  6. I was involved in VR hardware design with Boeing and UWa back in the late 80s , early 90s. With system rendering lag and the user response mismatch, we kept airline bags handy. There was also some concern that, in extended use in young users, we could be retraining their vestibular systems to work better in the simulated environ but to over compensate in the real world.

    1. Yeah, that’s why timewarp is such a big deal in modern hmd based VR: it lowers the effective latency to basically exclude the app rendering duration by reprojecting. If you have the screen stuck to your face it’s pretty important. (CAVE style projection setups have much lower latency requirements because the screen is already in the place you look next, with approximately the right content.

  7. >While the brain is capable of re-learning how to deal with confusing sensory input to the vestibular system, this learning happens with a high degree of specificity. That means that if one practices a certain thing, such as looking left while moving forward, the brain only re-learns how to deal with that specific thing.
    <

    I think a few years back HaD had an article on a project for infinite movement in VR while keeping a safe distance to all four walls of your real VR room.
    The basic idea is: Walk straight in VR but the systems manipulates it so you actually walk in circles – or even better eights – in reality.

    At the time my comment was along the following lines:
    If you stay in the VR system for a long enough time do you walk like a drunk afterwards?

    Would be kinda the opposite of regular VR sickness – as in if the VR environment manipulates your "inputs" too much/long you get RL sickness (not the regular kind ;-) ).

  8. This doesn’t apply to VR but is similar. I recently got a nice big 27″ widescreen monitor, mounted on a hutch on my desk at eye-level for an immersive experience. All was well for several weeks doing normal computer things and videos, but then I connected the XBox and loaded Duke Nukem 3D. The first quick slide across the room in the game, and my gyros totally tumbled. I found that the only way I can play this is to sit well back from the monitor, like halfway across the room, so the screen is not the dominant part of my visual field. Being able to see the room stationary as opposed to the movement in the game is enough for everything to agree that I’m not in fact moving despite what my eyes see. Of course, this option would not be available with a VR headset, so I suppose I’ll just pass on one of those. The funny thing is that this never bothered me playing Quake 3 Arena on a smaller 19″ 4:3 monitor in the same spot. Once again, I suppose that was a small-enough part of my visual field that it didn’t cause the issue.

    1. One note: console games are optimised for playing at television distance, including the field of view. Console games will have a more narrow field of view compared to PC games which will be wider as you’re much closer to the screen. I don’t know if that would account for your experience, just a suggestion.

    1. Because sim-sickness and motion-sickness are INVERSE effects.

      Motion sickness is where your inner ear is telling your brain “stuff is moving!” and your eyes are telling your brain “Nah, stuff is stationary!”. Medication that supresses the inner ear response reduces that mismatch.

      Sim-sickness is where your inner ear is telling your brain “stuff is stationary!” and your eyes are telling your brain “Nah, stuff is moving!”. Medication that supresses the inner ear does nothing to solve the problem, and supressing vision rather defeats the point of VR.

      1. I’m not a doctor, but from what I’ve read about meclizine, it looks like it doesn’t simply suppress vestibular sensation. Are you aware of any studies on meclizine for VR sickness?

        I see lots of people claiming it works for them, but that of course means nothing — people believe all SORTS of stupid things are effective treatments for anything under the sun. But if your hypothesis is true, meclizine could very well make VR-sickness WORSE, and I’d think we’d find people relating that experience.

    2. Yeah, I was wondering the same. Over the counter meds are available for motion sickness and seem to work in VR. They’ve also been used by people for motion sickness on boats and stuff for a long time now, so I’d imagine they’d be considered quite safe (even if they taste like death itself).

      I take Dramamine (actually its generic version after the pharmacy stopped carrying the brand name) before any VR session if I think it’s possible I might do more than stand around/dance in a casual social setting, like if I might go practice flying a helicopter or jumping out of a space station or something. Otherwise I will get very sick if I don’t pop one of these.

  9. I’m not a gamer but was so impressed by Half Life Alyx that I bought a Valve Index. No VR sickness issues for me. However, I decided to try Half Life 2 as everyone raved about it. It turns out I feel totally sick gaming on a standard monitor after just a couple of minutes.

  10. A coupel of colleagues we working on an art instalation where you could “see things from another person’s point of view”. The prototype was 2 VR headsets with the video feeds swapped. As the other person’s head moved you’d see their VR view. It was named the instant sea-sickness machine and thankfully never got past the prototype stage.

  11. VR only works for piloting vehicles, where you are sitting or standing in place and the general trajectory all the time is either forward or reverse. Humans have been driving wagons and carriages for thousands of years, and it’s safe to say they have well adapted to it. You only need to focus on the points in the center of your vision to keep driving in a straight line, and you are less concerned about depth and perspective since the scenery is constantly changing.

    Suggesting that we can adapt to VR in this state when it’s only been available for barely a decade is laughable. Some people never get their sea legs no matter how hard they try, and people that spend the majority of their lives working at sea these days will often take supplements even if they are somewhat adapted, as exceptionally rough seas can still induce sickness in even the most hardy.

    The problem is the tech, not the people. You can’t control the focus of the foreground and background in a VR scene with your eyes the same way you would when looking at objects in real life. There is either no blurring of objects in the scene, or the application forces the focus on objects aribitrarily. Until VR can respond to eye movement and intelligently adjust focus exactly as your eyes do, it will always create headaches because it’s forcing your brain to process information in an unnatural way.

    1. yeah i think this observation about piloting is spot on. when i played with my ‘oculus go’, i loved the games where i was basically stationary. either standing in one place looking around a scene (like watching a movie with a still camera), or stationary inside the cab or cockpit of a vehicle. anything where my character was walking around without dragging a stationary frame around with him was always a little unsettling.

    2. From my own experiences I don’t think driving in a car on VR is exempt. I sim race, albeit poorly, in VR. The first time I tried it I felt a little ‘off’ and stopped after about 45 mins. Going back to it the next day I didn’t have any further motion sickness issues with the experience. The exception to this was, at least for a time, putting the car I was driving in reverse, or hitting banked corners the first few times i drove around an oval racetrack. Neither of these bother me anymore.

      Meanwhile, I’ve had other people try sim racing in VR on my equipment with varying success. Some people had no issues at all. While others have had to stop due to motion sickness within five to fifteen minutes. Those who have had to stop haven’t had any issue switching back to driving on a flat screen.

    3. VR currently works best at room scale (with good software). e.g. Beatsaber, Art of the Fight (what ever they’ve renamed it to).
      The trick, such as it is, is to coordinate your in game motion with your real world motion. Only break the sim when leaving border.

      Next best is sitting down cockpit/car games. With the cockpit frame/car interior being important to minimize VR sickness. A solid controller to hold onto also helps a lot.

      Worst is 3d shooters/sneakers. It’s the in game movement with no corresponding inner ear etc that screws it up.

      The absolute worst I’ve ever personally played was Descent 2 (on an ancient VFX-1). Instapuke.

  12. From my own experience and observation of others the suggested ‘short periods’ thing is a bad idea.
    Short period and then a rest before you get really affected means you will never advance.

  13. I can’t even watch my kids playing Minetest as a team on 2D screens without wanting to puke, then I have to go off and take a powernap to reset my system if I want to stop the nausea. I wish I understood that nap benefit phenomena better, it may be the key to adaptation because I can fly around in my own lucid VR when I am dreaming, but then my physical body is not moving, so why does that not make me feel ill at all?

  14. Quick and dirty solution that seems to work for everybody i’ve given this advice:

    When you want to play games with joystick movement but it makes you uneasy/unbalanced, the trick is to start by walking in place when you walk in game, that way it will be less weird for your brain (after all, you are technically kind of walking now when your eyes get the same signal) and then just make sure to not overdo it, play short sessions of 30-60 minutes tops, as you play more slowly increase that time but stop as soon as you feel any sort of uneasy-ness

    And then as your brain gets used to VR (after 15-20 hours or so?) / once you play 90-120 minute sessions with ease, your brain will suddenly have the realization that this whole walking in place thing is just stupid, its like some sort of minor eureka moment, all of the sudden you’re completely fine with joystick movement while standing still.

    This change stays if you play VR every now and then (say once a week at minimum?) if you take a break of more then a few months you will need to ‘train your vr legs’ a bit again but it will go much faster then first time, after a few sessions your brain just goes “oh right, this stuff, all is well”

    Finally, if you can afford it, get a headset with as high of a framerate (read: screen hz) as possible, so PSVR or Valve Index or something, even tho you dont really notice the higher end of framerates your subconscious does notice and higher hz is less chance on ‘sickness’.

  15. Sometimes I even get sick when playing FPS games, especially with too much bobbing views, Shogo MAD on 17″ CRT was the first time I experienced it. Recently it was Just Cause 3. But I even felt it with Minecraft. I blame it on my 42″ display I use as my monitor, it is too immersive. Playing in smaller window helps. Never had it when playing on Switch or PS4 on a TV that is far away from me.
    VR is even worse, anything with smooth movement makes me sick pretty quick. Teleporting is much better.
    I have been playing games for 40 years, and I still haven’t gotten used to it. So I am not sure I can teach my brain to deal with it.

  16. If VR ever becomes a standard for professional work, I guess I’ll have an occupational disability. I felt like I had the flu for a whole day after half an hour in a CAVE (room where walls and floor are projection displays). MAYBE intelligent display design (pinning content to real-world positions) and adequate frame rate/position sampling/latency will make it tolerable. Fingers crossed.

  17. Not everyone can adapt to simulator sickness (‘VR legs’). Studies done by the AFRL on pilot sim sickness (https://apps.dtic.mil/sti/pdfs/ADA434495.pdf) – a population already selected for and/or adapted for tolerance to vision/vestibular mismatches – found around 5% of that population NEVER gained adaptation to sim-sickness. We can expect the proportion of the general population affected to be much higher.

    I’ve been messing with consumer VR since the pre-DK1 days (back before the name Oculus was even coined to describe the duct-tape prototypes), and a decade on and there’s no sign for ‘VR legs’ arriving anytime soon. If you application messes with the horizon or forces horizontal movement or breaks orthostereo, then it is an immediate reject for me, as failing to meet those basic minimum standards means an immediate and very obvious nausea response.

  18. Article headings” “Why does it happen?” “How can it be dealt with?

    There is an old joke where a guy goes to his doctor and says “Doc, it hurts when I do this…” To which the doctor replies, “Then stop doing that.”

    Assuming that the body’s negative reaction to a technology is the fault of the body–and not of the tech–is both presumptuous and potentially dangerous.

    To be clear, I find this tech fascinating and when a friend bought an Oculus a few years ago, I confess I spent several hours playing with it. Yet, I would absolutely prohibit it’s use by any young child in my house, owing to the extreme plasticity of their brains at that stage in life.

    Also, I have long predicted that when VR reaches a sufficient state of development, society will face the effects of an addiction epidemic that will make crack look like M&Ms.

  19. I hope this helps others like it has helped me – I discovered that keeping the back of the head cool stops the sicky feeling. I tend to put cold water on the lower back part of my head (where the skull meets the neck). This condition also happens much more when I have smoked cannabis and is very similar to ‘The Whitey’, which by the way can also be fixed with the cool water technique.

  20. Hi, Iโ€™m a person with motion sensitivity in cars, when reading while in a city bus or metro. I considered myself in the past being limited to static VR scenes marked as comfortable.

    I believe Ubisoft did some amazing research and work when they made Eagleflight. Itโ€™s called vignetting. When difficult things for the vestibular system happen, a slightly transparent darkened edge appears around the periphery of the entire image temporarily, letting your brain know itโ€™s not in the real world.

    Vignetting works wonders for people like me and games that implemented it like Walking dead Saints and Sinners, Blade and Sorcery (requires manually enabling setting through modding), Eagleflight to name a few, are entirely playable for me even if not a static comfort game and a godsend.

    Itโ€™s a shame that the vignette accessibility comfort feature has not yet been implemented across all VR applications. If you have nausea problems in VR for intense movements, I highly recommend you try the titles above with the vignettes comfort option. Devs, all of you, please implement vignettes, itโ€™s light and day the difference for many people.

    For the hackers, please add a way to add this in for existing titles missing it. Something like a pixel shader image you inject into the rendering pipeline, when detecting position changes in the sceneโ€™s world.

    Cheers

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