Digital Health Monitoring and Intervention Suite for Stress in Frontline Nurses: Prospective Cohort Trial

Background: Stress among health care workers (HCWs) contributes to burnout, workforce attrition, and adverse patient outcomes. Although virtual reality (VR), psychoeducation, ecological momentary assessments (EMAs), and wearables have independently shown promise in stress research, no integrated digital suite has combined controlled stress induction, intervention delivery, and longitudinal real-world monitoring in HCWs. Objective: This study aimed to evaluate the feasibility, engagement, and preliminary effectiveness of a multimodal Digital Health Monitoring and Intervention suite for Stress framework integrating VR simulation, psychoeducation, EMAs, and wearable biometrics. We examined (1) the impact of VR simulation and psychoeducation on stress outcomes and (2) associations between physiological and self-reported mental health outcomes. Methods: Ninety-nine nurses (mean age 33.7, SD 8.9 yr, 87% female) were enrolled in 2023. We conducted a single-arm prospective cohort study (NCT05923398). Using convenience sampling, participants were recruited from social media advertisements, flyers, and email notices distributed through professional listservs. Participants completed ≥2-week baseline monitoring, a single VR session (2 runs separated by a brief psychoeducation intervention), and 12-week follow-up. In-VR stress was assessed using the Subjective Units of Distress Scale (SUDS) and 4-item Moral Injury Outcome Scale (MIOS-4), with synchronous heart rate variability. Longitudinal outcomes included weekly and biweekly EMAs alongside 70 wearable-derived features. Paired tests, aligned rank transform ANOVA, and Pearson correlations informed study objectives, with P values adjusted for multiple comparisons. Qualitative content analysis classified emotional responses during and after VR. Results: VR significantly increased subjective stress across checkpoints in both runs, with attenuation in Run B relative to Run A (all <.001). No significant heart rate variability differences were observed between runs (.15). During VR, 92% (91/99) of participants felt stressed, 36% (36/99) reported anxiety or nervousness, and 51% (50/99)‐78% (77/99) endorsed anger, guilt, shame, and/or betrayal. Most (59/99, 60%) HCWs returned to an emotional baseline post-VR, although 12% (12/99) reported lingering distress. Immediate reliable improvements in anger, guilt, shame, and/or betrayal occurred for 50% (50/99)‐75% (74/99) of participants post intervention. Anxiety (mean −0.53, SD 2.34; .03) and stress (mean −3.05, SD 11.35; .01) decreased 2 weeks post intervention, but were not sustained at 12 weeks. Increased sleep restlessness was the only wearable feature showing significant changes (mean 2.46%, SD 5.43; <.001). In-VR stress correlated with 12-week real-world stress (SUDS: =0.57‐0.58; MIOS-4: =0.58‐0.61; all .01). Data completion exceeded 90%, with 71% achieving full compliance. Conclusions: This study moves beyond single-tool interventions to demonstrate the feasibility and preliminary effectiveness of an integrated, multimodal stress platform within a single coordinated framework. This trial demonstrates high engagement, short-term symptom responsiveness, ecological validity, and emotional safety. The framework provides a scalable model for proactive stress identification, skills training, and implementation in high-risk occupational settings. Randomized controlled trials are needed to establish sustained efficacy and optimize deployment for real-world implementation. Trial Registration: ClinicalTrials.gov NCT05923398; https://clinicaltrials.gov/study/NCT05923398 International Registered Report Identifier (IRRID): RR2-10.2196/54180
<![CDATA[Alixorexton boosts wakefulness in type 1 narcolepsy, shows cognitive and fatigue gains, and hints at ADHD and neurodegenerative uses.]]>

Inclusivity in Insomnia: Adolescents’ Perspectives on the Sleep Solved App: Qualitative Interview Study

Background: Adolescent sleep duration can substantially impact mood, behavior, and academic attainment. While hundreds of sleep-related apps are available to download, none have been cocreated with adolescents from underserved populations in the United Kingdom. Objective: This study aimed to explore adolescents’ views, expectations, and experiences with a novel app to improve sleep, called Sleep Solved, to understand which features were perceived as positive and helpful, and to identify ways to further enhance its usefulness. Sleep Solved is part of a larger stepped behavior change study and was cocreated with adolescents from underserved groups to make the app accessible and engaging for this population. Methods: A total of 63 participants aged 16‐18 years from across the United Kingdom completed semistructured interviews after trying the app. Interviews were analyzed using inductive thematic analysis, as outlined by Braun and Clarke, with a particular focus on the views of individuals from underserved ethnic and socioeconomic groups. Results: Participants perceived Sleep Solved as a useful tool that provides helpful advice regarding changeable behaviors to improve sleep hygiene. Cocreated features of the app, such as the Sleep Stars gamified rewards system and the easy-read, science-based “sleep hacks,” were viewed positively by participants, who reported that they had a beneficial impact on their sleep and sleep schedule. Praise was given for the app’s ease of use and how the science of sleep was explained at an appropriate level, without being overwhelming. Compared to sleep advice on social media platforms, Sleep Solved was considered more reliable and trustworthy. Participants described better sleep hygiene, such as a regular sleep routine and a longer sleep duration, and increased feelings of improved mood and energy. Conclusions: This study found that a cocreated sleep app, designed with input from adolescents in underserved UK populations, was perceived as accessible, reliable, and effective in supporting positive sleep behavior change. Although sleep duration was not objectively tested, participants, particularly those from low socioeconomic status backgrounds and diverse ethnicities, reported improved sleep routines and mood, highlighting the potential of co-designed digital tools to engage and benefit adolescent users.
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<![CDATA[Explore the brain’s 5 monoamines—beyond serotonin and dopamine—revealing histamine, melatonin, and trace amines shaping sleep, appetite, and mood.]]>

SleepPathfinder: A Socratic Questioning and Self-Decision–Based Chatbot to Support User Engagement in Digital CBT-I: Usability and Feasibility Study

Background: Chronic insomnia is a highly prevalent sleep disorder that adversely affects quality of life and mental health. Cognitive behavioral therapy for insomnia (CBT-I) is internationally recommended as the first-line treatment, and digital CBT-I (dCBT-I) has been developed to improve accessibility and scalability. While existing dCBT-I systems effectively support structured behavioral training through standardized protocols, they provide relatively limited support for users’ cognitive exploration and meaning-making processes, particularly in helping users reflect on and internalize the rationale behind CBT-I practices in daily life. These limitations may contribute to challenges in sustained engagement and long-term adherence. Objective: This study aimed to examine the usability and feasibility of SleepPathfinder, a conversational CBT-I support chatbot that integrates Socratic questioning and a self-decision mechanism to support users’ understanding of and engagement with CBT-I practices. Methods: SleepPathfinder was designed around a 4-stage conversational flow: education on CBT-I techniques, Socratic cognitive exploration, self-decision, and advice provision. We conducted (1) a single-session pilot usability study (n=45) to assess system stability and user experience and (2) a 5-day condition-based comparative experiment (n=30) consisting of daily sessions, comparing an exploratory dialogue condition with a directive, protocol-guided dialogue condition. Quantitative measures assessed usability, cognitive appraisals related to sleep problems, autonomy-related experiences, and behavioral readiness, while qualitative feedback and conversational log analyses were used to examine interaction patterns and engagement characteristics. Results: In the comparative experiment, the exploratory dialogue condition showed a tendency toward reduced perceived threat and severity appraisal of sleep problems compared with the directive condition, accompanied by moderate effect sizes in cognitive perception measures. Autonomy-related experiences, including perceived choice and engagement, demonstrated suggestive upward trends in the exploratory condition. Behavioral intention changes were comparable across conditions, while overall readiness for change increased across participants. Conversational log analyses indicated that greater depth and volume of user self-narrative were associated with larger shifts in cognitive appraisals, whereas the frequency of chatbot questions alone was not. The pilot usability study indicated generally positive evaluations of system usability and content credibility, while identifying areas for improvement in emotional responsiveness and conversational naturalness. Conclusions: These findings suggest that a Socratic questioning–based and self-decision–based conversational structure is usable and feasible as a supportive interaction layer within dCBT-I systems. Rather than altering the directive behavioral structure of CBT-I, such an approach may complement existing protocols by facilitating cognitive exploration and supporting user-perceived autonomy. This study provides design-oriented evidence to inform the refinement of dialogue-supported digital CBT-I systems aimed at enhancing user engagement with CBT-I practices.
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The Download: whole-body rejuvenation drugs and five things to know about AI

This is today’s edition of The Download, our weekday newsletter that provides a daily dose of what’s going on in the world of technology.

David Sinclair plans to test whole-body rejuvenation drugs in the XPrize competition

The outspoken longevity scientist David Sinclair has predicted that, one day, you’ll go to the doctor and get a prescription that will make you 10 years younger. MIT Technology Review has learned of his latest step toward this: human tests of a “reprogramming” drug.

Sinclair, a biologist at Harvard Medical School, plans to launch the tests in a $101 million competition organized by the XPrize Foundation. The winners will “restore” a person to an earlier apparent age, as measured by improvements in immune, cognitive, and muscle function.

The grand prize goes to any team able to show a 10-year (or greater) relative improvement after one year of treatment. 

Sinclair says he plans to give an oral drug mixture to volunteers, in a bid to seek “evidence for age restoration in humans.” Find out how he hopes to reverse ageing through chemical reprogramming.

—Antonio Regalado

Five things you need to know about AI

—Will Douglas Heaven

At SXSW London last week, I gave a talk called “Five things you need to know about AI,” in which I shared what I think are the biggest themes in AI right now.

I pulled a few things from our first AI10 list, an annual guide to the top trends in this buzzy world, but I also veered off on several tangents. In my half-hour slot, I tried to cover the key talking points that I think help to make sense of what’s going on in tech—and thus the economy—today.  

Five key thoughts emerged: AI is everywhere all at once, it’s getting scary, a backlash is growing, it’s becoming a big deal for science—and I didn’t even need to show up at the talk. Read the full story for all the details.

The must-reads

I’ve combed the internet to find you today’s most fun/important/scary/fascinating stories about technology.

1 OpenAI has confidentially filed for a US IPO
The listing could come as early as September. (Reuters $)
+ OpenAI is targeting a valuation of up to $1 trillion. (Financial Times $)
+ The IPO will test investor appetite for AI companies. (WSJ $)
+ The move follows IPO filings from Anthropic and SpaceX. (CNN)

2 The US claims BYD, Baidu, Alibaba, and others are aiding China’s military
The Pentagon added them to a list of military-linked companies. (WSJ $)
+ The designations limit their operations in the US. (BBC)
+ The new additions also include humanoid firm Unitree. (TechCrunch)
+ The Pentagon is adapting to China’s tech rise. (MIT Technology Review)

3 Apple’s long-awaited AI overhaul of Siri is finally here
“
Siri AI” promises to be a more conversational assistant. (NYT $)
+ It includes a standalone app and screen-reading features. (Reuters $)
+ And arrives after two years of repeated delays. (Axios)

4 The White House and Congress are working to limit state AI laws
A new deal would curb state rules for federal legislation. (Axios)
+ AI regulation has divided US politicians. (MIT Technology Review)

5  Meta is launching a “workforce academy” for building data centers
The five-week program is free of charge and guarantees a job. (WSJ $)
+ It arrives shortly after Meta laid off 8,000 employees. (NPR)

6 Taiwan is mulling curbs on AI chip exports to China

The new controls would further align with US restrictions. (Bloomberg $)
+ Future AI chips could be built on glass. (MIT Technology Review)

7 Meta has quietly removed face-recognition code from its smart glasses app
The code identified by investigators has disappeared. (Wired $)

8 Humanoid robots are edging towards the battlefield
American and Chinese militaries are pursuing the tech. (BBC)

9 The world’s first wind-powered underwater data center has launched
It uses less power and water than land-based equivalents. (Guardian)

10 You could get some benefits of sleep without having to nod off
If new brain stimulation works as well on humans as on mice, that is. (New Scientist $)

Quote of the day

“You’re on the train, but you know that there’s no destination.”

—Clara Shih, a former top AI executive at Salesforce and Meta, tells the New York Times that AI training can’t keep up with the field’s advances.

One More Thing

biomilq concept illo

ILLUSTRATIONS BY AMRITA MARINO


Inside the race to make human sex cells in the lab

An embryo forms when sperm meets egg. But what if we could start with other cells—if a blood sample or skin biopsy could be transformed into “artificial” sperm and eggs? What if those were all you needed to make a baby?

That’s the promise of a radical approach to reproduction. Scientists have already created artificial eggs and sperm from mouse cells and used them to create mouse pups. Artificial human sex cells are next.

The advances could herald the end of infertility, but they raise major scientific and ethical challenges. 

Read the full story on the new recipes for sperm and eggs.

—Jessica Hamzelou

We can still have nice things

A place for comfort, fun, and distraction to brighten up your day. (Got any ideas? Drop me a line.)

+ These chefs turn Pop-Tarts into the desserts that inspired them.
+ A choir has beautifully transformed System of a Down’s “Chop Suey!”
+ Scientists finally traced crabs’ sideways walk in this fascinating study of evolution.
+ This nostalgic essay on the family computer is a touching throwback to early internet life.

Top image credit: Stephanie Arnett/MIT Technology Review | Getty Images

Please send Pop-Tarts to hi@technologyreview.com. 

You can follow me on LinkedIn. Thanks for reading!

—Thomas

A data-driven measure of REM sleep propensity for human and rodent sleep

IntroductionMammalian sleep is characterized by alternations between episodes of rapid-eye-movement sleep (REMS) and non-REM sleep (NREMS). The phenomenon of REMS pressure, namely a drive for REMS that builds up between REMS episodes, is thought to govern the timing of these ultradian NREMS-REMS cycles. Prior analyses of NREMS-REMS cycles in mice suggested that time in NREMS is a primary contributor to REMS pressure. We previously introduced a REMS propensity measure defined as the probability to enter REMS before the accumulation of an additional amount of NREMS. Analyzing mouse sleep data, we showed that REMS propensity at REMS onset was positively correlated with REMS bout duration and with the probability of the occurrence of a REMS bout followed by a short inter-REMS interval, called a sequential REMS cycle.MethodsHere, we extend the analysis of NREMS-REMS cycling to human and rat sleep behavior. We compare REMS propensity measures computed from sleep data recorded in humans, mice, and rats. As REMS in humans is influenced by the circadian rhythm, we also analyze circadian modulation of the expression of NREMS-REMS cycles across the human sleep episode.ResultsWe find that, as in mice, human and rat sleep contain both short sequential NREMS-REMS cycles and longer single NREMS-REMS cycles, with differences in the timescales of cycle durations. Although rodents exhibit polyphasic sleep in contrast with the consolidated sleep of humans, the calculated REMS propensity measures in all three species show similar profiles as functions of time spent in NREMS. Importantly, positive correlations of REMS propensity at REMS onset with REMS bout duration were present in both human and rat data as previously found in mouse data, suggesting that time spent in NREMS also influences REMS duration in these species. In the human data, we identified nuanced changes in the occurrence of single and sequential NREMS-REMS cycles suggesting that increased percent time spent in REMS as the sleep episode progresses is not solely due to increased REMS bout duration.ConclusionResults suggest that similarities in the regulation of NREMS-REMS alternation exist, despite temporal differences, in nocturnal polyphasic rodent sleep and diurnal monophasic human sleep.

Cortical On/Off Switch Provides Sleep Benefits to Awake Mice

Researchers have demonstrated that key restorative functions of sleep can be triggered in localized regions of the awake brain, providing new insights into why sleep is essential for learning and memory.

The NIH-funded study, led by investigators at the University of Wisconsin–Madison, showed that artificially inducing sleep-like patterns of neural activity in specific brain regions of sleep-deprived mice restored memory performance and reduced the need for subsequent sleep in those areas. The findings, published in Nature Neuroscience, suggest that the characteristic activity patterns of non-rapid eye movement (NREM) sleep, not simply reduced brain activity, play a central role in maintaining healthy neural circuits.

The work offers a new window into the biological mechanisms that allow sleep to refresh the brain and may eventually inform non-invasive approaches to combat cognitive impairment associated with sleep loss.

A closer look at sleep’s restorative role

Researchers have long shown that sleep is essential for memory formation and learning, but the precise mechanisms underlying these benefits remain incompletely understood.

During NREM sleep, which accounts for approximately 80% of adult sleep, the brain undergoes extensive reorganization. Connections between neurons, known as synapses, are selectively strengthened, maintained, or weakened. This process is thought to secure important memories while preventing neural networks from becoming overloaded with information accumulated during wakefulness.

Previous studies from the laboratory of senior author Chiara Cirelli, MD, PhD, found that sleep-deprived animals and humans occasionally exhibit brief episodes of localized slow-wave activity, the characteristic electrical pattern of NREM sleep, even while remaining awake. These observations raised the possibility that small portions of the brain might temporarily enter a sleep-like state independently of the rest of the brain.

The question remained whether a more sustained version of this phenomenon could reproduce some of sleep’s restorative effects.

Inducing local sleep while animals remain awake

To investigate, the researchers developed an experimental system that allowed them to generate sleep-like activity in targeted regions of the brain without causing the animals to fall asleep.

Using genetically modified mice equipped with light-sensitive neural circuits, the team delivered rhythmic pulses of light that produced alternating periods of neuronal activation and silence. These oscillations closely resembled the “on-off” firing patterns observed during NREM sleep.

The stimulation was applied to one hemisphere of the brain in sleep-deprived mice for 30-minute periods while the animals remained awake and responsive to their environment.

Cirelli compared the phenomenon to a strategy observed in nature.

“What we’re essentially doing is forcing sleep in a local region of the brain,” she said. “While that part is solidifying memories and restoring learning capacity, other parts stay aware/vigilant and connected to environment.”

She noted that dolphins exhibit a related behavior, sleeping with one cerebral hemisphere at a time while the other remains awake.

Reduced need for recovery sleep

The researchers found that brain regions receiving the sleep-like stimulation subsequently displayed lower levels of slow-wave activity during natural sleep.

Slow-wave activity is widely considered a measure of sleep pressure, the biological drive to sleep that accumulates during wakefulness. Reduced slow-wave activity suggested that the stimulated brain regions had already undergone part of the restorative process normally achieved during sleep.

The results challenged a longstanding hypothesis that sleep’s benefits primarily arise from globally reducing neuronal firing rates to relieve fatigue.

Instead, the study found that restoration depended specifically on the rhythmic alternation between active and inactive states characteristic of NREM sleep. Simply suppressing neuronal activity was insufficient.

The findings suggest that the temporal structure of neural activity during sleep may be more important than the overall amount of activity.

Restoring memory after sleep deprivation

To determine whether the induced sleep-like activity produced meaningful behavioral benefits, the researchers evaluated the animals using a tactile memory task that normally depends on adequate sleep.

Sleep-deprived mice typically perform poorly on this type of test, reflecting impaired memory consolidation and reduced learning capacity.

However, sleep-deprived mice that received bilateral stimulation of sensory and motor brain regions performed nearly as well as animals that had not been deprived of sleep. In contrast, sleep-deprived mice that did not receive stimulation showed significantly impaired performance.

These results suggest that localized sleep-like activity can compensate for at least some of the cognitive deficits caused by sleep loss.

Understanding how the brain resets

The work provides new support for the concept that sleep serves as a form of neural recalibration.

Throughout wakefulness, experiences continuously modify synaptic connections, increasing the strength and number of neural links. Without a mechanism to rebalance these networks, the brain could eventually lose efficiency, consume excessive energy, and struggle to encode new information.

NREM sleep appears to provide a structured period during which these connections are selectively refined. The current study indicates that the characteristic slow oscillations of NREM sleep may be the critical driver of this process.

By recreating these oscillations in isolated brain regions, researchers were able to trigger aspects of the reset mechanism without requiring the entire brain to enter sleep.

Potential implications for human health

Although the experiments relied on invasive genetic and optical techniques that are not currently applicable to humans, the investigators believe the findings may inform future therapeutic strategies.

The next step will be determining whether similar effects can be achieved using non-invasive approaches such as transcranial brain stimulation, which can modulate neural activity through the scalp.

If successful, such methods could eventually help mitigate cognitive deficits associated with sleep deprivation, shift work, aging, or neurological disorders.

“This research further decodes why we sleep and how we learn, which brings us a step closer to understanding how to better prevent and treat cognitive decline,” said Amy Bany Adams, PhD, acting director of the NIH’s National Institute of Neurological Disorders and Stroke.

While a replacement for sleep remains firmly out of reach, the study reveals that some of sleep’s most important restorative processes may be far more localized, and potentially more controllable, than previously appreciated.

The post Cortical On/Off Switch Provides Sleep Benefits to Awake Mice appeared first on Inside Precision Medicine.

Divergent dFC stability of DMN and SMN in narcolepsy

Narcolepsy type 1 (NT1) is characterized by profound sleep-wake state instability, pointing to a fundamental dysregulation of large-scale brain network dynamics. To elucidate this, we assessed whole-brain dynamic functional connectivity (dFC) stability using resting-state fMRI in 27 patients with NT1 and 25 matched healthy controls. Our analysis revealed a pattern of opposing alterations: patients exhibited significantly increased dFC stability within the bilateral somatomotor network (SMN), concurrent with decreased stability in the medial prefrontal default mode network (Default_PFCm). These opposing alterations were clinically relevant, as increased SMN stability correlated with poorer objective sleep efficiency, and decreased Default_PFCm stability was similarly associated with lower objective sleep efficiency. Here, we identify for the first time this coexisting neural signature of SMN hyper-stability and Default_PFCm instability in NT1. By simultaneously destabilizing higher-order cognitive networks and disinhibiting primary sensorimotor processing, orexin deficiency may contribute to a synergistic dysregulation that blurs sleep-wake boundaries. The divergence in dynamic network stability provides a novel systems-level framework for understanding state instability in NT1.