Virtual reality and simulation tools enable us to assess daytime functioning in environments that simulate real life as close as possible. Simulator sickness, however, poses a problem in the application of these tools, and has been related to pre-existing health problems. How sleep problems contribute to simulator sickness has not yet been investigated. In the current study, 20 female chronic insomnia patients and 32 female age-matched controls drove in a driving simulator covering realistic city, country and highway scenes. Fifty percent of the insomnia patients as opposed to 12.5% of controls reported excessive simulator sickness leading to experiment withdrawal. In the remaining participants, patients with insomnia showed overall increased levels of oculomotor symptoms even before driving, while nausea symptoms further increased after driving. These results, as well as the realistic simulation paradigm developed, give more insight on how vestibular and oculomotor functions as well as interoceptive functions are affected in insomnia. Importantly, our results have direct implications for both the actual driving experience and the wider context of deploying simulation techniques to mimic real life functioning, in particular in those professions often exposed to sleep problems.Read less <