The purpose of this study was to evaluate the effectiveness of virtual reality meditation compared with standard care on sleep quality and delirium incidence in patients admitted to the ICU. We conducted a randomized controlled trial with 96 patients in an 11-bed surgical ICU at a South Korean university hospital. The control group received usual sleep care, whereas the intervention group received an additional 20-minute virtual reality-based mindfulness and relaxation meditation before bedtime. Using the Verran and Snyder-Halpern Sleep Scale, we found significantly improved subjective sleep quality in the intervention group compared with controls during both the first (47.82 vs 39.75, P = .015) and second nights (50.26 vs 43.65, P = .025) of ICU admission. However, objective sleep measurements using Fitbit devices showed no significant differences in total sleep time between groups for either the first (384.59 vs 358.19 minutes, P = .450) or second night (319.94 vs 310.77 minutes, P = .807). Delirium incidence was similar between groups (12.2% vs 12.8%, P = .938). These findings suggest the need for larger-scale studies with robust experimental designs to definitively establish the impact of virtual reality meditation on sleep quality and delirium in ICU patients.