Seasickness Causes & Treatments by David Rowell, The Travel Insider

A Common and Often Preventable Affliction

They say that, when you're seasick, you start off worrying that you might die, and then, after a while, you start to worry that you won't die!

As many of us know from personal experience, seasickness is a debilitating affliction that can destroy the otherwise idyllic experience of a sea journey.  Car sickness and motion sickness can similarly impact on necessary travel.

Understanding the causes of seasickness enables you to work on preventing the problem. 

Motion Sickness in General

There are many experiences that can cause what is generally termed motion sickness.  In addition to being at sea on small boats or large ships, there are plenty of other situations that can bring on motion sickness - in planes, cars, buses, even trains.  Roller coasters and other fair rides, and even high impact movies can all trigger motion sickness.

All have common causes and effects.  While we focus this article on seasickness, the comments relate equally to all other forms of motion sickness.

The Causes of Seasickness

The more we can understand what makes people seasick, the better we can respond to minimize these underlying issues, thereby helping prevent seasickness itself.

Movement

This is probably obvious.  Being at sea on a boat or ship that is moving about a great (or, for some people, not so great) deal, and changes in velocity in general, all can cause sea sickness.

A winding road in a car, air turbulence, or anything else involving the sensation of changes in speed/direction can induce motion sickness.

Visual Disorientation

The other cause is not quite so obvious.  Visual disorientation and strain.  Visual disorientation is when your body senses you are moving, but when your eyes see no movement.

It can also happen the opposite way - for example, in an Imax theatre, you might receive strong visual information suggesting that you're moving, but your body feels no sense of motion.  This can also make you ill, but fortunately, there's an easy cure for this - simply close your eyes.

Strain happens when you've having to continually refocus your eyes, for example if trying to read a book in a car and having the distance and line between you and the book constantly changing.

Medical Explanation

The symptoms of motion sickness include nausea, vomiting, and dizziness (vertigo). Early signs are paleness, salivating, yawning, sweating and a general feeling of discomfort and not feeling well (malaise).

Motion sickness relates to our sense of balance and equilibrium. Researchers in space and aeronautical medicine call this sense spatial orientation, because it tells the brain where the body is in space - what direction it is pointing, what direction it is moving, and if it is turning or standing still.

Our sense of balance is regulated by a complex interaction of the following parts of the nervous system:

·         The inner ears (also called the labyrinth) monitor the directions of motion, such as turning or forward-backward, side-to-side, and up-and- down motions.

·         The eyes observe where the body is in space (i.e., upside down, right side up, etc.) and also the directions of motion.

·         Skin pressure receptors such as those located in the feet and seat sense what part of the body is down and touching the ground.

·         Muscle and joint sensory receptors report what parts of the body are moving.

·         The central nervous system (the brain and spinal cord) processes all the bits of information from the four other systems to make some coordinated sense out of it all.

The symptoms of motion sickness appear when the central nervous system receives conflicting messages from the other four systems -- the inner ear, eyes, skin pressure receptors, and the muscle and joint sensory receptors.

For example, imagine you are riding in an airplane during a storm, and the plane is being tossed about by air turbulence. But your eyes do not detect all this motion because all you see is the inside of the airplane. Consequently, your brain receives messages that do not coordinate with each other. You might become air sick.  Or suppose you are sitting in the back seat of a moving car reading a book. Your inner ears and skin receptors detect the motion of your travel, but your eyes see only the pages of your book. You could become car sick.

Who Gets Seasick

Probably the only person that really matters is yourself - do you get seasick or not, and probably, you already know the answer to that!

One study suggested that 14% of the population gets seasick, but this is a fairly meaningless number.  In an extremely rough sea, way more than 14% of passengers will get sick.  And it shouldn't be taken as a sign of weakness if you get motion sick - 70% of space shuttle crew members experience some degree of motion sickness during the first 3 days of any shuttle flight.  You'll even find that many crew on ships occasionally get sick, too - including, I must add, me too back when I worked at sea, with tiresome regularity!

Babies under the age of about two seem immune from seasickness.  Children are more susceptible than adults, and the older you get, the more resistant you become (at last - a benefit of growing old!).

The type of motion also has an impact.  The most seasick causing motion is one with about a five second cycle of repetition.  This might be why some people get sick on big ships (with about a 5 second cycle of moving from one side to the other and back) but not on small boats (which move with much quicker motion periods.

Women seem to be more susceptible to seasickness than men.  People of oriental race seem more susceptible than westerners.

How Likely is it You'll Get Seasick on a Cruise

Modern cruise ships are incredibly stable, and their captains do all they can to avoid rough weather, even to the extent of skipping ports and rearranging the itinerary if necessary.

The gargantuan size of a modern cruise ship adds to its stability, and almost every ship is also fitted with stabilizers to cancel out most of the ship's movement.

Best of all, most cruise itineraries have only short periods at sea - often at night, while you're sleeping - alternating with days in ports.

Most people will find modern day cruising comfortable and without any associated sea-sickness.

Getting - and Losing - Your Sea Legs

If you're on a multi-day cruise, you'll find that eventually - usually within 36 - 72 hours - your body adapts and trains itself to ignore the conflicting messages it is getting.  In other words, you have got your sea legs and are no longer susceptible to seasickness.

There is an interesting (and sometimes uncomfortable) opposite to this.  You've probably noticed, when stepping back onto land after being at sea, that at first it feels as if the land is moving - this being due to your body automatically anticipating the boat's movement and having to adjust back to the 'normal' that involves no continual motion.

Some people find this 'phantom' movement so real that they become seasick again when they return to shore.  This is called 'mal de debarquement' (as opposed to 'mal de mer' or 'mal d'embarquement' for regular seasickness).

Minimizing the Causes

Usually the sickness causing situation is of temporary rather than permanent duration, and so if you can minimize the impacts on you, there is a better chance you'll last out until you're back in calm conditions once more, with both your dignity and your stomach intact.

A Stitch in Time Saves Nine

At the first suggestion of rough weather, take the following precautions so you don't even start to feel unwell.  The more unwell you feel, the more likely it is that you'll get worse and worse.

Minimizing Movement

If you're on a boat, try and get as close to the boat's center of motion as possible.  This is in the middle of the boat, close to the waterline.  If you are at the bow or stern, you'll experience more motion than amidships.  If you're on the port or starboard railing, you'll again get more motion than if you're in the center of the boat.  And if you're on the top deck, once again you'll be feeling more pronounced movements than if you're lower down, close to sea-level.

In trying to find the optimum place on a boat, it might be necessary to consider some compromise so you are also in a place with fresh cool air and a view outside.

If you're on a plane, the middle section of the plane, about where the wings are, moves less than the front, and the back section seems to move most of all.

And, as just about everyone knows, the ride is smoother (and the visuals better - see next point) in the front seat of a car or near the front of a bus.

Minimizing Visual Disorientation

You should focus your eyes at a distant point, preferably the unmoving horizon.

Don't face backwards.  This aggravates the feeling of visual disorientation.

If you're unable to look at a far-away and hopefully unmoving point of reference, then closing your eyes might be better than staring at close-by things and adding to the sense of spatial confusion caused by feeling the sensation of movement but with no apparent movement visible.

If nothing else, closing your eyes might help you to relax.  Don't read and don't watch television.

And Also

If you are with other people and are embarrassed at feeling unwell, try and find somewhere private where you can suffer stoically and alone.  The fear of being sick is a powerful magnifying factor that can make you very much more likely to become sick than if you're not so worried at the thought of possibly being sick.

Some people advocate lying down, and/or closing your eyes.  The primary benefit of this is that it might help you to relax, and perhaps even to go to sleep.

Giving yourself a steady stream of cool fresh air definitely helps, although I have no idea why that is.  Avoid strong smells in general and the smells of engines and gasoline/diesel in particular.

Try to avoid other travelers who may also be seasick.  There's nothing like the sudden and powerful combination of sight, sound, and smell of another passenger vomiting to bring you past the 'point of no return' as well.

Try to be healthy and well, so your body has more natural resistance.  Don't be hung over, don't be drinking alcohol, and avoid any food extremes that might give you an upset stomach, even when on dry land.  You definitely don't want to have a lot of food and liquid sloshing around in your stomach, so eat and drink in moderate balanced portions.

Try and be well rested.  Lastly, be prepared, so if you do need to be sick, you're able to do so with a minimum of mess.  If you use a bag, you should double bag if possible in case one bag has any holes or comes apart at a seam.

How to Cure Sea, Car, and other Motion Sickness

Choose from many different remedies

Cures for seasickness and other forms of motion sickness have been around for as long as the underlying cause has also been present.  But not all cures work, and some can have severe side-effects.

Cures for seasickness seem to be one part urban legend, one part myth, another part quackery, one part 'mind over matter' and one part 'cure is worse than the disease'.

We strip out the nonsense, and tell you what you need to know and what you need to do. 

Different Types of Seasickness Cures

There are plenty of different suggested remedies for being seasick and for motion sickness in general.

Basically they can be grouped into the following six categories:

·         Prescription medicines

·         Over the counter medicines

·         Homeopathic remedies

·         Other alternative medicine

·         Normal things that seem to help

·         Weird and wacky

Interestingly, almost all the different cures described below have been shown to work with some people, while also not working with others.  Even the least effective mainstream methods have at least halved the incidence of seasickness.

This may be the placebo affect at work - the curious but undeniable power of mind over matter, such that when you tell a person that something will cure them of their ailment, some people are cured, no matter what it is you give them.

Does this make any of the 'cures' less valid?  Absolutely not.  Find something that works for you, and then embrace it and grow comfortable with it as your solution.

There has been insufficient valid scientific testing of how well these cures work, and testing which has been done generally uses a revolving chair to mimic the motion experience - something that is in reality quite different from being on a boat/ship, or in a car, etc.

I've also found vague references to one study of about 1400 people at sea, which apparently determined that incidences of sea-sickness dropped from about 80% of people taking no medication to 20% when people were using one of the prescription or non-prescription medicines below.

Try Before You Go

If you're considering one of the prescription or non-prescription medicines that sometimes have associated side-effects, we suggest you should try it before you go.

That way you have a chance to see how strong the side-effects may be.  You won't know how effective the anti-motion sickness properties are, but at least you'll know if you can live with the side-effects or not.

Prescription Medicines

One of the problems with taking medicine orally (ie swallowing it) is that if you're sick, you may vomit up most of the medicine.  These two prescription medicines will avoid that issue, because neither needs to be swallowed.

Both need a doctor's prescription.

The Patch

Commonly referred to as 'the Patch', the Transderm-Scop patch is placed behind your ear, and worn for up to 72 hours at a time.  After 72 hours you replace it with another one if necessary, and it is suggested you alternate patches, one on your left side then one on the right side.

The active ingredient in the patch is absorbed through the skin.  It takes up to four hours for a full dose to be initially absorbed, so for best results, put a patch on at least four hours before you'll need it.

The active ingredient is scopolamine - the same drug that is used, in much larger doses, as a 'truth serum', and a derivative of belladonna poison.  Nasty stuff!

The good news is the Patch is highly effective.  But you may experience side-effects, ranging from minor things like a dry mouth, to more unpleasant things such as sedation, difficulty urinating, and blurred vision.  Some people have reported hallucinations, and of course, worst of all, there's always a danger you might experience an uncontrollable urge to start telling the truth!

You may also sometimes experience withdrawal symptoms when stopping using the patch - symptoms including dizziness, headache, nausea and poor coordination.

The Patch is not recommended for children, the elderly, or for pregnant or breast-feeding women.

Notwithstanding the side-effects mentioned above, the Patch is a popular and commonly used medication, because it does work very effectively, and is generally rated as better than Dramamine. 

Phenergan Suppositories

There's always a certain amount of yuckiness associated with the thought of suppositories, but if you're seriously unwell and vomiting, this is probably the only way to administer some heavy-duty medicine that will put you right.

These are best used only in the case of severe seasickness and vomiting.  They will almost certainly cause major drowsiness, but that is probably preferable to how you'd otherwise be feeling.

Other drugs

There are various other drugs occasionally prescribed for seasickness (including orally administered scopolamine), but all of these are, to a greater or a lesser extent, fairly powerful drugs.  Our own preference is to entirely avoid such things if possible, and you too might prefer to try the milder remedies in the sections below before turning to heavy-duty products requiring a doctor's prescription.

Over the Counter Medicines

Over the counter medicines are primarily anti-histamine type products best known in the form of Dramamine and its various related products.

These medications reduce the dizziness and the nausea associated with seasickness, but all seem to bring about some degree of sleepiness, ranging from mild drowsiness to severe sleepiness and lethargy.

A key feature of these medications is that it takes time for them to be absorbed and to take effect.  You should start taking them two hours before you need them.

Dramamine is available in both a regular (with dimenhydrinate as its active ingredient) and a less-drowsy formulation (with meclizine as the active ingredient).  Bonine and Antivert are also meclizine based and so are similar to the less drowsy Dramamine.

Benadryl is a diphenhydramine based product, and is similar to Dramamine.

Other products, more common outside of the US, include Marezine (cyclizine) and Stugeron (cinnarizine).  Both seem to be less sleep inducing than original Dramamine and perhaps better than Dramamine-2 (the less drowsy meclizine derivative).

Homeopathic Remedies

Homeopathic medicine is growing in popularity, and while some people automatically reject anything that isn't the result of millions of dollars of research and exclusively produced by the major drug companies, the ancient arts of homeopathy seems to be based on underlying valuable benefits.

Various different homeopathic substances can help with seasickness, and the two main homeopathic products offered to combat seasickness are each a combined mixture of the various active ingredients.

I have no idea which of these two products might be better.  I can say that the Trip Ease people also make the No-Jet-Lag product which seems to work well, so perhaps my inclination would be to try that first, but choose whichever seems more suited to your preference.

Trip Ease

Made in my home country of New Zealand by the same people who make NoJetLag, this product is a mix of six different homeopathic ingredients and a pack of 32 tablets costs $9.85 and is available through Magellan's.

Sea Sik Oral Spray

This product is a mix of seven different homeopathic ingredients, and is administered by spraying under your tongue.  It is well described and explained on this web page.  A 30 ml bottle is $14 and available through the link above.

Other Alternative Medicine

Acupuncture - or more accurately, acupressure - is another approach to healing once derided in the west, but which is now finding growing acceptance.

This field of study believes that pressure applied to the P6 or nei kuan point will reduce the sensation of nausea from any/all causes.  This point is located about an inch up the inside of your arm from the crease between your hand and arm.

Pressure is most commonly applied to this point via a band of some type, and there are now three different styles of bands.

Studies have tended to confirm that bands can definitely help reduce seasickness, although there has been quite a variation in displayed effectiveness.  This might be due to how accurately people place the bands on the appropriate pressure point.  The more pressure the better, it seems.

Because acupressure bands relieve all types of nausea, they are often used by pregnant women to prevent morning sickness as well.

Regular acupressure bands

The original acupressure band was the Seaband, which is still available in some places.  These days the leading 'regular' band seems to be the BioBand, which is more comfortable and adjustable.  They are $12.85 each from Magellan's.

Magnetic acupressure bands

The Magna Band or other bands that have a magnet in them sound very much like a gadget rather than bona fide added value medical device to me.  The magnet probably won't do any harm, but I'm aware of no studies that show the magnet adds to the relief of the band.  They are available, two for $25, here.

Electric acupressure bands

The ReliefBand also sounds gimmicky, although they offer a bit more pseudo-science to back up their claim of effectiveness.  The band is worn in the same place as a regular band, but a battery delivers a pulsed mild electric shock to your arm (you adjust the level until your fingers mildly tingle) which supposedly helps to calm your stomach.  Batteries last about 150 hours and are replaceable.  The unit is priced at $89 and is available from Magellan's.

MotionEaze

Another product, not really a homeopathic remedy, is MotionEaze.  This is a liquid that you dab behind your ears, in a manner vaguely reminiscent of the Patch.  But the liquid is not scopolamine.  Instead they say it is a proprietary blend of herbal oils including Birch, Chamomile, Frankincense, Lavender, Myrrh, Peppermint and Ylang-Ylang.

We're unaware of any studies to support their claims of effectiveness, and our own opinion of the product (which we've never tried) nosedived when we read their page suggesting that, if you're feeling sea-sick, you should avoid looking at the horizon and perhaps read a book instead!  This advice contradicts that offered by almost everyone else, and also clearly contradicts our own experience of what makes us feel ill and what makes us feel better.  A bottle costs $16 and has enough liquid for 40 applications.

Normal Things that seem to Help

There are many ordinary foods which may help.

Ginger

Perhaps the most common normal thing that many people claim works well for them is ginger root (Zingiber officinale).  Whether you eat pure ginger root, crystallized ginger, ginger tablets, ginger tea, or ginger cookies, ginger seems to help calm people's stomachs and reduce their susceptibility to sea-sickness.

You only need to take a very little, but because ginger is natural, you're welcome to take as much more as you wish.  About 1 gram (1/28th of an ounce) of powdered ginger has been shown effective against motion sickness in double-blind studies.  In Germany, up to 4 grams per day is recommended.

Best of all, there are no side-effects from taking ginger.

Ginger is an aromatic bitter (see below) and is generally credited with improving the digestive process.  A 1982 study found that ginger was better than Dramamine for preventing seasickness.  Subsequent studies have tended to confirm that ginger provides effective relief from motion sickness.

Like medications, you should take ginger prior to experiencing the sickness causing event.

Soda Crackers/Saltines

Soda crackers are recommended by some people - the soda crackers both soak up any excess liquid in your stomach and also it is suggested that the alkaline soda in the crackers neutralizes any excess stomach acid.

This suggestion is probably nonsense - the small amount of alkali in the cracker is dwarfed by the amount of acid in your stomach, but perhaps eating pieces of ginger on soda crackers is a great way to adopt two strategies at the same time, while also enjoying some food.

Coca-Cola

Some people suggest that Coca-Cola is helpful, although it contains caffeine, which some people suggest is harmful, and of course it is also a liquid, and you don't want too much liquid sloshing around in your stomach.

Being as how Coca-Cola was originally developed as a patent medicine, it is perhaps not impossible that it has some palliative effect.

You need to walk a fine line between staying hydrated and having too much liquid in your stomach.

Bitters

Another liquid that supposedly has near miraculous powers is bitters.  An article in Cruising World some years back reputedly surveyed various types of bitters and found the best is Italian Fernet Branca, followed closely by Angostura.

Take a tablespoon or two, mixed in half a glass of water, and expect to get nearly immediate beneficial results.

Other Foods

Other foodstuffs that are credited with alleviating sea-sickness include mint, citrus, apricot juice, carrot juice, unroasted pumpkin or squash seeds, parsley, and peppermint tea.

Weird and Wacky

Aromatherapy

Aromatherapy has been suggested as a way to counter the affects of seasickness.  For sure, bad aromas can hasten the onset of nausea and vomiting, but whether you can create a 'good aroma' and surround yourself sufficiently in it may be difficult to achieve.

Oils of mandarin, peppermint, spearmint and lavender are recommended, both added to boiling water and, after diluting with massage oil, rubbed into hands and feet.  Effects are said to last for 24 to 48 hours.

I've read one report by a person who found this very effective, but the report was lacking in specifics about the proportions of each oil, so if you're a proponent of aromatherapies, and can conveniently create the environment for administering such relief, you'll need to do some more research.

Royal Made Ping an Dan

Royal Made Ping an Dan (PAD) sounds very unusual, and perhaps it is.  It is a Chinese remedy that dates back to the Qing Dynasty (1644 - 1911) when it was made for members of the Royal Household.

Two recent Chinese clinical studies have shown it to be as effective, or perhaps more effective than Dramamine.  That is the good news.  The not so good news is that I've not found anywhere that sells it.

Artificial Horizon Glasses

Another weird and wacky approach is to wear glasses with always level horizons on them.  The theory is that this way you can always see a steady horizon, even if the boat is moving.

Sounds unlikely to us, but who knows; although no medical research is offered to support their claims.

And at €99 ($130) you'd have to be pretty sure of them working before buying a pair. 

Summary and Recommendation

So, how best to avoid motion sickness?  Try to minimize the situation that could cause motion sickness in the first place, and make use of one - or more than one - of the remedies suggested in this second part, and in a timely manner before you start to feel unwell.

Although some people like the patch, and even though it is probably the most certain medical remedy, we just find the idea of slowly dosing ourselves with 'truth serum' completely unappealing.  Who knows what we might not inadvertently say over dinner.

Dramamine makes us uncontrollably drowsy.

Eating ginger biscuits is a painless and pleasant strategy.

We'd probably back this up with a band and or a homeopathic remedy.

There's no reason not to adopt a multi-layered defense.  So we'll be the person resolutely standing out on deck staring ahead through the artificial horizon glasses, while eating ginger biscuits and saltine crackers, drinking coca-cola and Angostura bitters, wearing bands on both wrists, and taking Trip Ease pills every hour.

At least we won't be in the rest-room making a call on the great white porcelain telephone.

Lastly, if all else fails, cling to the thought that, eventually, you'll get your 'sea legs' and will get better all by yourself.