Seasickness Won't Kill You

The dreaded mal de mer is a lottery. It will not kill you, though many sufferers have wished for a merciful release.

Seasickness has afflicted sailors since time immemorial. It was well known to the ancient Greeks and Romans, who were avid mariners on the Mediterranean Sea. In the early 6th century BCE, the Greek philosopher Anacharsis said, “There are three human beings, the living, the dead and the seasick”. Around 400 BC, the Greek physician Hippocrates declared that “sailing on the sea proves that motion disorders the body”. The Roman statesman Cicero must have been disordered to a great degree for he “would rather kill myself than become seasick once more".

Since then, there have been many improvements in the design of ship stabilisation, and yet seasickness continues unabated among seafarers in the modern age. To understand why this malady afflicts some people dreadfully and others not at all, let’s consider the nature of the ailment, why it occurs and who is more prone to it than others. Once the enemy is known, steps can be identified to prevent, or at least minimise, its debilitating effects.

Motion sickness (kinetosis) is the state of being dizzy or nauseated when the body experiences or perceives motion. When this occurs while travelling on water, it is called seasickness (naupathia, nauseum mares or mal de mer) and is typically brought on by the erratic motion of the vessel. It is not a disorder or disease in the true clinical sense but rather the normal response of a healthy person to an abnormal or unfamiliar environment - a natural response to unnatural conditions.

The human body has three motion-sensing faculties: sight, the vestibular system of the inner ears and the musculo-skeletal framework. They all send signals to the brain which interprets them to orient the body within its surroundings and coordinate a response. Seasickness is the outcome of a ‘sensory conflict’, a mismatch between perceived and actual motion - your eyes see one thing, your muscles feel another and your inner ears sense something else. 

These contradictory signals confuse the brain - it might think that you are moving when you are not, and vice versa, or it might be completely disoriented. Agitated by this perceptual incongruity, the brain responds with a cascade of stress-related hormones that can cause unpleasant symptoms including sweating, dizziness, headache, nausea and vomiting. Protracted sickness can lead to dehydration, low blood pressure and loss of mobility but, so far as anyone knows, no one has ever died from sea sickness. In fact, it is said that the worst thing about seasickness is knowing that you are not going to die.

SEA LEGS AND LAND LEGS

Seasickness usually occurs within hours after setting sail, and dissipates as the body gradually adapts to the boat’s motion on the water. Having gained one’s ‘sea legs’, it’s rare for a person to become or stay ill, unless the vessel is subjected to extremely rough conditions. But the body has to make a further adjustment back on terra firma. Closely related to mal de mer is the converse ailment known as mal de debarquement (sickness of disembarkment) experienced by people who have been at sea for an extended period. Back in the low-mobility environment on shore, they may feel the illusion of sea-borne motion through sensations of rocking, swaying or bobbing, which may persist for hours or days before regaining a normal sense of stability with ‘land legs’.

WHO MIGHT GET SEASICK?

Almost anybody can get motion sickness and most healthy people will be affected under extreme conditions, including seasoned travellers, professional fishers, sailors and marine scientists. About 7 percent of seagoing passengers report vomiting during a voyage, while up to 90 percent of those who go fishing will become seasick at some point. While anyone can suffer, an estimated one-third of the population are highly susceptible to motion sickness. 

Women are more easily affected by motion than men, by a ratio of about 5:3, particularly during menstruation and pregnancy. Children aged between 2 and 12 are highly susceptible to motion sickness, being more than four times more likely to get sick than 30-year-olds. In adults generally, the risk decreases with advancing age and it is unusual for people over 70 to experience symptoms.

Physical fitness appears to increase the risk of motion sickness, as a fit person’s autonomic nervous system, (which transmits nausea and vomiting) is more sensitive compared with someone who is out of shape. Heredity may also be a factor affecting susceptibility. Some studies suggest that people with Asian ancestry have less tolerance for motion than people of European descent. While seasickness genes have not been found, the ailment is more common in families with a history of it and there is a significant correlation among identical twins.

SEASICKNESS REMEDIES

The only sure-fire way to prevent seasickness is not to go to boating, but where’s the fun in that? For those who want, or need, to sail on the briny for recreation, a cruising holiday or work, the key to avoiding seasickness is to take action before you become sick. There are many ways to prevent or at least reduce the unpleasant effects of seasickness. There’s no magic bullet and the effectiveness of any particular measure may vary from one person to another - what works for you may not work for others. First time passengers should have a few options on hand when they travel; regular sailors may need to experiment in finding the best solution that works for them. And if in doubt, seek advice from a healthcare professional for your specific circumstances.

PRE-SAIL PREPARATION

Like most aspects of sailing, the key to avoiding seasickness is preparation. Here is a pre-sail checklist of simple things to do in the 24 hours leading up to embarkation:

• Eat healthily the day before departure. For dinner, take a light, easily digested meal that does not include greasy, spicy or heavy foods, and avoid food with high levels of salt and sugar.
• Go easy on the alcohol. Even a mild hangover can quickly degenerate into seasickness in the wrong conditions.
• Get plenty of sleep and wake in good time so you arrive at the boat well-rested and stress-free.
• Eat a light breakfast but don’t fast. Stick with cereals, grains, bread, apple juice and bananas, and avoid heavy, greasy foods and highly acidic drinks, like coffee and orange juice.
• Take any motion sickness medication at least an hour before you get on the boat.
• Drink plenty of water and stay hydrated throughout the day.

THINGS TO DO ON BOARD

Once you’re on board and the voyage is under way, there are some things that you can do (and not do) to keep motion sickness at bay.

• Decongest the nasal passages with Vicks vapor rub or over-the-counter sprays, as stuffed and runny noses can play havoc with the inner ear. 
• Find a breezy or well-ventilated place, preferably outdoors, and take slow, deep breaths of fresh air. Breathing into a paper bag may help. Avoid unpleasant smells and diesel exhaust fumes. Don’t smoke and stay upwind of smokers.
• Weather permitting, stay on deck and look at the horizon or some distant, stable object.
• If you have to be inside, don’t sit below deck or in an enclosed area where you can’t see outside.
• Sit facing forward as close as possible to the boat’s middle where motion is least pronounced, and avoid the bow and stern.
• If you’re cruising, try to get a cabin toward the front or middle of the ship, on a level near the waterline.
• Stand rather than sit and keep moving. Try to roll with the ship instead of stiffening up and fighting the motion.
• Be active and, if possible, participate in working the boat or other activities. If the skipper lets you, take a turn at the helm.
• Avoid reading, watching TV or using your phone or tablet for long periods without a break. 
• If you get tired or feel nauseous, recline or lie down on your back (fore-to-aft) with your eyes closed, keeping your head as still as possible.  Relax, take a nap or zone out to music on your ipod.
• Keep well hydrated with water, low-acid juices like apple and carrot, or low-sugar carbonated soft drinks (ginger beer works well). Avoid alcohol, milk and caffeinated drinks.
• Eat light snacks (old tars swear by saltines) and avoid greasy, high-fat foods.
• Avoid other passengers who have become seasick. Seeing others with motion sickness could also bring you unstuck.
• If all else fails, head for the railing on the leeward side to ensure that an unpleasant experience doesn’t get even worse.

MEDICATIONS

If you’re still daunted by the prospect of seasickness, or it comes on despite your best efforts to avoid it, consider using medication before symptoms become severe - after that, it’s usually too late for any benefit. Options include readily available over-the-counter products and stronger prescription drugs. Do your own research and consult your doctor before taking any of them, especially if you are pregnant or taking other medications. Those involved in high-risk activities, such as scuba diving, should seriously weigh the risks against the benefits of any medication. 

Browsing the shelves at your local pharmacy, you will find several products for treating motion sickness, including TravaCalm, Nausicalm, Kwells and some generic brands. The active ingredients in most of them are antihistamines that go by various names, such as Meclizine, Dramamine, Scopolamine and Cyclizine. They are all generally effective in treating motion sickness if taken 1-2 hours before departure and repeated at intervals as may be necessary up to a dosage limit in any 24-hour period. Medications suitable for adults and children over 14 years may be given to younger children in modified doses which should be carefully controlled. Common side effects include drowsiness and blurred vision, and may increase the effects of alcohol. They also tend to be dehydrating, so drink plenty of water while using them.

ALTERNATIVE REMEDIES

If you prefer to take a more ‘natural’ approach to the prevention or treatment of seasickness, there are many products and techniques that may help you. Some have been tested and proven to be effective, while the benefit of others is more anecdotal than empirical. In either case, their efficacy may vary from one person to the next.

If you want a good head start, try taking vitamin B6 in the weeks leading up to the voyage. It is abundant in chickpeas, tuna, salmon and chicken, and B6 supplements are also available in tablet form.

Many plants have a natural anti-nausea effect. One of the best and most popular is ginger root. It can be eaten raw (which definitely clears the sinuses) or obtained from health food stores in many different forms: tablets, capsules, powder, candied, syrup, and tea. It also flavours soft drinks such as ginger beer and ginger ale. Note, however, that ginger can thin the blood, so if you’re on blood-pressure medication consult your doctor before using it. Peppermint and green apples may also help alleviate nausea. 

You don’t need to eat plant-based products to feel better; aromatherapy may work just as well. Essential oils such as lemon, cedar wood, lavender or spearmint can be sniffed or applied to the skin, or made into solutions for use in fine mist atomisers to be lightly sprayed on your face.

Many people find acupressure is good for combating motion sickness. Use your thumb to press your inner arm about two inches from your wrist and either hold or massage the point between the tendons for a few minutes or until symptoms subside. You can also buy wristbands that do this for you, with either a small round button for pressure or a small magnet that applies a neuromodulating current on the pressure point. However, research has shown them to be ineffective on people in a physically active environment.