Mal de Mer
Vivian Vuong is a professional sailor who has written a wonderful article talking about her struggles with seasickness. It is a honest, and quite refreshing piece showing that those that suffer from it - even those who earn a living on the sea - are not alone, and that it is manageable - that there is hope!
As a physician I have here republished an old article of mine that gets a little more into the medical aspects of seasickness and the strategies one can use to combat it.
This article is for general information and education only and is not a substitute for personal medical advice, diagnosis, or treatment. Always discuss seasickness prevention and treatment with your own clinician, especially before using prescription medications or combining drugs. In an emergency, seek local medical care and follow the instructions of qualified professionals.
Seasickness (a form of motion sickness or kinetosis) arises from a mismatch between what your balance organs, eyes, and body sense, and it is best managed with a layered strategy that combines behavioral tactics, medications, and non‑drug measures tailored to your risk and voyage.
Why seasickness happens:
Seasickness is fundamentally a sensory conflict problem: the vestibular system in the inner ear detects motion that your eyes or body position do not fully “agree” with. On a moving boat, your otoliths and semicircular canals sense heave, pitch, and roll while your visual field (especially below decks) may look relatively stationary, and this mismatch feeds into brainstem “emetic” centers. Neurochemically, histamine and acetylcholine play major roles in the vomiting pathways, which is why H1‑blocking antihistamines and anticholinergic agents like scopolamine can be so effective. Histamine release in response to vestibular stimulation appears to increase in key brain regions, and higher histamine levels correlate with more severe motion sickness in experimental models.
Some people habituate quickly to sea motion, developing “sea legs,” while others remain highly sensitive despite repeated exposure. Fatigue, dehydration, anxiety, alcohol, and strong odors can lower your threshold, making symptoms more likely and more intense for a given sea state.
Behavioral and environmental strategies
Non‑pharmacologic tactics are foundational and often make the difference between mild queasiness and full incapacitation.
• Choose the least‑motion location on the vessel: near the center of the boat and close to the waterline rather than at the bow or high decks.
• Get your eyes on a stable horizon or distant fixed object whenever possible, and avoid staring at moving interior objects or screens.
• Avoid reading, close work, and screen use during rough conditions; these drive visual–vestibular mismatch.
• Minimize head movement: keep movements slow and deliberate, and avoid frequent looking up/down or side‑to‑side in confused seas.
• Align your body with the direction of motion (“wave‑riding”): stand or sit so that gravity and the boat’s acceleration act along your spine, and lean into the motion when possible.
• Lie supine when very symptomatic; this reduces head motion and can ease nausea, though it may limit your ability to perform tasks.
• Optimize cabin choice on cruises: forward or mid‑ship cabins near the waterline are preferable to aft or high‑deck cabins.
• Maintain hydration with frequent small amounts of water, and avoid excessive alcohol and caffeine, which may worsen dehydration and symptoms.
• Eat light, bland, low‑fat meals; large, greasy, or histamine‑rich foods (aged cheeses, cured meats, some fish) may aggravate nausea in susceptible individuals.
With repeated exposures under controlled conditions, gradual habituation is the single most effective long‑term “treatment,” though it takes time and periodic re‑exposure to maintain.
Medications: what works best
Medication choice depends on how prone you are, trip length, need for alertness, and your medical profile.
Scopolamine patches are widely used for seasickness prevention and can be effective for many people.
Key features:
• Route: Transdermal patch behind the ear.
• Onset: Apply 4–12 hours before departure for optimal effect.
• Duration: Typically up to 72 hours per patch.
Common side effects:
• Dry mouth, blurred vision (especially if drug contacts the eye during application), dilated pupils.
• Drowsiness, dizziness, occasional euphoria or dysphoria.
• Confusion, hallucinations, or delirium in susceptible individuals (especially older adults or those with underlying cognitive impairment).
• Urinary retention, constipation.
Important cautions:
• Contraindicated or used with great caution in angle‑closure glaucoma, serious urinary retention, and some cardiac arrhythmias.
Because of the potential for serious neuropsychiatric side effects, scopolamine should be trialed on land or a short outing first, and only used long‑term offshore if the individual response is known and acceptable.
Antihistamines (first generation)
These agents act both on histamine receptors and as central anticholinergics. They are available in many countries without prescription.
Common options (names and availability vary by region):
Meclizine -Dramamine
Dimenhydrinate - another form of dramamine.
Cyclizine - known as Bonine
Promethazine (more sedating, often prescription only).
Cinnarazine - Stugeron
General points:
• Best used prophylactically: take 30–60 minutes before exposure to motion and repeat as directed.
• Sedation, dry mouth, and slowed reaction time are common.
• Rarely, paradoxical agitation can occur, especially in children.
Non‑drug aids and “natural” options
A number of non‑prescription, non‑pharmacologic measures can be useful, especially for mild to moderate susceptibility or as adjuncts to medication.
• Ginger: Ginger capsules, chews, or candies have shown modest benefit in reducing nausea in several settings, including pregnancy and motion, and many travelers report subjective improvement at sea. It is generally safe for most people but can interact with anticoagulants at high doses.
• Acupressure bands (e.g., P6/Neiguan wristbands): These apply pressure to a point on the inner wrist; evidence is mixed but suggests possible benefit for nausea with low risk and low cost, so they are reasonable to try.
• Electrical stimulation wristbands: Some commercial devices use mild cutaneous electrical stimulation over similar points; limited but emerging data suggest they may help some users.
• Relaxation and breathing techniques: Slow, controlled breathing and mindfulness‑type exercises can reduce anxiety and autonomic arousal, which may attenuate symptoms for some individuals
For multi‑day offshore passages or cruises, expert travel clinicians often recommend combining one primary medical option (e.g., scopolamine patch or meclizine) with ginger or acupressure plus environmental measures (cabin choice, horizon view, task modification) rather than relying on a single modality.
Practical “protocols” for sailors and passengers
Layered, anticipatory planning usually outperforms reactive treatment once vomiting is established.
• For a known‑susceptible person on a multi‑day voyage, a common clinician‑advised pattern is: apply a scopolamine patch the night before departure (if appropriate), carry meclizine as oral backup, keep ginger chews handy, choose a mid‑ship low cabin, and stay topside with eyes on the horizon when seas build.
• For a mildly susceptible day‑trip passenger, starting meclizine or dimenhydrinate 30–60 minutes before boarding, avoiding alcohol and heavy meals, and using ginger or acupressure bands can be sufficient.
• Once someone is actively vomiting, lying them flat or semi‑recumbent in the most stable part of the boat, providing small sips of clear fluids as tolerated, and using the previously selected anti‑motion medication (if still safe) are key steps; severe or refractory cases on ships with medical staff may warrant parenteral antiemetics under physician supervision.