Living with seasickness

Trish Comer is a long-time sufferer from seasickness, but still manages to enjoy liveaboard bluewater cruising. Here she tells how she prevents and manages seasickness herself and leads the way through the maze of products on the market.

The very mention of the word “sea sick” can make people queasy. It stops some of us from ever setting out on a boat, others from enjoying life at sea, and can actually cause others to quit their cruising life.

Believe me, I know.

I am writing this on the comfort of land. Why? Because today the sea is rough, and even snuggly tucked away in the marina pen, that means seasickness for me when working on the computer on board. What a joke. What sort of sailor am I?

Back in the beginning (see “My Boat” article, CH February 2011), my first experience aboard Auspray involved a wretched dose of seasickness which left the skipper/husband seriously concerned that the sailing adventure would simply not begin at all. With tenacity, planning, positive thinking and all types of drug experimentation (of the legal kind), here I am, some 18,000nm under the belt and still prone to seasickness in a marina. Ha! But at least I now know what works for me in terms of prevention and remedy.

With so many different strategies and options available there is something out there for just about everyone who suffers seasickness. We can now have our cake and eat it too (not the best analogy, when dried toast is a much safer alternative). But it does take trial and fine-tuning.

Hopefully some of the hints and remedies listed below, many of which have been tried by yours truly, will help to set fellow sufferers at ease. But first we have to understand what we are dealing with.

What is seasickness?

Seasickness happens when the body, inner ear, and eyes all send different signals to the brain, resulting in confusion and queasiness. It is a problem generally attributed to disturbance in the balance system of the inner ear. Your sensory perception gets out of synch as these nerve fibres attempt to compensate for the unfamiliar motion of the boat moving through water.

The visual stimulus is misleading because it reports things like cabin walls and furniture in such a way that the brain interprets these things as stable. Your brain is being told by your eyes that the world is stable, while the inner ear is screaming that it’s not.

The good news for most sufferers is that the condition often improves without medical treatment within a few days. As your brain learns to compensate for the swaying and pitching of the boat you will get your “sea legs”.

Just about everyone will have suffered from motion sickness at some point in their lives. Almost anyone who has normal inner-ear balance function can suffer motion sickness — even long-time sailors (my husband has only ever had it when we are hove to).

Sleepiness can often be the first sign and some people who think they don’t get seasick actually do without realising it.

After sleepiness comes the nausea but it is often mild and may not be much of a problem. Studies have shown that maintaining a positive state of mind can help offset the effects.

For many unfortunate souls the symptoms escalate to extreme nausea, dizziness, headache, pallor, cold perspiration, a sense of hopelessness and vomiting.

Prevention is better than a cure

There are some triggers known to cause uncomfortable symptoms in sufferers. These triggers should be avoided whenever possible before, and during the first few days at sea:

• A hard night of celebrating (with alcohol) the night before

• A “fry-up” just before setting off

• Having a head cold, sinus, throat or ear infection (plan departures for when all crew are feeling well)

• For women, just before or the first day or two of menstruation

• Departing in rough conditions (unless, you have to, why would you?)

• Moving/working below deck for extended time periods, particularly any activity requiring your head to tilt downwards (or upwards) by more than 20 degrees

• Looking through binoculars for anything longer than a glance

• Reading a book, looking at a compass, doing detailed work or staring at one point. Try to keep your peripheral vision out on the horizon and not staring at objects your brain will interpret as stable.

What to do?

At the very beginning, think carefully about the boat you will buy — a monohull with narrow beam is going to have a different movement to a cat — try the feel of different boats at sea, if you can.

Find a haven on your boat, preferably facing forward, with fresh air on your face, where the motion is at its minimum and you can gaze at the horizon (but don’t actually lock your eyes on that horizon!).

It’s often said that you can avoid seasickness by staying busy and keeping your mind occupied. This doesn’t usually work for me — although incidentally, I found that terror — in the form of going through a gale — did actually work, but not again, thank you!

Staying in fresh air helps and taking deep breaths does too. Sip plenty of water. Avoid too much caffeine and definitely no alcohol until you have proven yourself sea-worthy.

Avoid fatty or spicy foods. Also stay away from food that has a lot of sodium or is rich in protein such as preserved meats and dairy products several hours before weighing anchor. But don’t avoid food altogether. You should eat something light an hour before you leave so your stomach has something to process and while underway snack lightly on dry, simple foods such as crackers or pretzels.

Do extra preparation before lifting anchor. This includes locating extra batteries for equipment, water for the trip, snacks etc. all should be within reach so you don’t need to go below to get them. Pre-cook light meals for easy re-heating.

Sail to conditions, but attempt to find a course which minimises beam-on swell or (the very worst, trust me) corkscrew swell. For this you need a compassionate skipper and trip flexibility.

Lying down horizontally while looking at the horizon or your eyes are closed may help fend off the ill feeling. Lying on your left side, facing forward, may improve this remedy.

Steering the boat can help to keep your mind off motion sickness and temporarily stops symptoms. (This doesn’t work for me because it requires gazing at chartplotters and gauges as well as horizon.)

Drink a weak solution of hot tea mixed with ginger, or better brew up some ginger-only tea. (Ginger has never worked for me but does work for others. I find a can of Coke — and not just any fizzy drink — as a break in the routine of sipping water has better effect.)

When visiting another boat, even on anchor in that peaceful anchorage, be prepared for a relapse of seasickness due to the change in motion (as mentioned before, from monohull to cat, there can be a huge difference).

Remedies — when prevention steps are just not enough

Prevention is certainly better than remedy, but I find in the first few days at sea I’ll do anything and use anything that helps. Remedies must be taken before setting sail or at least before the condition takes hold. None of the herbal or non-medication remedies have worked for me but some have taken the edge off the symptoms. All medicinal remedies have side-effects and should be used for a limited duration only. Most medications work by sedating the balancing organs and consequently cause drowsiness — not a good thing when you need your wits about you at sea. 

Ginger

There is some evidence to suggest that Ginger has a beneficial effect on motion sickness. It appears to be related to its action on the gastrointestinal tract rather than the central nervous system. The usual recommended dosage is about a gram. Some report that the dosage is consistent with easy administration via a biscuit or cup of tea.

Side-effects of ginger are rare when used as recommended. However, some people may be sensitive to the taste or experience heartburn. People with a history of gallstones should consult a doctor before using ginger. Short-term use of ginger for nausea and vomiting of pregnancy appears to pose no safety problems; however, long-term use during pregnancy is not recommended.

Wristbands

These are merely elastic straps you wear around the wrists which press an acupressure point that is supposedly effective in reducing nausea. There’s a lot of cynics about regarding the effectiveness of wristbands for seasickness (and the studies do support them). I have used wristbands to reduce the effects of seasickness — but this may be due to the placebo effect.

Medications

Pharmaceutical drugs, mostly antihistamines, include the following: Scopolamine (transdermal patches) also known as hyoscine hydrobromide (in tablet form such as Kwell), Cinnarizine (eg Stugeron) (oral), Buclizine Hcl (oral), Cyclizine Hcl (oral), Meclizine Hcl (oral or suppository), Promethazine Hcl (eg Phenergan) (oral or suppository).

Quite a few of the above listed medications do not appear to be available in Australia (cinnazirine, and scopolamine patches, for example). These may be sourced through friends travelling overseas or through online providers.

Scopolamine/hyoscine hydrobromide/levo-duboisine

The most effective preventative for motion sickness (according to just about every recent study undertaken — note there are exceptions, see the Australian Cochrane report) is transdermal scopolamine.

However, scopolamine must be used with caution in people with glaucoma and benign prostatic hypertrophy and can cause hallucinations, confusion, disorientation and memory disturbance. It is available in oral and transdermal patch formulations. The patch takes up to six hours to be effective and lasts for three days. It produces less drowsiness than other drugs but a greater number of other side-effects including dry mouth, dizziness, ocular disturbances, disorientation, irritability (in children), slowed heart rate, psychosis and amnesia.

The tablet form is faster and has a shorter duration of action. There is also more flexibility in dosage which means side-effects can be reduced. So while the patches may be the most effective, the tablet form seems generally more suitable for sailors. In Australia, the tablet form is readily available.

Bearing in mind the potential side-effects, if you haven’t had success with other remedies, this might be a choice to explore with your doctor.

Most recent studies show that the next most effective drug is cinnarizine (Stugeron). Cinnarizine  is an antihistamine, originally developed for use in the treatment of Parkinson’s disease, is said to work very well for most people with fewer side-effects than scopolamine/hyoscine.

Other drugs

If the above aren’t suited to your needs or are unavailable, you may wish to try meclizine. This is available over the counter as Bonine and Dramamine II.

Another alternative is either dimenhydrinate (Dramamine) or diphenhydramine (Benadryl) 25-50mg every 4-6 hours. Dimenhydrinate turns into diphenhydramine under the influence of stomach acid, so to carry both would be unnecessary.

To varying degrees, drowsiness is a side-effect of all of these medications.

And yet more alternatives . . .

Phenytoin (Dilantin)

Anectodal reports are that phenytoin may also be effective. This drug is used and approved for the control of seizure activity in epilepsy. Dosage has not been developed for the medication to be used for seasickness — although reports indicate that it be taken the night before going to sea.

There have been several studies where a single dose of phenytoin (200mg) was given to volunteers who were then spun around. It seems there was a significant decrease in incidents of nausea in those subjects that were given the phenytoin. It seems that it acts on the nervous system of the digestive tract to decrease nervous activity associated with nausea.

Phenytoin has potential side-effects that would be adverse to cruisers. These include ataxia, slurred speech, blurred vision, nystagmus, mental confusion, hallucination, headache and dizziness. There are also many drug interactions with phenytoin. Taking this drug while using other  medications may produce the side-effects mentioned above.

Reglan (metoclopramide), Zofran (odansetron), and Stemetil (prochlorperazine) are effective for nausea but generally won’t prevent motion sickness.

Combining drugs

Many people and some studies suggest adding pseudoephedrine (Sudafed and others), 15-30mg, every 4-6 hours if drowsiness is a problem. This should be avoided with a history of high blood pressure, heart irregularities and in combination with certain other drugs, especially MAO inhibitor-type antidepressants. The other Sudafed PE contains phenylephrine which may be no better than placebo. Ephedrine (Primatene tablets) has been used in the past.

What works for you

Check with your doctor prior to setting sail regarding your children and any seasickness medications.

Always check with your doctor or pharmacist again in relation to your other medications to make sure there are no drug interactions.

Take enough medication for the entire crew. If vomiting is already present, tablets are unlikely to work so you may need to consider having suppository medication on board.

If unsure of what works for you, and you are planning extended cruising take one or two alternative medications with you for your journey.

These days, due to the difficulty of finding preferred medications while cruising international waters, I opt for promethazine in 10mg form — it has been readily available everywhere we have travelled except for Indonesia. It doesn’t cause me too much drowsiness — and if I need to, I add a Sudafed — although these are getting harder to find as time goes by. But just because this works for me, does not mean it will for you.

Is there a cure?

There remains no permanent cure for seasickness. However, I have found that as my sailing confidence built together with my awareness of the condition, the frequency, severity and duration of my “bouts” lessened. But seasickness will always be a factor we take into account in our cruising plans.

IMPORTANT TRAVEL TIP

Whenever you are searching for pharmaceutical products internationally, don’t ask for a brand name, but the active ingredient. Write it down, together with the composition amount so that you are more able to compare apples with apples, so to speak.