What are the most effective cures for seasickness? Josh Arnold cites a survey of crews in the ARC transatlantic rally last year and Elaine Bunting reports first hand
Seasickness is an age-old problem, but how common is it and how can we prevent or treat it? We conducted a survey among 450 sailors taking part in the ARC rally last year, to find out how people coped with this dreaded affliction.
The 2015 ARC provided participants with an exciting start to their ocean passage. During the first few days there were 25-40-knot winds, with large seas around the wind acceleration zones to the south of the Canary Islands and bumpy seas.
With only a few days of calm conditions for most amid the downwind rolling of a typical transatlantic crossing, the chances of feeling seasick at some point was high. At the end of the rally, participants were invited to complete our survey on seasickness, asking whether they had suffered, for how long and the remedies they had used.
An age-old affliction
There are references to seasickness as far back as Ancient Greece. Briefly, seasickness will arise when the body experiences a mismatch between the information received from our vision, balance (sensed via the ear) and the anticipated model of sensory behaviour that the body has built up from normal and previous experiences.
For example, when at sea our ears tell us that we are moving, however our sight (when focused on something within the boat) suggests that we are stationary.
As so many of us know all too well, symptoms include pale skin, cold sweat, dizziness, increased saliva, vomiting, headaches and drowsiness.
Evidence suggests that given the appropriate provocative conditions, almost all healthy individuals can develop seasickness. Indeed, it is estimated that as many as 90 per cent of seafarers have suffered at least once, if not several times from seasickness. This is despite many people’s reluctance to admit it.
Despite the apparently level playing field among individuals, susceptibility to seasickness may depend more on your threshold. This can also vary across different conditions for each individual – ie with changes in sailing angles or sea states – making it hard to predict.
Data from ARC 2015 suggests that 119 (26 per cent) of 456 survey respondents experienced seasickness to some degree during their 2015 Atlantic crossing. Some 67 (57 per cent) of those who did suffer from seasickness during the rally used some form of prevention strategy or remedy and 52 (43 per cent) did not.
Other factors not addressed by the survey, yet of potential interest include the conclusion in a 2012 report that motion sickness is considered to have a heritability of around 57-70 per cent, and racial differences in sensitivity appear to exist. For instance, Chinese populations were observed in a study in 2002 to be more sensitive than Caucasians.
Gender differences also appear to exist, with women more sensitive than men. And finally, fitness and anxiety are also known to influence sensitivity to seasickness.
How long does seasickness last?
Something that should provide a degree of comfort to those who are susceptible to seasickness, only 58 per cent of sailors on the ARC experienced symptoms for a maximum of one or two days. A further 27 experienced symptoms for three to four days, 9 per cent for five to seven days, and only 7 per cent for longer than one week.
Furthermore, the majority (60 per cent) of those who experienced seasickness said that it did not prevent them from taking part in any activities on board. These results would suggest that seasickness is relatively short-lived, and there is potential to work around it.
Prevention and treatment
There is now a wide range of countermeasures available to aid in the battle against seasickness. Some are founded on good practice and evidence, while others are more controversial. Some 162 people on the ARC took some kind of action to combat seasickness, and 78 per cent rated their chosen methods as effective and helpful to them in some form.
Here is a brief breakdown of various remedies they took, how they align with evidence from other studies and how popular they were across the fleet as a whole:
There are at least nine different drug types available for use against seasickness. Anticholinergics (scopolamine) and antihistamines (dimenhydrinate, cinnarizine, betahistine) appear to be the most effective, evidence-based pharmacological agents. These have all been found in scientific studies to be more effective than a placebo.
Our survey showed ARC sailors had a heavy preference for pharmacological agents over any other kind of remedy, and the most common were Stugeron (cinnarizine) and scopolamine patches.
Though effective, these drugs are not without potential side effects such as drowsiness and dry mouth. One recent scientific case study from 2015 even described one individual who experienced withdrawal-type symptoms after consistent use of scopolamine patches.
In our survey, crews made clear references to side effects, particularly drowsiness.
Caffeine intake alongside the drugs described above may provide a means of combating side effects such as drowsiness, although that was suggested by only a few ARC respondents.
Grapefruit juice can also be used to increase the absorption of oral scopolamine and there are a number of clinical studies that suggest ginger might reduce the nausea and vomiting caused by seasickness, though the means by which it actually works are not yet fully understood.
Finally, recent scientific evidence suggests vitamin C can be an effective tool for use in seasickness, though this does not appear to be recognised by the sailing community and was barely mentioned in our survey.
Getting over it
Put scientifically, habituation to seasickness can be induced in humans – that is, repeated exposures to seasickness may reduce someone’s susceptibility to it. Short repeated exposures to motion rather than a single extended exposure is thought to be more effective.
But it’s worth noting that evidence suggests habituation may only last for several weeks at a time, and is thought to be highly specific to the original conditions. So extensive downwind sailing may not stop someone experiencing seasickness while sailing upwind.
We must not forget the importance of distractions to counteract many seasickness symptoms. A large number of anecdotal accounts from the survey addressed the need to ‘keep busy’, find things to do such as helming, trimming, cleaning or cooking. Scientific evidence suggests that controlled breathing can help, as can viewing a distant horizon.
Evidence supporting the use of acupressure bands is controversial and this seems to be recognised by ARC sailors – there were few references to these in our survey.
Seasickness is an unavoidable hurdle that many sailors continue to have to overcome. But on a positive note, the survey shows that symptoms do ease with time and are often short-lived.
Seasickness round the world
In a previous survey we conducted in 2004, we found broadly similar results, writes Elaine Bunting
We surveyed 223 crew in the final stages of the Global Challenge round the world race, who had sailed over 27,000 miles.
We found that 62 per cent had suffered from seasickness at some stage, compared with 38 per cent who had never been sick, distributed fairly evenly among the boats.
Our results indicated that the incidence of seasickness might decrease with age because the percentage of seasick crew declined markedly after a peak between the ages of 20 and 24.
As with the ARC survey, we found most people who reported being sick (84 per cent) were able to carry on working, but 16 per cent reported such severe vomiting that they were not able to stand a watch.
Race doctors recommended a ‘multi-modal’ approach to medication, whereby two or more different types were taken simultaneously. A number of crewmembers on one yacht took cinnarizine (Stugeron) and domperidone (Motilium) in combination. On another yacht, domperidone (Motilium) was widely favoured, on another cyclizine (Dramamine II), on a third promethazine (Avomine).
But most crews stuck to cinnarizine or hyoscine patches (Scopoderm). The latter appeared to be the most effective – half of the 20 users said it ‘helped a lot’. Cinnarizine was more evenly split between ‘helps a little’ (35 per cent) and ‘helps a lot’ (35 per cent), though drowsiness was said in one case to be ‘totally debilitating’. Hyoscine patches caused blurred vision, skin reaction or a dry mouth and one medic noted dry eyes with contact lenses.
Other drugs used for the most severe cases were ondansetron (Zofran), which was reported as ‘the only drug that was able to retrieve people who had started vomiting’, and prochlorperazine (Buccastem).
Expert’s guide to seasickness
by Elaine Bunting
I don’t claim to be an expert at many things, but when it comes to seasickness I’m an authority, in a league of my own. I have ‘talked to god on the great white telephone’ and ‘done the technicolour yawn’ more times than I care to remember, in times of calm (peculiarly) as well as storms, and it is never fun.
Sometimes you get over it reasonably quickly; other times you don’t. I’m usually fine after three days, which I always think of as the magic amount of time for stomach, crew and routine to settle down on a long passage. But not always. My worst experience was being seasick for 12 continuous days while pounding north up the Red Sea. The upwind motion floored me. I lost 8kg. It is not a crash diet I’d recommend.
I had tried all sorts of remedies. I won’t touch Stugeron any more; it is like a cosh and makes me too drowsy to stand a watch safely. I find the dry mouth side-effects of Scopoderm patches insufferable – they are much nastier than they sound – and if you touch the patch and get any of the drug in your eyes, your pupils dilate. It also makes me feel weird (or, my husband puts it: “go mad”).
Acupressure bands are the sailor’s equivalent of lucky heather or hare’s feet charms. Ginger? Possibly it helps a little bit, but against that it stings nastily on the way back up.
I had resigned myself to self-management: cans of Coke to help quell nausea, pockets full of barley sugar sweets and dry crackers, spending as little time below deck as possible unless sleeping, and waiting it out for the magic three days. You suffer, but this works OK.
But then in Chile three years ago, while waiting to sail round Cape Horn, I met Keri Pashuk. Although a vastly experienced and famous Antarctic sailor, Keri confessed to being a terrible sufferer too. She gave me some of the tablets she used. Regrettably, I didn’t take them and so, of course, heaved miserably past the Horn.
While preparing for a rough passage from Harris out to St Kilda the summer before last, I found Keri’s tablets in my foulweather trouser pocket. I popped a couple. To my amazement, they worked. Most of the crew was seasick, but I was able to go below to make food and edit video. Unheard of.
When I got ashore I looked up Keri’s magic pink pills. Meclizine hydrochloride. Good, old-fashioned Sea Legs, the tablets they sell on cross-Channel ferries but, at 25mg, twice the dose. Unbelievable.
The problem with seasickness remedies of any kind, it seems to me, is that each person is different in what they can tolerate and what works for them. I had given up trying to find a panacea, so my advice now is: try everything. The chances are you will find something that at least makes those first few days tolerable. If you can get past that, the brain works it out and most people get over it.
And bear in mind, too, that one of the best therapies available is an understanding and sympathetic skipper and crewmates.