A stiff breeze pushes us up the lake, along with some choppy water, as we set out on the season’s first cruise. The fresh air feels great on this crisp morning and the crew is excited. The chop, however, is building and an occasional steep roller lays us hard over. We slog north and after taking it on the nose for two hours I notice one of the crew starts looking a little pale. Seconds later, the guy is gripping the lifeline, feeding the alewives and praying for salvation. We’re just starting our five-day sail. What could have been done to prevent this and what to do now? Can we salvage our sail?

Seasickness or mal de mer strikes even the most hardened sailor occasionally. Seasickness occurs when the vestibular system, the balance mechanisms within the inner ear, become disrupted and out of sync with visual signals. The inner ear, consisting of the semicircular canal and utricle, tracks a boat’s up and down and sideways motion. The brain registers motion, but the visual system fails to provide confirming information, and the mismatched messages can cause nausea. The most common example is a boat’s rising and falling without an external reference point such as horizon or fixed landmarks (or other boats in motion). If the body is moving up and down, but vision is focused on something static, like the cabin sole, nausea may ensue.

Many people are sensitive to motion alone, even without mismatched signals. Factors that precipitate or exacerbate motion sickness include diet, illness, dehydration, fatigue, negative associations from previous sailing experiences (diesel exhaust or other fumes often become powerful triggers) and anxiety. If car, airplane or roller coaster rides make you queasy, sailing in rough weather may test your gut as well.

If seasickness threatens your sailing enjoyment, or hampers your crew, there are effective countermeasures, including over-the-counter and prescription drugs, non-drug therapies such as wristbands, dietary, health and psychological strategies. Some approaches will work even when the misery has already set in.

Prescription treatments
Prescription motion sickness medications fall into two classes: anticholinergic and antihistamine. The most commonly prescribed seasickness medication is Transderm Scop also called “the patch.” This round bandage, worn behind the ear, contains the anticholinergic medicine scopolamine. Scopolamine diffuses through a membrane at a constant rate, and is absorbed through the skin, slipping in between vestibular system nerve cells, which help regulate motion malaise. Blocking key signals at cholinergic nerve junctions, scopolamine stomps out nausea pretty effectively. The patch must be applied well ahead of time as effective blood levels are not achieved for six to eight hours.

Scopolamine is also available in tablet form (Scopace), which has rated more effective than the patch in some studies, possibly because dosing may be more accurate. Scopolamine also comes in an injectable form, used for mariners stuck in a life raft or rescue pod in offshore emergencies where prolonged seasickness can become very dangerous. Because of its anticholinergic properties, Scopolamine may cause dehydration, blurred vision, short-term memory disruption and dry mouth and drowsiness. Your physician must prescribe this powerful medication; make sure your doctor knows what other medications you’re taking or if you have health problems.

In addition to scopolamine, the prescription drug Stugeron (brand name for the drug cinnarizine) is often used in the United Kingdom and Germany, but has not yet been approved in the United States. Stugeron is a prescription antihistamine that inhibits stimulation of the vestibular system. It is often included in studies that evaluate several drugs with scopolamine and nonprescription drugs.

Antihistamines were not originally developed to aid sailors suffering from seasickness. Ocean travelers suffering from allergies reported fewer problems with motion sickness and nausea. Antihistamines also have intrinsic anticholinergic properties, similar to scopolamine. Unfortunately, antihistamines typically cause drowsiness.

Another prescription drug available in the U.S. is Phenergan (brand name for the drug promethazine). Promethazine prevents vomiting and can serve as an anti-motion sickness agent. It is also used as a sedative compound at high doses. Promethazine has been used to treat astronauts—motion sickness in space can be a serious problem.

Chlorpheniramine is another drug that has recently been tested in humans and may become indicated for motion sickness.

In general, prescription drugs are stronger than the over-the-counter remedies, and may conflict with other medications. The strength required for motion sickness drugs varies with each individual. Sailors on a daysail have different needs than those making transatlantic passages or offshore sailors stuck in foul weather for several days.

Alternative remedies
Often, mild nausea or seasickness experienced on daysails or coastal cruises can be prevented with nonprescription drugs or alternative relief methods. The most recognized nonprescription drug, Dramamine, is formulated with the antihistamine dimenhydrinate. This drug has helped many green-gilled sailors, but it can leave the crew crawling for a bunk—this antihistamine makes many sleepy. Dramamine and Bonine tablets now come in a newer formulation, meclizine HCL. Meclizine HCL has fewer side effects, including sleepiness. Bonine comes in chewable raspberry-flavored tablets. Sedation caused by antihistamines has been prevented in tests by spiking the compounds with nonprescription stimulants such as caffeine. Meclizine HCL has been tested with caffeine in some studies. Scopolamine is available with stronger, prescription stimulants as well. These combinations are used when alertness and clear concentration are particularly important, as antihistamines can interfere with concentration.

It is important to note that some medications may have side effects that may make one more prone to seasickness or may reduce the effectiveness of seasickness medications. Always remind your physician about your daily, maintenance medications when requesting a medication for seasickness. Sometimes a simple dose adjustment of your meds will reduce seasickness tendency.

Ginger comes in many forms but is most often sold either as Sailors Secret or Anti-Nausea Ginger Gum, produced by the Sea-Band folks. Research studies suggest ginger may speed up digestion, block nausea directly or otherwise soothe a turbulent gut. The active constituents of ginger, polyphenolic compounds or gingerols, inhibit Helicobacter pylori, a causal culprit in dyspepsia, peptic ulcer and possibly colon and gastric cancer. Ginger root extract (SGRE) has been combined with pycnogenol (a natural extract) into Zinopin, a travel supplement that is supposed to reduce risk of deep vein thrombosis (DVT) and motion sickness. Ginger does indeed seem to be good stuff.

Other herbal remedies include Sea-Sik Oral Spray, a mix of homeopathic and herbal remedies; Queasy Pops, also from natural herbs that come in ginger, peppermint and lavender flavors; and On The Move capsules, a combination of ginger root, licorice root and cayenne. The effectiveness of the above herbal remedies is not well documented, although Sea-Sik cites numerous research studies on its Web site.

A natural remedy that has received attention is the herbal concentrate Motion Eaze. Motion Eaze consists of oils from birch, frankincense, lavender chamomile, and myrrh peppermint and ylang-ylang. Motion Eaze is dabbed behind the ear, and probably absorbed into the vestibular system, much like the scopolamine.

Acupressure relieves seasickness for some by stimulating or altering nerve impulses at the wrist’s median nerve, which ultimately changes brain chemistry associated with nausea. Sea Bands, BioBands and ReliefBands all work on this principle. Sea Bands and BioBands exert pressure on the wrist via a plastic bead. BioBands come with a Velcro strap that permits pressure adjustment. ReliefBands apply an electrical shock to the wrist, blocking impulses en route to the brain. ReliefBands are available as disposable bracelets or with rechargeable butteries and a battery life indicator. Multiple settings permit adjustment based on need, but they offer no relief without batteries.

There is also some evidence that hypnosis reduces motion sickness. The Journal of Clinical Pharmacology reported in 2000 that hypnosis was more effective than promethazine in preventing sickness in laboratory testing.

A good diet
Any food or drink that is acidic or hard to digest such as orange juice, coffee, fried bacon, sausage or eggs can cause stomach upset that may precipitate more serious nausea and seasickness. Coffee also contains caffeine, a diuretic that causes the body to eliminate water, even if water is needed.

Grease-ball breakfasts are better replaced with oat bran, granola, water or less acidic juices and drinks. Sugary sodas may taste good, but in the heat of a hot beat they can suck the water right out of you. Alcohol may take the edge off, but too much increases the risk of serious seasickness for two reasons. First, it impairs balance, equilibrium and can upset the stomach. Secondly, alcohol is a major dehydrator; heat, wave motion and booze cruising is a sure recipe for spiraling mal de mer. Sports drinks such as Powerade, Gatorade and All Sport, help maintain electrolyte balance and fluid control. Water, however, is still the best hydrator in many people’s books.

When seasickness tightens its grip, doctors and research studies indicate lying on your side or back helps. This reduces head movements relative to your body and also gives muscles a chance to relax, rather than fighting seas and wind. Keeping an eye on the horizon may help too. When the chop starts to churn, so does an upset stomach, and antacids such as Maalox or Tums can help.

When medications, rest, sleep or prayer just can’t keep you from blowing your bilge, it might seem a good idea to stop drinking or eating. However, if misery spirals down drastically enough for dry heaves to kick in, you may be en route to serious dehydration. Weakness from lack of calories may complicate the situation. Try to keep hydrated with sports drinks or water, even if you can only keep them down for a short while. Fluids are quickly absorbed, as are liquid calories. Managing this cycle is very important to feeling better. Energy bars, get into your system quickly and can really help.

Anxiety can bring on seasickness. How many times have we jumped on a boat stressed to the max only to find that a challenging sail may actually put our tired, stressed souls over the edge? Anxiety can make a person more susceptible to seasickness, and worrying about hurling definitely makes it worse.

Fear goes hand in hand with anxiety. Remember: If your spouse, child or friend wants to sail, but has had bad experiences with seasickness, don’t push them. Pick a couple of bluebird days to get them out, make sure they have adequate seasickness protection, and let them know you’re willing to run back to the dock should they start to feel poorly or scared. It is definitely possible to reverse seasickness fear and anxiety, but you have to be patient. Much of the battle is won by having confidence in the medications and prevention steps.

There are many options and strategies to cope with seasickness. Several effective prescription medications work well when tested ahead and taken at the proper time. Nonprescription medications, alternative herbal medications, ginger and wristbands all provide relief to some and can be used together. Diet is important, avoiding alcohol, too much caffeine or meals that are difficult to digest and greasy. Taken together, this information should help take the misery out of sailing while seasick.