Managing Mal de Mer

Given the proper conditions on or under the water, just about any diver can be made to call for Ralph. Sea sickness is thought to occur when the motion of water causes the brain to receive conflicting messages from the eyes, inner ear, muscles and joints.

The Scop Patch

There are many ways to treat it, but the most effective is the prescription drug scopolamine, which has an improved release system after having been pulled from the market a few years back. Scopolamine can be delivered through a patch worn behind the ear (e.g., Transderm Scop), orally (e.g., Scopace) and as a gel applied to the wrist. The former is the longest acting. The latter two, in addition to not falling off, are faster acting and allow for more flexible dosing.

While many divers believe scopolamine has a sedating effect, a study conducted for NASA evaluating the effects of oral scopolamine on operational proficiency found no significant impact on the selected tasks. Drowsiness and blurred vision were not significantly greater than that for a placebo.

One study involving naval crew found that cinnarizine (Stugeron) and transdermal scopolamine were free of adverse effects on the cognitive and motor performance tests, and the only side effect was dry mouth with scopolamine. This study used a large dose of cinnarizine, 50 mg. Another study has shown impairment of psychomotor performance and increased daytime sleepiness as dosage increases, so it would be prudent not to exceed 25 mg the night before boarding the boat and 12.5 mg every eight hours thereafter when necessary. Adverse effects tend to diminish with use.

Another study asked divers on an extended 60 ft. air saturation profile to complete psychomotor tasks several times during the dive and to record perceived side effects. There was no significant difference between the groups receiving a transdermal scopolamine or a placebo patch, suggesting that recreational scuba depths likely would not increase the probability of side effects or impair performance.

Many day boats and even liveaboards that claim their design prevents seasickness – the Nektons come to mind – have plenty of sea sick passengers. On a boat, don’t sit up in the pilot’s tower or a high deck. Move to the lowest deck that still allows you to face forward, then focus on a distant fixed object or slightly above the horizon, while avoiding unnecessary movement of the neck and head. Don’t read or look through binoculars. Delay donning your suit until the last minute and get in the water as quickly as possible. And, avoid fatigue, pass on heavy meals and fatty, spicy or acidic foods in favor of blander fare. Acidic, caffeinated beverages and some sodas should be consumed only in moderation; ditto for alcohol.

If such measures fail, there are over-the-counter and prescription medications. None are as generally effective as Scopolamine, but different ones work for different individuals. Most have side effects, particularly dryness of the mouth and drowsiness, but also blurred vision, dizziness and even confusion.

Popular and effective OTC drugs include Bonine and Dramamine II (both meclizine; in prescription strength as Antivert). Also widely used are Dramamine Original Formula and Chewable Tablets and Triptone, all of which contain dimenhydrinate, a drug with demonstrated adverse effects upon alertness and performance both topside and at depth. A British product, Stugeron (cinnarizine), has been shown effective, but is not on the market in the US.

These OTC medications are most effective if taken at bedtime the night before diving, followed by a second dose about an hour before leaving the dock.

In addition, there are those who prefer, or assert the superiority of, herbal or natural remedies, most popular among them ginger. Is ginger effective? Maybe. Several controlled studies have found that about one gram of ginger notably reduces vomiting and cold sweating. Nausea and vertigo also are reduced, but apparently to lesser degree. Several articles report that ginger is as effective, or more so, than Dramamine Original Formula in controlling motion sickness, and produces fewer side effects.

If you’re going to try ginger, powdered, root or crystallized forms make it easiest to control the amount of active ingredient ingested. Eating ginger snaps or drinking ginger soda or tea makes getting adequate quantity and control much more difficult. A reasonable daily starting regimen is 1 gram/1,000 mg of powdered ginger root 4-6 hours before, then another about one hour before boarding the boat. Additional doses can be taken every 4-6 hours provided they are well tolerated. Read the labels as some products contain ginger flavoring only.

Others swear by such natural remedies as the Sea-Band and ReliefBand, bracelets that exert pressure/stimulation on an acupressure point on the inner surface of the wrist just above the joint. While results are not consistent, research suggests these bands do not control seasickness. Moreover, the ReliefBand, costing 55 to 120 nonrefundable dollars, is slightly water resistant but not waterproof.

Even farther out are products such as MotionEaze, an aromatic mixture dabbed behind the ears, or various fragrant essential oils rubbed into the hands and feet. While these might make you smell better while you’re praying to the porcelain princess, they have no scientific support.

But never underestimate the power of placebo. Every preparation and device for motion sickness, no matter how wacky, has it advocates and believers.

But, in the final analysis you’ll need to discover, probably by trial and error, what works best for you with the least adverse reaction, cost and inconvenience. Whatever pill, patch or potion you choose, give it at least a 24-hour trial topside and use only according to instructions or more conservatively.

-- Doc Vikingo