Professor Thomas Stoffregen is an expert on seasickness or motion sickness. In this interview we chat about some facts, myths and proven ways to stack the odds in your favour with regards to preventing or minimising the effects of seasickness. His wealth of knowledge stems from a keen interest in the space race and the big problem astronauts face with regards to motion sickness. He went on to diversify his scientific studies in the area of motion sickness. We chat about seasick drugs and remedies and the placebo effect. His advice on the best way deal with seasickness is based on fact and not the stories of old salts. His ability to put a complicated condition into simple terms that are easy to understand makes this podcast very helpful to those who would like to go to sea but fear seasickness.
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LINDSAY: Today we’re very excited because I’ve found Professor Stoffregen on the internet, who’s an expert in perception and action and has interests in human factors, control of posture and orientation, ecological psychology, embodied cognition and coordination dynamics.
In short he’s an expert on seasickness. That’s something that I’ve been interested in for a long time, and I’ve often tried to educate my crews before going out to sea in what causes seasickness. But, I don’t pretend to know it all and I managed to get a hold of Professor Stoffregen here and he’s agreed very kindly to answer a few questions to see if he can educate me and hopefully you guys a little bit more.
Thank you very much Professor Stoffregen for agreeing to this chat we’re gonna have. Can you start by telling us a little bit about what is seasickness?
PROF STOFFREGEN: Seasickness is a form of motion sickness. It’s the form of motion sickness that comes when you’re out at sea. You can talk about it in terms of subjective symptoms: sweating and pallor and stomach awareness, all the way up to the end point of course, which is emptying the contents of your stomach. It happens to some people but not to others. It varies of a function of the sea state and even in terms of sometimes the size of the vessel or you know, lots and lots of factors can be involved.
The good news about seasickness is that it naturally goes away if you stay on the ship for a sufficiently long period of time. You will accommodate, you will adapt and this horrible malady will disappear. I call it a horrible malady because I’m quite susceptible to it myself and I know exactly what it feels like, and it just absolutely feels horrible. It’s great when it finally goes away.
LINDSAY: That’s an important point because a lot of people have this unreasonable fear of seasickness. It is uncomfortable while you’re there, but the fact is your body does adapt.
I’d just like to take you back a little bit in time and get you to tell us a bit about yourself and your research into seasickness, and how you became an expert on seasickness.
PROF: I grew up as a boy in the 1960’s and it was the space program and astronauts were being launched into space and I thought that was the coolest thing, along with many other people. Years later when I got into graduate school and became an experimental scientist, I thought back to that childhood interest and I just started to wonder, you know, what would life in space be like from a sort of a behavioural science perspective. I thought it would be cool to study the astronauts.
And so I looked around, I talked to people, I looked through the literature and I was surprised to discover that one of the things that happens very much to astronauts is that they get terribly motion sick. Motion sickness is the bane of sending humans into orbit, and it is something that the people at NASA and the corresponding – any space agency in any government around the world has struggled with forever. It’s an ongoing struggle. That is to say they haven’t solved this problem yet.
So when you take a human being and put them into orbit you might say “Well that couldn’t possibly be motion sickness because there’s no motion. They’re just floating around.” You know, you can describe it that way if you want to, but it is the case that many, many, many astronauts get horribly, violently sick. Fortunately it is temporary there, as well as at sea and people naturally get over it, so it goes away. But that’s what I discovered as a real problem when I was trying to find some sort of behavioural science connection to orbital flight.
I found that I couldn’t study motion sickness in space flight because, you know, that’s kinda expensive and it’s hard to get access to that. So I looked around as a more general phenomena. That’s the origin of my interest in motion sickness in general.
I looked into the motion sickness literature and I became very dissatisfied with the explanations that were being offered there. This was still when I was in graduate school and I just sort of decided, you know, there has to be a better way. And that really became the focus of my work for some time. Was to figure out an explanation for motion sickness that might be at least in my judgement more successful and was able to do that.
I spent the last 25 years really, doing research in laboratories, on ships at sea, in flight simulators, with video games – lots and lots of different venues, evaluating various phenomena in motion sickness and trying to understand the basic science aspects of it, in terms of basic theory, why it happens and so forth. But also, looking at some of the more applied things. A lot of motion sickness happens nowadays with virtual environments and interactive technologies and stuff like that. So there’s just some practical questions about that.
But you know, seasickness is the original. It’s the historical origin of human motion sickness and I’m very aware of that. I love the sea. I’ve been able to do research on ships at sea. I find that very rewarding and I very much am attracted to that very deep historical angle. And so I was able to direct some of my nautical research into looking at questions of seasickness and we’ve done this a little bit with some success.
LINDSAY: That’s incredibly interesting. The fact that you were drawn into the study of seasickness because of the NASA problem of astronaut, but then obviously being restricted by the expense of researching in outer space. So you found a better way and that 25 years that you were studying it, you realised that there was a connection between the sea, simulators, vessels at sea and even aeroplanes and things like that. You’ve certainly had a good look around at all the different forms of motion sickness and they all come down to the same sort of thing. Is that correct?
PROF: Yes. And just to underline some of the obscure corners of this phenomenon: As we build taller and taller buildings these buildings become more and more subject to the wind. Your super tall buildings tend to sway back and forth in the wind and it is now well documented that motion sickness occurs among people who work on the upper floors of these buildings.
LINDSAY: Oh, that’s incredible. I never even considered that.
PROF: Who would! Who could imagine such a thing, and yet as I say, this is very well documented. There’s a guy – I can’t remember his name off the top of my head but there’s a guy, he’s from Singapore but he’s on the faculty at a University in Australia actually, and he’s done the foundational research on this. Just demonstrating through surveys and onsite testing and stuff, that in windy places with tall buildings it’s not a good idea to pay all that extra money to rent the top floor.
LINDSAY: It’s interesting that you say that. I remember when I was touring around America in 1988, I think it was the Seattle Tower that I went up that is supported by wires and it had a movement sensor digital read out and it was quite phenomenal how much the tower was moving on a windy day. That’s something I’d never expected to hear. It’s not just vessels at sea.
So obviously there’s a lot of people affected by seasickness. I’m one of the lucky ones. I’ve only ever been sick at sea three times, although I’ve felt crook many times in the thousands of miles that I’ve done, but never actually got to the stage where I’ve emptied my stomach. We really need to do something to help these people.
You said earlier there’s no real definitive answer, but I know that there are drugs that people can take. For those that suffer seasickness, what kind of seasickness medication can they take where it can effectively dampen or control?
PROF: Well I have two answers to that question. One answer is very personal and the other answer is more scientific.
The personal answer is that the only medication that I’ve ever taken that appeared to make any difference was the one called Bonine. B-o-n-i-n-e I believe it is. In January of this year I was on a ship in a hurricane and I was mortally afraid of seasickness but I had taken Bonine and to my astonishment, I wasn’t very happy but I didn’t get seasick.
LINDSAY: A hurricane! Now that’s really testing the limits.
PROF: But that’s the personal answer.
My answer as a scientist is less encouraging. As you know there are quite a few medications available on the market and as you may know, they have a somewhat spotty record of success. There are pretty well documented placebo affects and you know, I had that one personal experience, one time on one ship with one storm and I cannot be absolutely certain that the Bonine was what did the job. Maybe I was just lucky in general.
Here’s what I can tell you. To the extent that the available medications have an actual benefit, and that’s not really that well documented, but to the extent that the available medications have an actual benefit it may be because most of them are sedatives. So you’re Scopolamine, your Dexedrine and Bonine for that matter – most of the over the counter medications that are sold for seasickness, whatever else they do, they are mild sedatives.
From my perspective based on my research, anything that makes you want to sit down or lie down is going to help. It doesn’t need to be a medication. You can go to the manufacturers – the drug companies and say “Well you know, what’s your evidence that this works?” And they’re not obliged to disclose that to you. It’s hard to know what the real basis for this is. I mean, there are published studies of some of these things, but the published studies are not really all that encouraging. There definitely is not a silver bullet here.
As I say, I’m somewhat sceptical of these things because they’re general pharmacological agents. Mostly they’re anti-histamines that have a mild sedative effect. Exactly why that would prevent people from having the symptoms that they have is not at all understood. The way that I think of it is that they are well known to be mild sedatives and from my perspective, as I say, anything that makes you sit down or lie down is gonna help.
LINDSAY: Do you know of any effective alternatives other than the pharmaceutical medication. Like, it’s fairly well documented that ginger and wristbands, pressure points, do you know of any evidence that shows that that sort of thing like that might work?
PROF: The wristbands – I have not seen any scientific testing of those. I know that they’re out there. I know that a lot of people swear by them. I am open minded to the possibility that they might have some benefit, but as I say I’ve seen no controlled scientific data about that. I really don’t know.
The one that I can talk about is ginger. There is controlled scientific research on ginger and no one has any idea why this is true, but ginger actually helps. Again, it’s not a silver bullet you know, it doesn’t prevent everything for everybody, but it is the case that having a small amount of ginger in your stomach – like a couple of ginger snaps or something like that or maybe a ginger hard candy that you can suck on. Even ginger chewing gum, or something like that. It is the case, and I say this, you know, we have no idea why this is true, but the data clearly showed that ginger can serve as some benefit in terms of seasickness.
LINDSAY: Well that’s very interesting. When we went offshore with my family, we left New Zealand on the back edge of a gale, I got a bit of a funny story there. I won’t go on too much but we decided we were gonna use ginger to help us settle into the motion sickness when leaving New Zealand. A word of warning for people that use ginger tablets – read the label. We took the tablets and chewed them and they weren’t supposed to be chewed. They left a foul taste in our mouths.
PROF: Follow the directions. Often helpful.
You asked me whether there were effective alternatives to pharmaceuticals and there are effective alternatives to pharmaceuticals that have nothing to do with either ginger or wristbands. They’re ones that you probably already know about. The most effective alternative to pharmaceuticals is to go up on deck and look at the horizon. That has a demonstrated benefit. That actually does help.
LINDSAY: That would be something to do with what I used to tell my crews. Correct me if I’m wrong here – but I used to tell them that seasickness has come about my a confusion of different senses that are getting to your brain. Your ears are telling you that you’re moving because your ears are sort of associated with balance, your eyes are telling you that you’re on a night stable platform because you can see everything as it normally would be in the boat. I said to my crews that because of the confusion your brain translates that into the fact that you’ve been poisoned and sets of a chemical in your gut which makes you get rid of the poison.
PROF: That is a classic narrative. That’s the classic explanation that’s given. I think that’s completely mistaken.
LINDSAY: Okay. I was wondering if you were going to say that. It was something that I’d read somewhere.
So that goes back to what you said originally that you weren’t happy with the information that you were finding online. I’ve been telling fibs to my crews all these years. Can you explain a little bit about why you think that?
PROF: For one thing, that theory offers no insight into why the horizon helps and so it’s just totally tangential to the horizon. As I said, the horizon is quite well documented to have this beneficial effect. I should add that since you have readers or listeners who are going to be interested in avoiding this problem: All – and I stress – all of the measures that I’m talking about here – ginger or Bonine or anything else, including going up on deck and looking at the horizon – all of these have value as preventative only.
If you wait until your’e sick, it’s too late. These are preventative measures only. I field these kinds of queries from people all the time who are saying “Oh, I’m going go on a cruise and I’m gonna do two weeks and want to avoid and what do I need to do?” I always give the same advice which is the first day, the first minute that you get onboard, put your stuff in your cabin and get yourself up on deck and stay there. Stay there as long as you possibly can – preferably in a deck chair and even better if the deck chair has a headrest, and look out to sea. Look at the horizon. Don’t look at fish, don’t look at the clouds, don’t look at the birds, don’t look at the people. If you want to converse with people that’s fine, but don’t look at them. Keep looking at the water and generally speaking I mean, the horizon is big. It goes all the way around. It’s not so dull. You know, you could do a whole lot worse than spend your day looking out at the lovely ocean.
Let me say that we were the first people that did any controlled scientific research to evaluate whether looking at the horizon actually had any physical benefit and it turns out that looking at the horizon actually physically increases the stability of your body. This is a quantitative effect that we were able to demonstrate.
We had people stand up on the deck, we had them look at things that were close to them, we had them look at the horizon. And we measured their body movement in these two simple conditions and looking at the horizon reduced the amount of body motion. It actually stabilises the body.
LINDSAY: That’s very good to hear that, because it’s one that crops up all the time and you’ve actually done controlled studies of it and proven that it is true. There’s a lot of misinformation out there about seasickness.
PROF: Absolutely. Old wives tales and sailors anecdotes and all that kind of stuff, and it’s very hard to sort them out. Well this is one where you have the data.
LINDSAY: I did have a question here that I wanted to ask about placebos and you touched on it a little earlier.
It’s been documented that placebos do have a positive effect in people suffering seasickness. Is it just the power of the mind?
PROF: I think the placebo effect here is the same level of mystery as the placebo effect anywhere. There are many sorts of medical treatment or medication, or whatever, that is associated with placebo effects and I think you hit the nail right on the head. That there is power of the mind there. It certainly is the case, that it’s very well known and well documented in motion sickness that there are psychological factors. The psychological factors are not the sort of basic cause or the root cause, but there are psychological factors.
It’s very well documented that if you’re with someone else and that other person gets sick, that that increases the chance that you will get sick. Even if you didn’t feel sick before. It’s called Behavioural Contagion and it certainly is the case that various activities that you can engage in will increase or decrease the chances of sickness.
Reading: very bad. Don’t read. Again, I get these requests from people all the time and my advice is always the same – go up on deck, look at the horizon, sit down on a deckchair, use the headrest. Do not under any circumstances whatsoever read a book and especially do not look at any digital device whatsoever. Do not look at an iPad. Do not look at a phone. Do not look at a computer. Do not look at anything that is electronic. Just absolutely don’t do that. That’s just asking for trouble.
The one thing that I recommend, you know, if people are bored – sitting up on deck can get a little old – if people are bored, what I very strongly recommend is using a pair of headphones or earbuds and listening to whatever the heck you want. Listen to music, listen to a book, listen to whatever you like. Just do it with headphones or earbuds and that’ll help.
LINDSAY: That’s a good point. Everybody’s pretty well connected with electronic devices but you don’t want to be reading them, but it’s okay to listen to whatever you like to listen to. That’s a very good point. I hadn’t heard that one before.
I do understand where you’re coming from when it comes to looking at computer screens. The one time that I was seasick without being influenced by alcohol the night before, was when we were going around the top end of New Zealand where the Tasman Sea and the Pacific Ocean meet – it’s very confused water. I was on the hydrographic survey ship Takapu and we’d had a new computer system installed with a truck seat that had suspension in it, and I was just sitting there trying to monitor the hydrographic systems on this computer screen and I thought “I’m gonna be sick.” Walked out to the bridge ring and threw up and felt better.
Something that quite often happens when people are sick, they often feel better for a little while.
PROF: Yes. This really highlights a serious problem with the Navy and with merchant marine. Crews are getting smaller and the work of the crew is changing. Back in the old days the work of the crew was physical labour and now the work of the crew is sitting at a chair looking at a computer screen. You have fewer people on the ship and those people are more likely to get sick. Which is not a good combination.
LINDSAY: That’s interesting. Now you talked a little bit about before about simulators and how people operating simulators can get sick. That surprised me as well. Is that because the simulators are sophisticated enough to be on hydraulics and the actual platform is moving?
PROF: No. You do not need physical motion for a simulator to make you sick. Driving video games make people sick and a driving video game is just an inexpensive automobile simulator. Basically any simulator that provides a hi fidelity simulation of motion of the user, motion of the driver, motion of the pilot, motion of the whatever – any hi fidelity simulation of you moving through the world has the capacity to make you sick.
LINDSAY: Gamers have got an interest in this as well.
PROF: Yes they do. They absolutely do.
LINDSAY: Well this has been an absolutely intriguing conversation. You’ve taught me some new stuff and put to bed some of the things that I’ve been telling my crews in the past, that weren’t necessarily true.
If people want to learn some more about your work on seasickness, where about can they go to read what you’ve done, some of the research that you’ve done?
PROF: All of this stuff is published in the public domain and it’s available. Some of the research has been published in journals that are free to the public. That stuff can simply be googled and downloaded. Other stuff you have to have library access through a University or something like that. Certainly I can send you a couple of articles that are publicly available and you can make them available to your readers if you want.
LINDSAY: Ah that would be very good. Yeah, we’ll put some links on my blog and hopefully that’ll help people just learn a little bit more. Educate themselves. It’s been very interesting talking to you Professor Stoffregen. I really appreciate your time. Is there anything else that you’d like to add?
PROF: I think the final thing I would say is to point out that there is a sex difference involved here. Pretty much always and everywhere. I’m choosing my words carefully, pretty much always and everywhere women are more susceptible to motion sickness than men. This is utterly uncontroversial, it’s totally well documented and it has been mysterious for a very long time.
How do you explain something like that? And the issue is getting more and more serious because it keeps coming up in these new technologies. As we make better simulators, as we make better computers, as we make better video games, the same sex difference keeps showing up and in fact there’s some evidence that it’s worse. There’s some evidence that women’s susceptibility is greater in virtual environments than it is in places like seasickness. This is a real problem. It’s a problem that seems to be growing and it’s one that could have social consequences.
LINDSAY: Yeah, that’s often the way that it’s the men that want to go to sea and cruise around the world in a family yacht, and the wives do get seasick. I’ve got an interview with my wife about it and she’s a very tough lady, and it’s interesting to see how they cope. Not necessarily a reason not to go to sea because it’s not permanent – all seasickness, you said earlier is something that the body will adapt to.
LINDSAY: It’s just a matter of time and patience and being organised to ride out that nasty period.
PROF: Well, as far as I’m concerned, it’s a matter of having a cruise that’s long enough that when you get over it you can still have time to have fun. A three day cruise is a waste of time. Give me two weeks!
LINDSAY: That’s very good advice. I agree with that. And it’s a proper holiday if you get away for a good couple of weeks.
Although seasickness is a nasty thing, it’s not a good reason not to go out and enjoy the sea.
PROF: I agree.
LINDSAY: Well, once again, I really, really enjoyed talking to you. I’ve learnt some new stuff and thank you very much for your time. I know you’re busy.
PROF: It’s my pleasure. I’m happy to talk with you and I’ll use your email and send you a couple of these articles.
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