Barf: a short and sometimes personal dissertation on airsickness

My earliest memory of car rides over the hill and through the woods (actually, north Texas cedar breaks) to Grandma’s house was of leaning out the car window to barf due to motion sickness. After a few such episodes, I always got the “shotgun” (front) seat, as that helped keep my lunch safely in place. My earliest memories of riding in Dad’s friend’s Cessna 170 on hot West Texas summer days are similar. Mr. Husky seemed to enjoy showing off what passed for a lake southeast of town by repeated steep-turn circles over it, with me in the deep pit back seat. Then there was the late-summer-day, dehydrated/hungry glider ride, including tight circling in the meager thermal over a pig farm… Need I say more?

Did things get better when I grew up? Only a bit. I have never been able to read during car trips, becoming queasy after only a few minutes. As it happened, my career required frequent airline travel, and I suffered motion sickness while taxiing, in cruise, on descent, and after landing. Only stewardesses – sorry, cabin attendants – of a certain age could tell of how much they disliked my presence on an airliner. Dramamine and I became good buddies, and I regarded the designer of reclining airliner seatbacks as a hero.

Airsickness
It happens to the best of us.

On one trip, sitting first row in first class, my seatmate insisted on a long conversation while turbulence made me increasingly ill. When I told him I was getting a bit sick, he launched into a long and colorful story about spectacular airsickness episodes as we bumped and ground down the final approach. Some people are so helpful! When the stomach pressure was about to explode, I bolted for the nearby lav; when the shocked stewardess tried to stop me, I said, “You’ll be happy I got up,” and she would have been. (Of course, if I tried that these days, I’d be tackled by her and nearby passengers and beaten to a pulp as a terrorist!)

Then there were boats: I could get nauseated just sitting in a docked boat rocked by a passing cruiser.

A passing anecdote: one day my dad called my brother to go flying on a warm West Texas day. On the way to the airport, they decided to stop off for a big Tex-Mex lunch of enchiladas, beans, chili, the whole bit. Big mistake. Once aloft and on their way somewhere, turbulence began to make them both airsick. They turned for home, and all the way back, argued over who needed to take the stick to keep from soiling the rented Cessna’s interior. So I wasn’t the only one in our family affected!

When we read about the pre-WWII Golden Age of Aviation, there is little mention of airsickness. Photos show men in suits with tightly buttoned collars and suits, and women in corsets, heels, hats, and stylish dresses. Just the thought of flying in such garb makes my stomach roil and my hand reach to unbutton an imaginary collar.

DC-3 stewardess
It wasn’t as glamorous as it looks – plenty of them were barfing too.

How, then, did this weak-stomached retcher become a pilot? I have told a big part of the story before, but there is more. On a particularly miserable airline flight, I realized that part of my intolerance for flying resulted from ignorance of what was going on. I had developed a kind of generic unease or fearfulness about flying that exaggerated my lifelong motion sickness. It seemed to me that learning more about airplanes would help. It was reassuring that even the great Bob Hoover had to conquer airsickness during his primary training.

All this coincided with my father’s death and a period of reflection and reaction, which included dealing with the motion sickness problem.

Having watched many an airshow and movie about WWII and later air combat, I have often wondered how the airmen tolerated the +/- g-forces, twisting maneuvers, inverted flight, and constant head-turning required. Turns out even our aerobatic and combat heroes are not immune to motion sickness. A report prepared by the American Society of Aerospace Specialists for the Aerospace Medical Association (ASAMA) to provide clinical guidelines for diagnosis and management of motion sickness states that more than 75% of troops become airsick “under extreme conditions.”

Of military primary flight students, 63% reported airsickness on the first flight, and only 15-30% claimed never to have gotten sick during training. For unknown reasons, the incidence of airsickness is reportedly twice as likely for women as for men; for both sexes, the incidence decreases with age. The report says, believably, that airsickness “can be induced in anyone with an intact vestibular system given the right type and duration of provocative stimuli.” It’s no surprise that the good doctors say the effects of airsickness “can range from distraction to near-incapacitation.” I’ll second that.

F-22 on afterburner
Even the fighter jocks get sick sometimes.

There is good news in the military experience; repeated exposure to the aerial environment and sometimes specific “desensitization” treatments in a lab can relieve airsickness in up to 85% of cases. From 1955 through 2001, 365 USAF crew members (not necessarily all pilots) were referred for evaluation of airsickness, and 199 (~55%) returned to flying status. It’s not clear to me what treatments the successful ones might have gotten.

The ASAMA report describes the USAF recommendations for prevention of airsickness, and they make sense to me, having used most of them myself:

  • Avoid high-fat meals before flight
  • Maintain adequate hydration
  • Limit head motion during flight [in combat???]
  • Watch the horizon [in combat???]
  • Blow cool air on the face
  • Slow diaphragmatic breathing

For me, being well-hydrated, not recently fed, and having cool air blown on my face are very effective measures.

Motion sickness scent
If it works, use it.

There are some medications effective in reducing the occurrence or severity of motion sickness. The two most effective and best known are promethazine and scopalamine, but unfortunately, their sedating properties make them illegal for pilots. Other medicine and physical measures lack firm scientific data to support their use, but hey, I won’t argue with apparent success for those who favor them.

It’s possible to predict who is at highest risk of airsickness, which is especially common in those who are anxious at the time of flight. A study reported in the Journal of Aviation/Aerospace Medicine found that among civilian primary flight students flight-day anxiety was predicted by insomnia the previous night, fatigue, urinary frequency (!), and “apprehension.”

Looking back at my own motion sickness issues in aircraft, I believe a big factor was my ignorance about and generic fear of flying. On airliners, I used to react with concern to various sounds – sudden power reductions, pitch changes, sounds of flap motors and landing gear deployment, panels slamming shut, etc. My flight ground school began demystifying some of these things, and remarkably, I never got airsick during my student flights. As my dad and brother found, having one’s hand on the stick is good treatment for airsickness! The more I learned about aircraft and how they work, the more fascinating they became; it became an airline trip game to feel and hear the changes that used to concern me— even to predict them and explain them to concerned fellow passengers. From the time I began my private pilot training, I never again had more than occasional queasiness on an airliner, even in heavy turbulence.

Motion sickness is partly in the inner ear, but also in the brain and the mind.

I have tried online to find information about airsickness in early aviation, with limited success. One online history article merely says, about the DC-3 era, “The airlines wanted to fly higher, to get above the air turbulence and storms common at lower altitudes. Motion sickness was a problem for many airline passengers, and an inhibiting factor to the industry’s growth.” Having bumped along at low altitudes in light GA aircraft and a DC-3, I can easily imagine the “inhibition.” If any readers come across contemporary publications about airsickness, I’d very much like to have the information.

My experience in giving rides to non-aviators suggests that the pilot can do a lot to reduce the risk of airsickness among naive passengers. My rules have been to give rides only in calm air, preferably late day (with the benefit of distractingly beautiful sunsets and city lights coming up); explain everything in advance; keep up a calm chatter when ATC permits; not banking more than 20 degrees, and even then with explanations and advance notice; keeping an eye on the passenger’s facial expression and body language; and keeping a first flight short, usually 15-20 minutes. I’d be interested to hear others’ experiences, preventative measures, and methods for cleaning up an aircraft interior after a real Barf-O-Rama!

9 Comments

  • Nice piece. The first literary reference to motion sickness dates back to Hippocrates. In my extensive research on early aviation, though, I can’t recall anyone admitting they blew chow. In fact, the first instance I found comes from “Yeager,” where Chuck cops to upchucking in 1942, during his first few training flights. The same year instructors reported that 11 percent of their students chundered. Why nothing during the first decade of flight? The average pilot logged only three hours of training before they soloed, and that was merely learning to take off and land; most pilots learned to fly solo [so no one was in the cockpit to ridicule them], the quickest method of curing airsickness is to fly the airplane yourself; and airplanes were simply too fragile to fly in less than calm weather. Transport pilots in the ’20s and ’30s, though, record passengers opening a window to toss cookies, and splattering a passenger behind them engaged in the same activity.

  • Phil, thanks. I was sure there had to be some information about airsickness in early aviation. I had not thought about the very early flyers and why they didn’t report motion sickness, but your explanation is perfectly sensible. Perhaps there are preserved diaries of early aviators that might, so to speak, spill the beans on this subject.

  • And for all these years, I thought I was the only pilot who used to get sick as a student. Not really, I just never found any who could write as well as Hunter. Nicely done!

    In my early days as a student pilot, on hot, humid, and bumpy days in the pattern or doing airwork, I could make it for about 45 minutes or so. As I progressed a felt more comfortable, I got to the point where I’d rarely feel ill, even in the most turbulent weather. Even today, put me in the back of nearly any airplane in the right conditions and I’ll get motion-sick. Same goes for boating or anything that moves.

    As for being PIC, I no longer get motion sickness. I think it has something to do with being in control and the adrenaline that accompanies flying through and around turbulence. As I’ve told my wife who knows that I can get bad cases of motion sickness: “When I’m doing the flying, I’m too busy to get sick!”

  • So good to read, thanks for the honest sharing. Nearly 30 years ago a kind pilot at Robert’s Aviation in Palmer, MA (now long gone – the airport is condos now) saw me hanging around the airport all the time, and extended some friendship to me, allowing me to ride along on his weekly document deliveries to Boston, MA. He even let me take the controls (once we were in straight & level flight, all trimmed up). But one trip I had to ride in the back because he was giving a lift to a friend. Without the clear line-of-sight to the horizon, and the fact it was a fairly hot day, I felt myself starting to get a bit green around the gills. I asked if there was any way to get some air back there. Nope. I opened my mouth to apologize… and the apology was summarily knocked aside. To make matters worse, he had just had his interior redone the previous week. And he had no air sickness bag. I apologized incessantly and nearly ran to my car. My embarrassment was so complete, I unfortunately never showed my face there again – I felt like I was a complete failure as a potential pilot. Fast-forward 30+ years and after several commercial flights with some of the most spectacular cloudscapes I ever saw, I decided to go for my pilots license. While I’m only a few hours in, the fact that I nearly always have some horizon reference, combined with the fact that motion sickness does seem to have faded with age, has made it so that my flights are a joy now. I’m very glad I decided to try again. I wish, though, that I could find Bob from Robert’s and apologize. I hope he got the smell out of his carpet…

  • Fine article, and after 22 years of airshows in fast jets, been there, done that, and all of your cures work, ie. fly the airplane. Worst days were airshows with temps in the 90’s, high humidity, and a tight timeline that tolerated little relaxation prior to saddling up. However, once airborne and in the fight to execute your maneuvers and keep the aircraft out of the dirt, all was good.

    best, always

    BIG DOG

    • Big Dog, thanks for the endorsement from the Real World of aerobatics. I have always marveled at the ability of airshow performers to do their jobs in the usual heat and humidity of midwestern events, esp. the steamy, bumpy, high-pressure days at Oshkosh. As I wrote, airsickness is based partly in physiology, and partly in psychology– hand on the stick solves all!

      • Yep, you are so right Hunter, and your article was spot on. Acclamation of the inner ear to acro usually takes time, and seems to be a learned experience especially when you are in sustained pulls of +5-6 Gs as you work your way through your routine at 400 kts. FYI, first few airshows I flew I ended real close to chunking, but loved the acro more so stayed in the fight, and conquered the inner ear war.

        FYI, have gone stupid a few times, flying with bad head congestion, and ended up with severe vertigo in the middle of the airshow routine which is terrifying. However, you go directly to your instruments, re-cage the inner ear, and finish. Then you don’t fly again until the T-33 AND you are Code 1. Common sense goes a long way! Attached is the airshow website that I have not taken down yet for your perusal: http://www.vintage-thunderbird.com

        Again, truly enjoyed your article, and from the responses I have seen a lot of other folks have too!

        best, always

        BIG DOG

  • Big Dog, thanks for the website link. Big difference between your show and one done in a J-3! Your description of the acclimatization process only increases my respect for pro airshow pilots. I take it you are retired from the show circuit now, but hope you are still flying something for fun, and not “chunking.”

Leave a Reply

Your email address will not be published. Required fields are marked *