Vestibular disease
Travel sickness and cyber sickness
This information is intended as a general introduction to this topic. As everyone is affected differently by balance and dizziness problems, you should speak to your doctor for individual advice.
For reasons of better readability, the generic masculine is used and the simultaneous use of the language forms male, female and diverse (m/f/d) is dispensed with. Unless otherwise indicated, the personal designations used in this patient information refer to all genders.
What is motion sickness and what is cyber sickness?
What is motion sickness?
Motion sickness is nausea or discomfort that occurs as soon as you are exposed to certain movements, such as when traveling on a boat, car or plane. Motion sickness is also very common in space travel. The nausea and discomfort can last for several hours after the movement has stopped.
Some people only have mild symptoms, but others suffer from severe symptoms that can seriously affect their lives. In rare cases, motion sickness can cause vomiting so severe that it leads to dehydration.
Not everyone gets motion sickness, but almost everyone can if the motion is strong enough. However, some people are more susceptible to motion sickness, including women and children under the age of 12. There is evidence that motion sickness is more common in the middle of the menstrual cycle. People with other conditions that cause nausea, such as early pregnancy, migraines and vestibular disorders, are also prone to motion sickness.
Motion sickness is less common in children under the age of 2 and people over the age of 50. People without a functioning vestibular system cannot suffer from motion sickness.
In some people, the symptoms of rocking or swaying continue for a month or longer after they have been exposed to movement. They suffer from a rare condition called mal de débarquement syndrome (MdDS). The main characteristic is the opposite of motion sickness: symptoms usually improve when the person is exposed to passive motion, for example in a moving car.
What is cyber illness?
Cyber sickness is nausea or discomfort triggered by viewing moving digital content on devices such as smartphones, tablets, computers and virtual reality (VR) devices. It is similar to motion sickness, with the difference that the triggering "movement" is virtual and not real. For example, if you scroll quickly on a smartphone, you see a movement, but you don't feel it. As with motion sickness, the symptoms of cybersickness can persist for several hours after the digital session has ended. Cyber sickness is a subtype of visually induced dizziness. It is also known as digital motion sickness.
People who are more sensitive to visual motion signals are more likely to be affected by cybersickness. If someone is prone to motion sickness, there is a good chance that they may also suffer from cybersickness. Cyber sickness is more common in people who have had a concussion, vestibular disorder, migraine or fainting (syncope).
A recent study suggests that changes in the visual and vestibular cortical network (outer layer of the top part of the brain) increase the likelihood of developing cybersickness.
Between 40-70% of people suffer from cybersickness when using VR.
Cyber illness affects people of all ages. It is still unclear whether gender plays a role. Researchers disagree on whether or not there are gender-specific differences in susceptibility to cybersickness.
Some researchers and health experts suspect that people with anxiety or personality traits such as perfectionism and ambition are more susceptible to cybersickness. So far, however, there is no scientific evidence for this.
Summary
- Motion sickness is caused by being in a moving vehicle.
- Cyber sickness is triggered by viewing moving content on digital devices.
- In both cases, nausea or discomfort occurs.
- The symptoms usually disappear within a few hours after the exercise or digital session has ended.
- It can be caused by a sensory mismatch or a contradiction between the signals that the vestibular system sends to the brain.
- If situations that trigger nausea or discomfort are unavoidable, various strategies can reduce the symptoms.
- Vestibular rehabilitation can help your brain get used to the factors that trigger these symptoms.
- Some medications can help prevent or treat motion sickness. They work best if they are taken in advance.
What causes travel sickness and cyber sickness?
The brain's balance system combines information from many sources, including:
- the vestibular system (the semicircular canals and macula organs in the inner ear), which perceives head tilt, rotation and changes in speed
- the visual system that lets you see
- the proprioceptive system, which sends signals about position, pressure, movement and vibration from the legs and feet and the rest of the body
The most common theory is that both motion sickness and cybersickness are caused by a sensory mismatch or contradiction between the signals that the vestibular system sends to the brain. These signals can also clash with the brain's expectations (known as the internal model of motion). For example, when you are riding in a car:
- The vestibular system signals that you are moving
- The proprioceptive system signals that you are sitting still
- The visual system can receive different signals depending on what you are looking at. For example, if you are trying to read or looking at your cell phone, your visual system will report that you are not moving.
- If you're not the driver, you don't know exactly when you're slowing down, speeding up or turning off. Motion sickness could therefore become even more of a problem in self-driving cars.
The situation is similar when you observe movements via a VR headset: Your visual system perceives movement, but your vestibular and proprioceptive systems do not. This can lead to a mismatch or contradiction between the different structures of the brain's balance system, similar to visually induced vertigo. It is caused by a mismatch or contradiction between the different parts of the brain's vestibular system, similar to motion sickness.
Some VR simulations are more likely to trigger cybersickness than others because the simulated movements are more extreme.
The main symptom of motion sickness and cyber sickness is nausea. However, before the nausea occurs, many people experience other symptoms, such as
- Feeling of stomach fullness
- Heartburn
- Headache
- Salivation
- Urge to urinate
- General malaise
- Drowsiness or tiredness (fatigue)
- Irritability or restlessness
- Belching
- Yawn
- Cold sweat
- Turn pale
- Blush
- Feeling of warmth
- Rotational vertigo
- Dizziness without rotation
- Feeling wobbly, unbalanced or unstable
In the most severe cases, people with motion sickness or cyber sickness vomit. Some people can also be completely incapacitated, but this is very rare.
Diagnosis of motion sickness and cyber sickness
Usually, the symptoms of motion sickness and cyber sickness disappear within a few hours after you stop moving or using an electronic device. If symptoms persist for days or are very severe, you should see a GP to rule out other illnesses. People with chronic or severe symptoms may be referred to a specialist, such as a neuro-otologist.
Prevention and treatment of travel sickness and cyber sickness
Prevention and treatment of motion sickness
When travel sickness occurs acutely, it is difficult to treat. It is therefore better to take preventative action. It is important to know what situations trigger motion sickness in you and to avoid them if possible. If this is not possible, there are other measures that can help to prevent or alleviate the symptoms.
Many factors can aggravate motion sickness, e.g:
- Stronger and unpredictable movements: For example, a ride in a car on a bumpy, curvy road is usually worse than a train ride.
- Reading, looking at the phone or other activities where the gaze is focused on something nearby.
- The absence of a visible horizon, for example in fog or when you are not near a window.
- An empty stomach.
- Unpleasant odors.
Reduce movements as much as possible
Avoid awkward movements as much as possible. For example:
- Try to avoid routes with lots of bends and differences in altitude
- Avoid boat trips when it is stormy or when there are strong waves
Sit where there is the least movement
Try to sit where there is the least amount of vertical (up and down) and rotational (twisting or swaying) movement:
- Sit in the front passenger seat in the car. If you have to sit in the back seat, lie down.
- If possible, sit in a row in the middle of the plane (above the wing).
- Sit in a boat close to the surface of the water and facing the waves. Do not sit forward (towards the bow) as this is often the bumpiest part.
- Seats in the front of the bus, with a view to the front and on the lower level (in the double-decker).
- Sit in the train facing forward, on the lower level (in the double-decker).
Get used to the movement slowly
If you have a long journey ahead of you, it can be helpful to take shorter trips with breaks to get used to the exercise. For example, you could spend a few hours on board a ship and see how you feel before you go on a cruise.
Move in step with the movement
Active movement of your body can help against motion sickness. If possible, try the following:
- Tilt your head in curves
- Imitate the movements of the driver
- Stand with your legs bent and move with the movement of the vehicle or boat, do not sit stiffly
- Walk around
- If it is not possible to move, support your body and head to avoid additional movement.
- If you can, lie down as flat as possible.
Make sure you have a view
Looking at the horizon can help with motion sickness:
- Avoid rooms without windows or where you cannot see the horizon.
- Don't read, don't look at your cell phone and don't do anything that draws your gaze nearby
- Look forward in the direction of travel
- Focus on a distant point on the horizon and keep a wide view
- If you can't see the horizon, close your eyes or wear sunglasses.
Make yourself as comfortable as possible
Physical, mental and emotional discomfort can make motion sickness worse. Try to make yourself as comfortable as possible and adopt a positive attitude:
- Do not drink alcohol
- Drink enough water to stay hydrated
- Eat light, low-fat and low-acid meals and snacks, such as bananas, crackers or apple sauce, frequently
- Rest well before your trip
- Try to sleep
- Make sure the room is well ventilated and does not smell bad
- Try not to think or talk about motion sickness
- Distract yourself with music, breathing exercises or other relaxation techniques
- Cognitive behavioral therapy can also be helpful
Vestibular rehabilitation
Vestibular rehabilitation is an exercise therapy. It can help people with vestibular disorders who suffer from motion sickness. Its goal is to get your brain used to the signals that trigger motion sickness. A certified IVRT® Dizziness and Vestibular Therapist can help you set treatment goals and create an appropriate program.
Medication and other treatments
Some medications can help to alleviate or treat motion sickness. They work best if you take them before you get the first symptoms. The most common medications for motion sickness are:
- Transdermal scopolamine patches: Stick the patch behind one ear at least 4 hours before traveling. Each patch lasts for 72 hours (3 days). It may cause drowsiness in some people.
- Anti-nausea medications such as dimenhydrinate: These are available in various forms, including capsules, chewable tablets and suppositories. Check the dosage instructions for the product you are taking. These medications can cause drowsiness, so you should not drive or operate heavy machinery while taking them.
Tell your pharmacist if you are taking any other medication or if you have any medical conditions, especially glaucoma. If you have never taken motion sickness medication before, you should try it at home to see how it affects you.
If you smoke, temporarily quitting smoking can reduce motion sickness.
Alternative therapies such as acupressure wristbands are found to be helpful by some people, although their effectiveness has not been proven. Glasses for motion sickness may be helpful, but more scientific research is needed to confirm their effectiveness.
Prevention and treatment of cyber illness
Little is known about the prevention of cyber sickness, but it is being actively researched. The best way to treat cyber sickness at the moment is to stop using the computer or VR device when you feel the first symptoms.
If you use a computer at work or school, some of these coping strategies can help minimize your symptoms:
- Adjust your head position and viewing angle.
- Increase the distance between your eyes and the screen.
- Reduce eye strain by using modern flicker-free monitors. These use direct current modulation instead of pulse width modulation (PWM) to control the brightness.
- Experiment with lower light settings on the screen. If you are using an older monitor, this may not help.
- Reduce the screen contrast.
- Increase the font size.
- Use the arrow keys instead of the mouse to reduce the scrolling speed. This slows down the speed at which your eyes are exposed to the movements on the screen.
- Reduce the scroll speed of your mouse.
- Turn off notifications and pop-ups on the screen to minimize distracting movements.
- Follow your fingers when you swipe on a touchscreen.
- Take short breaks to close your eyes. Alternatively, you can look away from the screen and focus on a fixed point in the distance / a simple background.
- Switch between tasks on screen and paper throughout the day.
- Print out documents and, if possible, read printed books.
- If possible, take part in telephone conferences instead of video conferences.
- Breathe deeply and in a controlled manner. This simple step increases your oxygen intake and can help reduce dizziness.
Some studies have found that cybersickness can be exacerbated if the VR headset does not fit well, i.e. if the distance between the lenses is too large for the person's eyes. This is more often a problem for women, who tend to be smaller than men. Proper adjustment of the glasses can help reduce cybersickness.
Vestibular rehabilitation therapy for cyber illness
Vestibular rehabilitation therapy can help with chronic cyber illness. The therapy involves looking at images that trigger the symptoms repeatedly and in a controlled manner. By doing this over and over again, your brain learns to process these visual signals correctly. Over time, your brain becomes accustomed to these stimuli and does not perceive the conflicting signals (eyes moving even though the body is not moving) as a threat. A certified IVRT® Dizziness and Vestibular Therapist can help you create treatment goals and an appropriate exercise program.
What happens next?
What you can expect in the future.
Travel sickness and cyber sickness in particular are active areas of research. Software developers continue to work on ways to eliminate or reduce the effects of cyber sickness. Scientists are investigating what causes motion sickness and cybersickness and how to predict who will be affected and what treatments will be effective.
In order to keep this patient information as short as possible, we have not included a detailed list of references. However, this can be requested at any time at info@ivrt.de.
