One of my enduring (thus far) disappointments with my flying has been that when I bought my RV-6 fifteen years ago, one of my ambitions and aspirations was to use it as a platform to tour Australia with my partner, so we could share what this amazing continent has to offer with each other. But that's never really come to pass: She's suffered airsickness from the get-go. So attaining those ambitions and aspirations has required conquering nausea first.
Yes, I said fifteen years. We've both needed a lot of patience. I remain astonished that she didn't pull the pin on this unpleasantness years ago.
I know a lot of other people struggle with this, so I'm writing a detailed account here to say, "Persistence, gentleness, understanding and patience can pay off." If a loved one doesn't want to fly due to airsickness, you can't force them to get better, but you can hold their hand and support them and if you're both determined you'll get there in the end.
The disaster
In January 2014, we embarked on a 50 minute flight to Canberra for a long weekend. During that flight, she started throwing up at the top of final, and kept throwing up, over and over, long past the point of empying her stomach. It seemed nothing was going to stop it as she dry-retched into the bag while we were taxiing to parking. She calmed down on the ramp after engine shutdown, and the experience left her so exhausted that she needed my help to exit the cockpit and had to sit down on the concrete next to the plane for ten minutes to recover before she was ready to walk off.
That traumatic experience poisoned any further effort at travel. That was the last time she flew in the RV more than about fifteen minutes radius from Bankstown Airport.
What is airsickness?
"Airsickness" is a bit like "respiratory illness" or "cancer" or "hay fever," in that it doesn't have a single cause. It's a syndrome that can be triggered from any number of conditions, each with their own set of causes and remedies. This is one of the major reasons why products marketed as "motion sickness tablets" don't work universally: They might be attacking a cause which isn't actually present in the individual receiving the dose.
There are well known physiological causes, such as vestibular/vision mismatches ("just keep looking at the horizon") and dehydration ("if you're feeling thirsty, it's probably already too late. Keep sipping water throughout the day.")
But there are also emotional/psychological causes which, to me, are far more insidious. They don't respond to any of the usual remedies, unless via a placebo effect. Much more difficult to treat.
Emotional responses
In my partner's case, we spent quite a while going through the usual selection of remedies before we both concluded that her nausea was likely a response to a psychological trigger, rather than anything physiological.
The "tell" for me was that she always puked about 40 seconds before touchdown, early final approach, regardless of how long or how short the flight was.
The usual progression was that she'd start out after takeoff with, "This is fine, I'm not feeling sick at all!" Happy days.
Then, some time later: "I don't think I'll be sick this time."
Then, later: "I'm not feeling sick yet."
Still later: "I might be getting a bit nauseous. Can we go back soon?"
Then: "How much longer? I'm feeling sick." (reaching for the bag)
Then on final: All further control lost, filling the bag.
My hypothesis was that that she was having an anxiety reaction to the prospect of being airsick, which was powerful enough to become a self-fulfilling prophecy.
She spent a while not wanting to believe that it was "all in her head," but had a bit of a breakthrough when we were out one afternoon when it was a bit choppy, and she reflected afterwards that the sensation was just like being on one of the Sydney Harbour ferries when the sea is a bit rough, "... and I love that sensation," so if it feels the same it should have the same outcome, right? The fact that she never gets sick on airliners played into the epiphany too.
Self-talk
Accepting that there was an emotional/psychological component to her airsickness put her into exploration mode, and she started reading self-help books about neuroplasticity and cognitive behavioral therapy. There's a lot of dreck out there (airport books, right?) but she gained enough nuggets of truth to give us some things to try.
First step: Consciously recognizing anxiety responses: Heart rate increasing, skin getting clammy from sweat, breathing becoming shallower and faster, "tight feeling" in her chest. Recognizable signs of fear and anxiety in all of us. Training herself to recognize her own condition enabled her to say, "Okay, I know I'm feeling like this, but are there any other ways I can feel instead?"
She built on her previous realization about the ferries: When she recognized signs of anxiety, she'd close her eyes and consciously visualize being on board a vessel in high seas. She found that helped a bit: The anxiety symptoms didn't dissipate, but they didn't get worse. But she can't fly around with her eyes closed all the time, right?
She tried bringing photos with her, depicting calm and relaxing settings: Mountain valleys in Switzerland, garden scenes, puppies and kittens, sunsets. Made a little flip-book of nice things to look at, which she could use to mentally relocate herself into the photo when fear physiology asserted itself. That helped a lot.
She tried self-talk: Personalizing the anxiety, visualizing it as a person knocking and trying to enter. "Not right now, Sir, I'm busy. Maybe come back later and I'll deal with you then." Can't eliminate the emotional response to fear, but you can negotiate with it.
We tried working on it together. Vagus nerve, amygdala response. Standing close together face-to-face and focusing on synchronizing breathing, deep and fast inhale, slow and measured exhale. I'm comfortable at 3 breaths per minute, 5 seconds in and 15 seconds out. Synchronizing with that demands focus from her, which removes focus from the source of anxiety. "If I'm afraid and when it's gone the only thing that's changed is how I'm breathing, was it really that important to begin with?"
Fear is the "fight, flight or freeze" reaction that kept us safe on the savannah from prehistoric predators. It's a useful emotion, but only when there's an active threat you weren't previously aware of. Outside that limited arena, it does very little for us, and if we have the resiliency skills to manage it we can make it go away.
She's spent more than a decade acquiring those skills.
This weekend
Yesterday we launched from Bankstown to go to lunch at Cessnock in the Hunter Valley, about 30 minutes flying time North of Sydney, in one of our wine-growing regions.
She'd been spending time with me at the hangar in the weeks leading up to the trip. Once she trained herself to recognize anxiety, she realized that she felt it every time she was in the vicinity of the airplane, so she's been coming with me to the airport as a form of exposure treatment. Sometimes we've taken local scenic flights -- more exposure. But sometimes we've just swept out the hangar, or she's read a book and nibbled snacks from one of the armchairs while I've been doing maintenance. So now she's comfortable being around the plane.
Once our occasional local scenic flights reached half an hour, that broke a kind of barrier, because Cessnock is half an hour away, and if she can fly laps of the Sydney area for 30 minutes without being sick there's no reason why she can't go in straight lines without being sick too, right?
So once we reached that threshold, she started looking for lunch dates on the calendar.
Early yesterday afternoon, I started us up and taxied out, departing Bankstown VFR via Parramatta for Cessnock. It was a pretty uneventful flight in smooth air, terminating on Runway 35 at YCNK. Walked over to the Lovedale Pub and got lunch, which we ate next to the pool.
Met up with Matilda, a local Freedom Formation member, for a pre-departure chat, then launched homeward. She was asleep by the time we reached Warnervale, woke up again on descent near Prospect.
A successful day: First time she's flown with me outside the Sydney city limits since January 2014. She didn't even mention airsickness.
The aftermath
Well, she wants more.
We'll do a $100 hamburger run to Scone at some point in the next month or so. That's about 45 minutes away, 50% further than Cessnock.
If she's good with that, maybe dropping in on Moruya. Later: Merimbula.
Or maybe just some consolidation, where we make sure we're comfortable with where we're at and don't stress-out over "stretch goals." Whatever matches the mood. If it's a psychological stress reaction, we're not going to add stress, right?
We now know that there's a pathway from a 30 min flight to a 120 min flight, and if we reach that we can fly just about anywhere in the country in 2 hour legs. I know now that if I say, "Swan Hill is 3 hours away," her heart will race unpleasantly; But we both know that it did the same thing last year if we talked about any flying whatsoever, so that's manageable now.
Light at the end of the tunnel. That's good enough for me. It's taken 15 years to get to this point, we'll be touring the country in no time.
- mark
Yes, I said fifteen years. We've both needed a lot of patience. I remain astonished that she didn't pull the pin on this unpleasantness years ago.
I know a lot of other people struggle with this, so I'm writing a detailed account here to say, "Persistence, gentleness, understanding and patience can pay off." If a loved one doesn't want to fly due to airsickness, you can't force them to get better, but you can hold their hand and support them and if you're both determined you'll get there in the end.
The disaster
In January 2014, we embarked on a 50 minute flight to Canberra for a long weekend. During that flight, she started throwing up at the top of final, and kept throwing up, over and over, long past the point of empying her stomach. It seemed nothing was going to stop it as she dry-retched into the bag while we were taxiing to parking. She calmed down on the ramp after engine shutdown, and the experience left her so exhausted that she needed my help to exit the cockpit and had to sit down on the concrete next to the plane for ten minutes to recover before she was ready to walk off.
That traumatic experience poisoned any further effort at travel. That was the last time she flew in the RV more than about fifteen minutes radius from Bankstown Airport.
What is airsickness?
"Airsickness" is a bit like "respiratory illness" or "cancer" or "hay fever," in that it doesn't have a single cause. It's a syndrome that can be triggered from any number of conditions, each with their own set of causes and remedies. This is one of the major reasons why products marketed as "motion sickness tablets" don't work universally: They might be attacking a cause which isn't actually present in the individual receiving the dose.
There are well known physiological causes, such as vestibular/vision mismatches ("just keep looking at the horizon") and dehydration ("if you're feeling thirsty, it's probably already too late. Keep sipping water throughout the day.")
But there are also emotional/psychological causes which, to me, are far more insidious. They don't respond to any of the usual remedies, unless via a placebo effect. Much more difficult to treat.
Emotional responses
In my partner's case, we spent quite a while going through the usual selection of remedies before we both concluded that her nausea was likely a response to a psychological trigger, rather than anything physiological.
The "tell" for me was that she always puked about 40 seconds before touchdown, early final approach, regardless of how long or how short the flight was.
The usual progression was that she'd start out after takeoff with, "This is fine, I'm not feeling sick at all!" Happy days.
Then, some time later: "I don't think I'll be sick this time."
Then, later: "I'm not feeling sick yet."
Still later: "I might be getting a bit nauseous. Can we go back soon?"
Then: "How much longer? I'm feeling sick." (reaching for the bag)
Then on final: All further control lost, filling the bag.
My hypothesis was that that she was having an anxiety reaction to the prospect of being airsick, which was powerful enough to become a self-fulfilling prophecy.
She spent a while not wanting to believe that it was "all in her head," but had a bit of a breakthrough when we were out one afternoon when it was a bit choppy, and she reflected afterwards that the sensation was just like being on one of the Sydney Harbour ferries when the sea is a bit rough, "... and I love that sensation," so if it feels the same it should have the same outcome, right? The fact that she never gets sick on airliners played into the epiphany too.
Self-talk
Accepting that there was an emotional/psychological component to her airsickness put her into exploration mode, and she started reading self-help books about neuroplasticity and cognitive behavioral therapy. There's a lot of dreck out there (airport books, right?) but she gained enough nuggets of truth to give us some things to try.
First step: Consciously recognizing anxiety responses: Heart rate increasing, skin getting clammy from sweat, breathing becoming shallower and faster, "tight feeling" in her chest. Recognizable signs of fear and anxiety in all of us. Training herself to recognize her own condition enabled her to say, "Okay, I know I'm feeling like this, but are there any other ways I can feel instead?"
She built on her previous realization about the ferries: When she recognized signs of anxiety, she'd close her eyes and consciously visualize being on board a vessel in high seas. She found that helped a bit: The anxiety symptoms didn't dissipate, but they didn't get worse. But she can't fly around with her eyes closed all the time, right?
She tried bringing photos with her, depicting calm and relaxing settings: Mountain valleys in Switzerland, garden scenes, puppies and kittens, sunsets. Made a little flip-book of nice things to look at, which she could use to mentally relocate herself into the photo when fear physiology asserted itself. That helped a lot.
She tried self-talk: Personalizing the anxiety, visualizing it as a person knocking and trying to enter. "Not right now, Sir, I'm busy. Maybe come back later and I'll deal with you then." Can't eliminate the emotional response to fear, but you can negotiate with it.
We tried working on it together. Vagus nerve, amygdala response. Standing close together face-to-face and focusing on synchronizing breathing, deep and fast inhale, slow and measured exhale. I'm comfortable at 3 breaths per minute, 5 seconds in and 15 seconds out. Synchronizing with that demands focus from her, which removes focus from the source of anxiety. "If I'm afraid and when it's gone the only thing that's changed is how I'm breathing, was it really that important to begin with?"
Fear is the "fight, flight or freeze" reaction that kept us safe on the savannah from prehistoric predators. It's a useful emotion, but only when there's an active threat you weren't previously aware of. Outside that limited arena, it does very little for us, and if we have the resiliency skills to manage it we can make it go away.
She's spent more than a decade acquiring those skills.
This weekend
Yesterday we launched from Bankstown to go to lunch at Cessnock in the Hunter Valley, about 30 minutes flying time North of Sydney, in one of our wine-growing regions.
She'd been spending time with me at the hangar in the weeks leading up to the trip. Once she trained herself to recognize anxiety, she realized that she felt it every time she was in the vicinity of the airplane, so she's been coming with me to the airport as a form of exposure treatment. Sometimes we've taken local scenic flights -- more exposure. But sometimes we've just swept out the hangar, or she's read a book and nibbled snacks from one of the armchairs while I've been doing maintenance. So now she's comfortable being around the plane.
Once our occasional local scenic flights reached half an hour, that broke a kind of barrier, because Cessnock is half an hour away, and if she can fly laps of the Sydney area for 30 minutes without being sick there's no reason why she can't go in straight lines without being sick too, right?
So once we reached that threshold, she started looking for lunch dates on the calendar.
Early yesterday afternoon, I started us up and taxied out, departing Bankstown VFR via Parramatta for Cessnock. It was a pretty uneventful flight in smooth air, terminating on Runway 35 at YCNK. Walked over to the Lovedale Pub and got lunch, which we ate next to the pool.
Met up with Matilda, a local Freedom Formation member, for a pre-departure chat, then launched homeward. She was asleep by the time we reached Warnervale, woke up again on descent near Prospect.
A successful day: First time she's flown with me outside the Sydney city limits since January 2014. She didn't even mention airsickness.
The aftermath
Well, she wants more.
We'll do a $100 hamburger run to Scone at some point in the next month or so. That's about 45 minutes away, 50% further than Cessnock.
If she's good with that, maybe dropping in on Moruya. Later: Merimbula.
Or maybe just some consolidation, where we make sure we're comfortable with where we're at and don't stress-out over "stretch goals." Whatever matches the mood. If it's a psychological stress reaction, we're not going to add stress, right?
We now know that there's a pathway from a 30 min flight to a 120 min flight, and if we reach that we can fly just about anywhere in the country in 2 hour legs. I know now that if I say, "Swan Hill is 3 hours away," her heart will race unpleasantly; But we both know that it did the same thing last year if we talked about any flying whatsoever, so that's manageable now.
Light at the end of the tunnel. That's good enough for me. It's taken 15 years to get to this point, we'll be touring the country in no time.
- mark
