What should you do with your breath when you start to feel sick in a car or on a boat?
Start the five-in, five-out timer above at the first hint of queasiness, turn the sound on, put the phone in your lap and keep your eyes on the horizon or the road ahead. Breathe in through the nose for five and out for five, small breaths, no holds, and keep going for as long as the motion lasts. Open a window if you can. If you know a trip makes you sick, start before it does.
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Motion sickness is the body disagreeing with itself. The inner ear says you are moving, the eyes say you are not, and the mismatch sets off a cascade that ends in a cold sweat, a stomach that has stopped behaving, and the certainty that it will get worse. One of the earliest links in that cascade is the breathing: it gets fast and shallow before you have noticed anything else, and fast, shallow breathing on its own makes nausea worse.
Slow breathing is one of the few countermeasures that has been tested in a lab against actual nausea rather than against a questionnaire, and in three small trials it helped. It does not help as much as a tablet. It also has no side effects, no cost, and no need to plan ahead, which is why it is the thing to try first and the thing to use alongside whatever else works for you.
How to do it in a moving vehicle
The timer is the metronome; your eyes stay on the world outside.
- Start early. If you know the road, the ferry or the game makes you sick, begin the timer before you feel anything. If the queasiness surprises you, start at the first hint, not when you are sure.
- Sound on, phone down. Looking at a screen in a moving vehicle is one of the reliable ways to make motion sickness worse. Turn the tones on in the timer settings, put the phone face up in your lap or face down beside you, and follow the sound.
- Eyes on the horizon. The front seat, the window, the far end of the boat. Looking at something that is not moving relative to you gives the eyes and the inner ear the same story.
- Breathe out first, gently, so the first breath in is not a gulp.
- In through the nose for five, out for five. Small breaths. The slowing is what matters, not the depth, and big breaths add their own queasiness. If five seconds in feels like too much air, use the four-in, six-out timer instead.
- Keep going. The trials that found a benefit kept the breathing up through the whole exposure. Stopping the moment you feel better is when the nausea comes back.
- Air and cool. A window open a crack, a fan, something cool on the back of the neck. None of it is breathing, and all of it is in the same direction.
Screens, games and simulators
The same mismatch happens the other way round when the eyes say you are moving and the body says you are not: a virtual reality headset, a first-person game, a film shot on a hand-held camera. One of the three trials below used a virtual boat on a screen, which is a fair stand-in for a long gaming session.
The plan is the same, with one change: you cannot look at the horizon, so make the breathing carry more of the weight. Start the timer before you put the headset on or sit down to play, run it with sound through one earbud, and take a real break at the first hint of queasiness rather than pushing through. Pushing through is how a mild session becomes a ruined afternoon.
When breathing is the wrong tool
Nausea has many causes and this page covers one of them. A few plain lines about the others.
Nausea with chest pain, with pain spreading to the arm or jaw, with sudden severe headache, or with a stiff neck and fever is an emergency. Call your local emergency number; do not sit and breathe.
Nausea in pregnancy that stops you keeping fluids down, nausea with repeated vomiting, or nausea that has lasted days without an obvious cause is a reason to see a doctor or midwife. Slow breathing will not hurt in the meantime, and it is not the answer.
Nausea that comes with a racing heart, a tight chest and a sense of dread, in a situation that is not moving, is more likely anxiety than motion. The anxious moments page is built for that and runs free for anyone.
Before you start
The five-five pattern has no holds and no fast breathing. The cautions are the ordinary ones, plus two that belong to vehicles:
- Never while driving, riding a bike or at the helm of a boat. The timer is for passengers. A driver who feels sick should pull over.
- Do not look at the phone in a moving vehicle. Use the sound.
- Keep the breaths small. Deep breathing when nauseous can tip into gulping air, which makes it worse. If you feel light-headed, breathe normally.
- If you have a heart or lung condition, or you are pregnant, check with your doctor before taking up any regular breathing practice.
Nothing here treats motion sickness, nausea or any condition. It is a way to spend the part of the journey that was going to be unpleasant anyway.
What the evidence shows
Three small lab trials, all on healthy adults who were known to get motion sick, all with the nausea produced on purpose.
In a 1999 study in Aviation, Space, and Environmental Medicine, Jokerst and colleagues put "46 healthy males and females aged 17-26" who were susceptible to motion sickness in a rotating optokinetic drum, with one group told to breathe slowly and deeply. They measured the stomach's electrical rhythm as well as symptoms. The gastric disturbance "increased during rotation for the Counting Breaths group and the Control group, but remained the same as baseline for the Slow Deep Breathing group", and "The Slow Deep Breathing group (5.3) reported significantly fewer symptoms than the Counting Breaths group (9.0), but not the Control group (7.8)." So the stomach result was clear and the symptom result was mixed.
In a 2003 study in the Journal of Travel Medicine, Yen Pik Sang, Golding and colleagues rotated twenty-four people until they reached moderate nausea, on three separate days, with controlled breathing, a calming audio tape, or nothing. Tolerance "was significantly longer (p <.01) for controlling breathing (10.7 +/- 5.6 min)" than for control "(9.2 +/- 5.9 min)", with the tape doing about the same. Their own summary is the one to remember: "These nonpharmacologic countermeasures are only half as effective as standard doses of anti-motion sickness drugs, such as oral scopolamine; however, they are easy to implement and free of side effects."
In a 2015 study in Aerospace Medicine and Human Performance, Stromberg and colleagues trained half of 43 susceptible people "to pace their diaphragmatic breathing at six breaths/min" and showed everyone ten minutes of a virtual boat in rough seas. The trained group only managed "eight breaths/min during the VR experience", which was still much slower than the controls, and they "reported feeling less motion sickness during exposure to the VR experience than those in the control group."
Taken together: slow breathing at around six a minute, started early and kept up, reduced nausea in three small lab experiments, by an amount the one head-to-head comparison put at about half a tablet. Nobody has tested it in a real car with real children, and none of these trials looked at nausea from any cause other than motion.
Common questions
When should I start breathing: before the trip or when I feel sick?
At the first hint of queasiness, and earlier if you know the trip makes you sick. In the trials, the people who did best started slow breathing before or at the first symptoms and kept it going; once you are already very nauseous there is less that any breathing can do.
How slow should the breathing be?
About six breaths a minute: five seconds in, five seconds out, which is what the timer counts. One trial trained people to six a minute and found they managed about eight a minute once the boat started rocking, which was still slow enough to help. Slower than your normal pace is the point; the exact number is less important.
Should I breathe through my nose or mouth?
Nose in, and nose or lips out, whichever is comfortable. The one thing to avoid is big gulps of air through the mouth, which add their own queasiness. Keep the breaths small and the exhale slow.
Does it work as well as travel sickness tablets?
No. The one trial that said so directly found controlled breathing and a calming audio tape each bought about a minute and a half more tolerance of a nauseating rotation, and the authors wrote that these methods are about half as effective as standard doses of anti-motion-sickness drugs. Breathing has no side effects and costs nothing, which is why it is worth having alongside whatever else you use.
Can I use it for morning sickness or a hangover?
You can try, and it will not hurt, but nothing on this page was tested for nausea that comes from the gut, hormones or alcohol. The trials were all about motion. Nausea in pregnancy that stops you keeping fluids down is a reason to call your midwife or doctor, not to breathe through it.
What about children who get carsick?
The same idea in a simpler shape: slow breaths with a long exhale, eyes forward, window open a crack. The three-count triangle on the kids page is easy for a child to follow, and a parent counting out loud works as well as any timer. Do not give a child a phone to look at in a moving car; that makes motion sickness worse.
A note on what this is
Nothing on this page is medical care, and none of it replaces treatment or a conversation with your doctor. Read the medical disclaimer. Nausea that is severe, persistent, or comes with pain, fever or a headache is a reason to seek care, not a reason to breathe through it.