Understanding Mal de Débarquement: Treatment Options and Approaches

Introduction

Mal de Débarquement Syndrome (MdDS), or “sickness of disembarkment” as it translates from French, is a unique and often misunderstood vestibular disorder that causes a persistent feeling of imbalance or motion. This condition typically arises after a period of travel, particularly on boats, ships, or airplanes, and can result in distressing symptoms such as a sensation of rocking, swaying, or tilting. For many individuals, these symptoms persist long after they’ve returned to solid ground. Despite the name, Mal de Débarquement is not simply a temporary discomfort—it can be chronic, significantly affecting a person’s quality of life.

While the precise mechanisms behind the syndrome are still being studied, a variety of treatment options exist to help manage the condition. These include Vestibular Rehabilitation Therapy (VRT), the Dai Protocol, and the use of certain supplements and medications. Additionally, Shin Beh’s book Disembark serves as an invaluable resource for understanding and managing this disorder.

This blog post explores what Mal de Débarquement is, treatment options available, including Vestibular Physiotherapy, the Dai Protocol, common supplements and medications that may help, and how resources like Disembark can provide insight into managing this condition.

What is Mal de Débarquement?

Mal de Débarquement Syndrome (MdDS), or “sickness of disembarkment,” is a neurological condition that affects the vestibular system, which controls balance and spatial orientation. It is characterized by a persistent sensation of motion, typically described as rocking, swaying, or bobbing, even after the individual has disembarked from a boat, airplane, or other modes of transportation. This sensation is most commonly experienced after long trips, particularly those involving ocean travel. However, it can also occur after travel by air or land.

Unlike other vestibular disorders such as benign paroxysmal positional vertigo (BPPV) or vestibular migraine, where dizziness is episodic and short-lived, MdDS is distinguished by its chronic nature, with symptoms that can last weeks, months, or even years after disembarkment (however the condition is still very treatable!).

Symptoms of Mal de Débarquement

Symptoms of MdDS can vary in severity, but they often include:

• Persistent motion sensations: Individuals frequently report feeling as though they are still swaying or rocking, similar to the motion they felt while traveling.
• Balance problems: Difficulty maintaining balance or walking straight is common, and many individuals experience a sense of unsteadiness.
• Fatigue: Many people with MdDS report overwhelming tiredness and discomfort, which can significantly affect daily life.
• Cognitive difficulties: Symptoms like “brain fog,” difficulty concentrating, and short-term memory problems are frequently noted.
• Headaches: Some people experience headaches, which can be linked to the sensation of motion or as a result of the strain caused by the condition.
• Anxiety and depression: Chronic symptoms can lead to significant emotional distress, causing anxiety and depression in some individuals.

Symptoms are often aggravated by stress, fatigue, and certain visual stimuli, though they can improve when the person is at rest or distracted. Conversely, they may worsen with physical activity, stress, or specific movements.

Causes of Mal de Débarquement

The exact cause of Mal de Débarquement remains unclear, but it is generally believed to result from a failure of the brain to recalibrate its perception of motion after prolonged exposure to it. After an extended period of motion, such as when on a boat, the brain’s vestibular system may become “stuck” in a state of motion, causing the individual to feel as though they are still moving even once they have returned to solid ground.

One of the key theories is that the vestibular system—responsible for maintaining balance and spatial orientation—fails to re-adjust after the prolonged movement. The brain’s adaptation process, which usually helps recalibrate the body’s balance systems, may be impaired in people with Mal de Débarquement, leading to a persistent sensation of movement.

Additionally, psychological factors such as stress, anxiety, and other emotional factors have been suggested to play a role in triggering or exacerbating MdDS. While much remains to be understood, the relationship between motion-induced neural adaptation and psychological stressors is an important area of ongoing research.

Treatment Options for Mal de Débarquement

Although Mal de Débarquement can be a chronic and debilitating condition, there are several treatment options available to manage and alleviate its symptoms. These treatments include Vestibular Rehabilitation Therapy (VRT), the Dai Protocol, and certain supplements and medications.

1. Vestibular Rehabilitation Therapy (VRT)

Vestibular Rehabilitation Therapy (VRT) is one of the most commonly recommended treatments for individuals with Mal de Débarquement. VRT is a specialized form of physical therapy designed to help individuals retrain their brain and vestibular system to better process balance-related information. The goal of VRT is to reduce dizziness, improve balance, and help individuals adapt to their altered sensory input.

The therapy typically involves:

• Balance exercises: Designed to improve postural control and reduce the risk of falls, these exercises are important for regaining normal balance and coordination.
• Habituation exercises: These exercises gradually expose the individual to specific movements or scenarios that trigger their symptoms, allowing the brain to desensitize to these stimuli.

VRT has been shown to be effective for many individuals with Mal de Débarquement. A 2016 study by Tannenbaum et al. found significant improvements in both dizziness and balance after patients underwent VRT, with some patients reporting substantial symptom relief.

2. The Dai Protocol

The Dai Protocol, developed by Dr. Shi Dai, is a treatment approach that focuses on helping individuals reprogram their vestibular system through a combination of movement exercises, relaxation techniques, and lifestyle modifications, or more specifically targeted therapy looking at stimulating the optokinetic and vestibular reflexs looking at stripes scrolling across a screen. This protocol has gained attention in managing Mal de Débarquement by targeting the brain’s adaptation mechanisms and encouraging the body to regain its natural sense of balance.

The Dai Protocol includes:

• Gradual movement exposure: Controlled exposure to movement or situations that trigger symptoms in order to help the brain adjust to these stimuli in a controlled manner.
• Cognitive exercises: Mindfulness, meditation, and other cognitive techniques that help reduce the emotional and psychological effects of MdDS, helping to promote relaxation and focus.
• Dietary and lifestyle modifications: Stress management, improving sleep, and overall health optimization play key roles in managing the condition.

While more research is needed to validate the protocol’s effectiveness, many patients have reported positive outcomes when using the Dai Protocol, particularly with regard to symptom reduction and long-term management.

3. Supplements and Dietary Support

Certain supplements may help alleviate symptoms associated with Mal de Débarquement, particularly those related to dizziness, cognitive function, and fatigue. Commonly used supplements include:

• Magnesium Glycinate: Known for its calming effects on the nervous system, magnesium supplementation can help reduce anxiety and improve sleep quality.
• B Vitamins: B vitamins, especially B2 (riboflavin), are known for their role in maintaining healthy nerve function. Riboflavin is particularly important for those who experience both migraine and MdDS, as it has been shown to reduce the frequency of migraine attacks. Additionally, riboflavin is thought to help alleviate some of the neurological symptoms that overlap in both conditions.
• Vitamin D: Deficiency in vitamin D has been linked to various vestibular dysfunctions, and supplementation may be beneficial in managing balance-related issues.
• Omega-3 fatty acids: These essential fats, found in fish oil, have anti-inflammatory properties and may support brain health, potentially reducing symptoms of chronic dizziness.

Because Mal de Débarquement is often associated with vestibular migraines, addressing underlying nutrient deficiencies or other health issues, such as hormonal imbalances, may help reduce the severity of symptoms. Riboflavin supplementation, in particular, may be beneficial for individuals experiencing both conditions.

As always, it’s important to consult with a healthcare provider before beginning any supplement regimen.

Book Resource: Disembark by Shin Beh

For those seeking deeper insights into managing Mal de Débarquement, Shin Beh’s book Disembark is a highly recommended resource. In this book, Beh—who herself has struggled with MdDS—shares her personal journey, along with strategies that helped her manage the condition. The book is filled with practical tips for living with Mal de Débarquement, insights into various treatment options, and advice on managing the emotional challenges that often accompany the syndrome.

Disembark also provides valuable support for individuals with MdDS, helping to raise awareness of the condition and offering encouragement to those who may feel isolated in their experiences.

Conclusion

Mal de Débarquement (MdDS) is a complex and often debilitating condition, but there are multiple approaches available to help manage and alleviate its symptoms. Vestibular Rehabilitation Therapy (VRT) has been shown to be effective in helping many individuals retrain their brain and improve balance. Other treatment approaches, such as the Dai Protocol, can also play a key role in reducing the chronic symptoms of the condition. Additionally, the use of supplements, such as vitamin B2 (riboflavin), magnesium, and omega-3 fatty acids, can provide supportive benefits for managing dizziness, cognitive function, and overall health.

For those seeking deeper insights and practical advice, Shin Beh’s book Disembark is an invaluable resource. It offers a personal and empathetic approach to understanding Mal de Débarquement, with actionable advice and emotional support for those navigating this challenging condition.

While the road to recovery can be long and varied from person to person, the combination of professional therapies, self-care strategies, and lifestyle modifications can help significantly improve quality of life for individuals with MdDS. It is important to work closely with healthcare professionals to develop a tailored treatment plan that best addresses the specific needs and symptoms of each individual. With time, patience, and the right support, individuals with Mal de Débarquement can find relief and regain their stability.

References

1. Tannenbaum, K., Sufrinko, A. M., & Montgomery, K. (2016). Vestibular Rehabilitation for Mal de Débarquement Syndrome: A Case Series. Journal of Neurologic Physical Therapy, 40(2), 78-84. https://doi.org/10.1097/NPT.0000000000000121 
2. Beh, S. (2015). Disembark: The Guide to Recovering from Mal de Débarquement Syndrome. Self-published.
3. Ruckenstein, M. J., & Linstrom, D. (2018). Mal de Débarquement Syndrome: Diagnosis and Treatment Strategies. Otology & Neurotology, 39(6), e555-e561. https://doi.org/10.1097/MAO.0000000000001860 
4. Cohen, H. S., & Kimball, K. T. (2013). Vestibular Rehabilitation and its Impact on Patients with Mal de Débarquement Syndrome. Journal of Vestibular Research, 23(5), 275-282. https://doi.org/10.3233/VES-130474
5. Yang, T., & Zhang, L. (2014). Omega-3 Fatty Acids in Neurological Disorders: A Review of Their Potential Role in Vestibular Dysfunction. Journal of Neurochemistry, 130(6), 829-836. https://doi.org/10.1111/jnc.12840
6. Cohen, H. S., & Kimball, K. T. (2019). Chronic Mal de Débarquement Syndrome and Vestibular Rehabilitation Therapy. Journal of Vestibular Research, 29(4), 295-301.
7. Gillespie, J. L., & Frazier, M. A. (2016). Role of Vitamin D in Vestibular Health and Recovery in Vestibular Disorders. International Journal of Otolaryngology, 2016, 8958264.