Dealing with Jet Lag

Quite simply, Jet lag is a mismatch between the time your body thinks it is and what time the clock says it is.  Desynchronosis, as it is known as in the medical community, is a serious phenomenon - one in which mismanagement can take days of enjoyment off of your trip or cause under performance on the job.  From a travelers perspective, jet lag can occur anytime travel crosses timezones.  The more timezones crossed, the higher the likelihood of developing symptoms.  For the non traveler, desynchronosis can occur when working several different shifts throughout the week.  

The symptoms of Jetlag eventually improve as your body becomes accustomed to the new pattern of sleep and wake cycles but this process can take several days.  While your body is adjusting you may experience numerous symptoms including: difficulty falling asleep or staying asleep, daytime drowsiness, difficulty thinking or concentrating, agitation, digestive issues such as nausea or diarrhea and decreased energy. For the road warrior proper management of jet lag can be the difference between closing a major business deal or a very long flight home with the boss.  For the leisure traveler, it can be the difference between watching the sun rise over Haleakalā or sleeping in.

Sunrise over Haleakalā

The biological basis of jet lag is simple.  Your body has an internal clock which is based on 24hour cycles of light and dark, wake and sleep.  When you cross timezones you either add (going west) or subtract (going east) hours from the day.  After a transatlantic flight, your body thinks it is 1am but the local time is 7am.  The best methods to coping with jet lag involve behavioral modifications.  If you are flying west you should attempt to stay up until it gets dark.  If you are flying east the best medical advice involves avoiding bright morning light but to get outside as much as possible in the afternoon.  In my personal experience I've had success with forcing myself to stay awake until around 9pm local time, then waking up with the sun the following day.  When it comes to meals, you should try to eat with the timezone, not when you are hungry.  Finally, try to get some sort of exercise the first day. 

When behavior modifications fail, there are a few pharmacologic options.  One of the most popular remedies is a supplement called melatonin.  Melatonin is a hormone which is naturally produced in a part of your brain called the pineal gland and helps to regulate your circadian rhythm.  While this supplement is relatively safe, it can interfere with certain medications, so please consult your doctor prior to taking it.  The usual dose is anywhere from 0.5-5 milligrams daily and the timing of the doses depends on the direction that you travel.  Melatonin was found to benefit adult patients crossing more than 5 timezones. 

Direction of travel	During the trip	1st-4th evenings in new time zone
East (for example, from the US to Europe)	After dark, 30 min before bedtime in the new time zone	After dark, 30 min before bedtime in the new time zone
West (for example, from Europe to the US or from the US to Australia)	Not needed	After dark, 30 min before bedtime in the new time zone

 

There are two newer medications which have been found to promote wakefulness called modafinil and Armodafinil.  These medications can be used to treat excessive daytime sleepiness.  While these medications were initially used in patients with sleep apnea, a large study has shown that they may decrease sleepiness in travelers.  These medications are available by prescription only and the consensus on their overall effectiveness and safety is still out. 

Finally, sedatives and stimulants also have a role in helping travelers adjust to jet lag.  Fast acting benzodiazapines such as Valium can be beneficial in promoting sleep in westward travel.  This class of medications can lead to dependence and you should have a through discussion with your doctor before starting this.  Stimulants such as caffeine may be beneficial in eastward travel, however this is more of a quick fix and does not address the underlying hormonal balance caused by the jet lag.

In summary, jet lag is common in people crossing one or more timezones.  The more timezones crossed the more severe and prolonged the symptoms will be.  Exposure to natural light and behavioral modifications are important in adjusting to a new timezone. When non medical interventions fail, melatonin is available over the counter and can help reduce the length and severity of the adjustment period