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Jet lag treatment guidelines

How long does it take for jet lag to kick in. What is jet lag and how long does it last. What is jet lag and how do you cure it.Greg Atkinson, Ronnie Henry, Alan M. Batterham, Andrew Thompson RISK FOR TRAVELERS Jet lag results from a mismatch between a person’s circadian (24-hour) rhythms and the time of day in the new time zone. When establishing risk, clinicians should first determine how many time zones the traveler will cross and what the discrepancy will bebetween time of day at home and at the destination. During the first few days after a flight to a new time zone, a person’s circadian rhythms are still “anchored” to time of day at home. Rhythms then adjust gradually to the new time zone. A useful web-based tool for world time zone travel information can be found atwww.timeanddate.com/worldclock/converter.html. If 3 time zones are being crossed, any symptoms such as tiredness are likely due to travel fatigue rather than significant jet lag, and will soon abate. Many people traveling 3 time zones away for a vacation accept the risk of jet lag as a transient and mild inconvenience, while other people who aretraveling on business or to compete in athletic events desire clear advice on prophylactic measures and treatments. If 2 days are spent in the new time zone, some people may prefer to anchor their sleep-wake schedule to time of day at home as much as is practical. Thereby, the total “burden” of jet lag resulting from the short round trip isminimized. CLINICAL PRESENTATION The symptomatology of jet lag can often be difficult to define because of variation between people, but also because the same person can experience different symptoms after each flight. Jet-lagged travelers typically experience 1 of the following symptoms after a flight across 3 time zones: Poor sleep,including difficulty initiating sleep at the usual time of night (after eastward flights), early awakening (after westward flights), and fractionated sleep (after flights in either direction) Poor performance in physical and mental tasks during the new daytime Negative feelings such as fatigue, headache, irritability, anxiety, inability to concentrate, anddepression Gastrointestinal disturbances and decreased interest in, and enjoyment of, meals Symptoms are difficult to distinguish from the general fatigue resulting from international travel itself, as well as from other travel factors such as the hypoxia in the aircraft cabin. TREATMENT Since light and social contacts influence the timing of internalcircadian rhythms, a traveler who is staying in the time zone for 2 days should try to follow the local people’s sleep-wake habits as much as possible and as quickly as possible. This approach can be supplemented with the following information on specific treatments. Light Exposure to bright light can advance or delay human circadian rhythmsdepending on when it is received relative to a person’s body clock time. Consequently, schedules have been formulated for proposed “good” and “bad” times for exposure to light after arrival in a new time zone . After flights that cross a large number oftime zones, the proposed best circadian time for exposure to light immediately after the flight may actually be when it is still dark in the new time zone, which raises the question of whether exposure to supplementary light from a “light box” is helpful. Unfortunately, to date, only 1 small randomized controlled trial on supplementary bright light forreducing jet lag has been conducted. No clinically relevant effects of supplementary light on jet lag symptoms were detected after a flight across 5 time zones going west. Diet and Physical Activity Most dietary interventions have not been found to reduce jet lag symptoms. In a recent study, long-haul flight crews showed a small improvement in theirgeneral subjective rating of jet lag, but not the separate symptoms of jet lag or alertness, on their days off work when they adopted more regular meal times. Because gastrointestinal disturbance is a common symptom, smaller meals before and during the flight might be better tolerated than larger meals. Caffeine and physical activity may be usedstrategically at the destination to ameliorate any daytime sleepiness, but little evidence indicates that these interventions reduce overall feelings of jet lag. Any purported treatments that are underpinned by homeopathy, aromatherapy, and acupressure have no scientific basis. Hypnotic Medications Prescription medications like temazepam, zolpidem,or zopiclone may reduce sleep loss during and after travel but do not necessarily help resynchronize circadian rhythms or improve overall jet lag symptoms. If indicated, the lowest effective dose of a short-to medium-acting compound should be prescribed for the initial few days, bearing in mind the adverse effects of these drugs. Taking hypnoticsduring a flight should be considered with caution because the resulting immobility could increase the risk of deep vein thrombosis. Alcohol should not be used by travelers as a sleep aid, because it disrupts sleep and can provoke obstructive sleep apnea. Melatonin and Melatonin-Receptor Analogs Melatonin is secreted at night by the pineal gland andis probably the most well-known treatment for jet lag. Melatonin delays circadian rhythms when taken during the rising phase of body temperature (usually the morning) and advances rhythms when ingested during the falling phase of body temperature (usually the evening). These effects are opposite to those of bright light. The instructions on mostmelatonin products advise travelers to take it before nocturnal sleep in the new time zone, irrespective of number of time zones crossed or direction of travel. Studies published in the mid-1980s indicated a substantial benefit of melatonin (just before sleep) for reducing overall feelings of jet lag after flights. However, subsequent larger studies did notreplicate the earlier findings. Melatonin is considered a dietary supplement in the United States and is not regulated by the Food and Drug Administration. Therefore, the advertised concentration of melatonin has not been confirmed for most melatonin products on the market, and the presence of contaminants in the product cannot be ruled out.Ramelteon, a melatonin-receptor agonist, is an FDA-approved treatment for insomnia. A dose of 1 mg taken just before bedtime can decrease sleep onset latency after eastward travel across 5 time zones. Higher doses do not seem to lead to further improvements, and the effects of the medication on other symptoms of jet lag and the timing ofcircadian rhythms are not as clear. Combination Treatments Multiple therapies to decrease jet lag symptoms may be combined into treatment packages. Although marginal gains from multiple treatments may aggregate, evidence from robust randomized controlled trials is lacking for most of these treatment packages. One treatment package offeringtailored advice via a mobile application was piloted to be used over several months of frequent flying. Participants reported reduced fatigue compared with the comparator group and improved aspects of health-related behavior such as physical activity, snacking, and sleep quality but not other measures of sleep (latency, duration, use of sleep-relatedmedication). In conclusion, there is still no “cure” for jet lag. Counseling should focus on the factors that are known, from laboratory simulations, to alter circadian timing. Nevertheless, more randomized controlled trials of treatments prescribed before, during, or after transmeridian flights are needed before the clinician can provide robust, evidencebased advice. BIBLIOGRAPHY Atkinson G, Batterham AM, Dowdall N, Thompson A, Van Drongelen A. From animal cage to aircraft cabin: an overview of evidence translation in jet lag research. Eur J Appl Physiol. 2014 Dec;114(12):2459–68. Herxheimer A. Jet lag. BMJ Clin Evid. 2014 Apr 29;2014. pii:2303. Herxheimer A, Petrie KJ. Melatonin for theprevention and treatment of jet lag. Cochrane Database System Rev. 2002(2):CD001520. Ruscitto C, Ogden J. The impact of an implementation intention to improve mealtimes and reduce jet lag in long-haul cabin crew. Psychol Health. 2016 Jan;32(1):61–77 Ruscitto C, Ogden J. Predicting jet lag in long-haul cabin crew: the role of illness cognitions

and behaviour. Psychol Health. 2017 Sep;32(9):1055–81. Samuels CH. Jet lag and travel fatigue: a comprehensive management plan for sport medicine physicians and high-performance support teams Clin J Sport Med. 2012 May;22(3):268–73. Thompson A, Batterham AM, Jones H, Gregson W, Scott D, Atkinson G. The practicality and effectiveness ofsupplementary bright light for reducing jet-lag in elite female athletes. Int J Sports Med. 2013 Jul;34(7):582–9. Van Drongelen A, Boot CR, Hlobil H, Twisk JW, Smid T, Van der Beek AJ. Evaluation of an mHealth intervention aiming to improve health-related behavior and sleep and reduce fatigue among airline pilots. Scand J Work Environ Health. 2014Nov;40(6):557–68. Waterhouse J, Reilly T, Atkinson G. Jet-lag. Lancet. 1997 Nov 29;350(9091):1611–6. Waterhouse J, Reilly T, Atkinson G, Edwards B. Jet lag: trends and coping strategies. Lancet. 2007 Mar 31;369(9567):1117–29. Jet lag cannot be prevented, but there are things you can do to reduce its effects.Get plenty of rest before you travel. Youcould start going to bed and getting up earlier or later than usual (more like the time zone of the place you're travelling to). drink plenty of water keep active by stretching and regularly walking around the cabin try to sleep if it's night time at your destination use an eye mask and earplugs if they help you sleep do not drink too much caffeine oralcohol – they can make jet lag worse change your sleep schedule to the new time zone as quickly as possible set an alarm to avoid oversleeping in the morning go outside during the day – natural light will help your body clock adjust do not sleep during the day – only sleep at night time If your trip is short (2 to 3 days), try to eat and sleep at the timesyou would at home.