1et Lag

Emad A. Yanni
OVERVIEW
Jet lag is a temporary disorder among air travelers who rapidly travel across 3 or more time
zones. Jet lag results Irom the slow adjustment oI the body clock to the destination time, so
that daily rhythms and the internal drive Ior sleep and wakeIulness are out oI synchronization
with the new environment.
The intrinsic body clock resides in the suprachiasmatic nuclei at the base oI the hypothalamus,
which contains melatonin receptors. Melatonin is manuIactured in the pineal gland Irom
tryptophan, and its synthesis and release are stimulated by darkness and suppressed by light;
consequently, the secretion oI melatonin is responsible Ior setting our sleep-wake cycle. The
body clock is adjusted to the solar day by rhythmic cues in the environment, mainly the light-
dark cycle, and the rhythmic secretion oI melatonin. Exercise is also believed to exert an
eIIect on the body clock, although with a somewhat weaker eIIect than other cues.
RISK FOR TRAVELERS
Eastward travel is associated with diIIiculty Ialling asleep at the destination bedtime and
diIIiculty arising in the morning. Westward travel is associated with early evening sleepiness
and predawn awakening at the travel destination. Travelers Ilying within the same time zone
typically experience the Iewest problems, such as nonspeciIic travel Iatigue. Crossing more
time zones or traveling eastward generally increases the time required Ior adaptation. AIter
eastward Ilights, jet lag lasts Ior the number oI days roughly equal to two-thirds the number
oI time zones crossed; aIter westward Ilights, the number oI days is roughly halI the number
oI time zones.
Individual responses to crossing time zones and ability to adapt to a new time zone vary. The
intensity and duration oI jet lag are related to the number oI time zones crossed, the direction
oI travel, the ability to sleep while traveling, the availability and intensity oI local circadian
time cues at the destination, and individual diIIerences in phase tolerance.
CLINICAL PRESENTATION
Jet-lagged travelers may experience the Iollowing symptoms:
O !oor sleep, including delayed sleep onset (aIter eastward Ilight), early awakening
(aIter westward Ilight), and Iractionated sleep (aIter Ilights in either direction)
O !oor perIormance in physical and mental tasks during the new daytime
O egative subjective changes such as increased Iatigue, Irequency oI headaches and
irritability, and decreased ability to concentrate
O astrointestinal disturbances and decreased interest in and enjoyment oI meals
PREVENTIVE MEASURES FOR TRAVELERS
Travelers can minimize jet lag by doing the Iollowing beIore travel:
O Exercise, eat a healthIul diet, and get plenty oI rest.
O egin to reset the body clock by shiIting the timing oI sleep to 12 hours later Ior a
Iew days beIore traveling westward and shiIting the timing oI sleep to 12 hours
earlier Ior a Iew days beIore traveling eastward.
O $eek exposure to bright light in the evening iI traveling westward, in the morning iI
traveling eastward (although it requires high motivation and strict compliance with
the prescribed lightdark schedules).
O reak up a long journey with a stopover, iI possible.
Travelers should do the Iollowing during travel:
O Avoid large meals, alcohol, and caIIeine.
O rink plenty oI water to remain hydrated.
O Move around on the plane to promote mental and physical acuity, as well as protect
against deep vein thrombosis.
O Wear comIortable shoes and clothing.
O $leep, iI possible, during long Ilights.
Travelers should do the Iollowing on arrival at the destination:
O Avoid situations requiring critical decision making, such as important meetings, Ior
the Iirst day aIter arrival.
O Adapt to the local schedule as soon as possible.
O ptimize exposure to sunlight aIter arrival Irom either direction.
O Eat meals appropriate to the local time, drink plenty oI water, and avoid excess
caIIeine or alcohol.
O Take short naps (2030 minutes) to increase energy but not undermine nighttime
sleep.
The use oI the nutritional supplement melatonin is controversial Ior preventing jet lag. $ome
clinicians advocate the use oI 0.55.0 mg oI melatonin during the Iirst Iew days oI travel, and
data suggest its eIIicacy. However, its production is not regulated by the Food and rug
Administration, and contaminants have been Iound in commercially available products.
Current inIormation also does not support the use oI special diets to ameliorate jet lag.
TREATMENT
The 2008 American Academy oI $leep Medicine recommendations include the Iollowing:
O #emain on home time iI the travel period is 2 days or less.
O !romote sleep with hypnotic medication, although the eIIects oI hypnotics on daytime
symptoms oI jet lag have not been well studied.
O onaddictive sedative hypnotics (non- benzodiazepines), such as zolpidem, have been
shown in some studies to promote longer periods oI high-quality sleep. II a
benzodiazepine is preIerred, a short-acting one, such as temazepam, is recommended
to minimize oversedation the Iollowing day. ecause alcohol intake is oIten high
during international travel, the risk oI interaction with hypnotics should be
emphasized with patients.
O !romote daytime alertness with a stimulant such as caIIeine, but avoid it aIter midday.
O Take short naps, shower, and spend time in the aIternoon sun.