General Travel Health

Jet Lag -- New Approaches to an Old Problem.
-- By Frank Gillingham, MD

Although the ease of international travel has increased, jet lag remains a common problem. A study by The Upjohn Company reported that 94% of long-haul travelers experience it, while another survey found that 9 out of 10 flight attendants complain of jet lag, despite their familiarity with international travel. The symptoms are well known: fatigue, insomnia and poor concentration. Travelers often report that they're exhausted but can't sleep--truly one of life's most frustrating experiences. The problem arises typically when you travel through three or more time zones and complete recovery can take 3 to 7 days for westward travel, and 5 to 14 days after an eastward flight.

Our bodies have internal clocks (circadian rhythms) which control many functions--including the sleep-wake cycle. Ever notice how you wake up a couple of minutes before your alarm clock rings--or you wake up at your usual 6 am even on Saturday when you'd hoped to sleep in? That's your internal clock. The key to dealing with jet lag is to reset your internal clock, the same way you reset your watch when the pilot announces the local time.

While there is genuine progress being made in understanding our biological clocks and in devising methods of resetting them, there is no miracle cure for jet lag. Here's my take on the specific methods you might consider:

• Light. Our internal clocks adjust based on daylight and many jet lag researchers believe the key to resetting the clock is to get out into the daylight. According to the Wall Street Journal, the professional golfer Gary Player walks 18 holes whenever he lands from a long flight, in an effort to adjust to the time change. The best thing about this approach is that it can't hurt--and you'll get some exercise as well. Bear in mind that light must be bright to help you adjust--standard indoor lighting is unlikely to make any difference. In addition, light helps more if you are exposed to it at a certain time of day. US travelers who fly east to west should seek sunlight in the late afternoon. US travelers who fly overnight from west to east should do so during the mid to late morning.
• Medication. Ambien and Sonata are two relatively new, prescription sleeping pills that are popular for preventing and treating jet lag. Many travelers have successfully used benadryl and other over-the-counter antihistamines that cause drowsiness (avoid Sudafed or other agents containing pseudephedrine). Medications work by helping flyers sleep--so they're particularly useful on west to east overnight flights. Of course the drawback is that these are real medications with real side effects and how you react might be different from the way other travelers react. Be careful with the dose--some travelers report trouble waking up the next morning and others fear that the medications might interfere with their ability to evacuate a plane during an emergency. Fortunately, the newer agents seem to be better tolerated than the benzodiazepine (or valium-like) agents. It's always a good idea to limit use of any of these agents to three days or so. And talk to your doctor about the medication option, particularly if you have any chronic health condtions.
• Melatonin. Melatonin is a naturally occurring hormone that is produced in the brain by the pineal gland and has been linked to the control of circadian rhythms. Melatonin is available as an over-the-counter "dietary supplement" in the U.S. and Singapore. Because dietary supplements are not regulated by the Food and Drug Administration (FDA), the composition of a pill labelled "Melatonin" may vary from manufacturer to manufacturer--even from batch to batch. In Canada, Australia and the EC pharmacies dispense Melatonin only with a doctor's prescription because of concerns over uncontrolled self-prescribing, possible impurities and long term safety issues. While some studies published over the last ten years suggest that melatonin may treat jet lag, there is continued debate about the amount and timing of the dose. Some travelers report side effects--nausea or mild depression. My feeling is that more extensive research is needed to determine the value of melatonin as a jet lag remedy--and the agent itself needs to be manufactured in a more reliable manner.
• Other treatments. Popular suggestions for combating jet lag include special diets, trips to the spa, massages, sensory deprivation flotation tanks, topical creams and acupressure, among others. There are also a number of homeopathic remedies made from herbs and other ingredients. NADH (Trade Name Enadalert) is the latest fad in this area and has been the subject of some rudimentary scientific studies, including one described recently in "The Wall Street Journal".

My advice here is to use common sense. The evidence supporting the use of these methods and agents is thin to non-existent (ie studies are fairly small and the conclusions subject to additional research). You should be hesitant to actually ingest an unknown compound to treat jet lag which you know will eventually go away. Then again, if the treatment can't hurt (a massage, a spa trip), why not? You are likely to be less affected by jet lag if you do something to combat it--regardless of what you do. That's the placebo effect and it's a good thing to put to work for you.