Jet Lag Disorder

Jet lag, also called jet lag disorder, is a temporary sleep disorder that can affect anyone who quickly travels across multiple time zones. Jet lag is caused by a disruption to your body's internal clock or circadian rhythms — which tell your body when it's time to be awake and when it's time to sleep. The more time zones crossed, the more likely you are to experience jet lag.

Jet lag can cause daytime fatigue, an unwell feeling, difficulty staying alert and gastrointestinal problems. Jet lag is temporary, but it can significantly degrade your vacation or business travel comfort. Fortunately, there are steps you can take to help prevent or minimize jet lag.

Symptoms

Symptoms of jet lag can vary. You may experience only one symptom or multiple symptoms. Jet lag symptoms may include:

• Disturbed sleep — such as insomnia, early waking or excessive sleepiness
• Daytime fatigue
• Difficulty concentrating or functioning at your usual level
• Stomach problems, constipation or diarrhea
• A general feeling of not being well
• Muscle soreness
• Menstrual symptoms in women

Symptoms worse the farther you travel
Jet lag symptoms usually occur within a day or two of travel if you've traveled across at least two time zones. Symptoms are likely to be worse or last longer the more time zones that you've crossed, especially if you travel in an easterly direction. It's estimated to take about a day to recover for each time zone crossed.

When to see a doctor
Jet lag is temporary. But if you are a frequent traveler and continually struggle with jet lag, you may benefit from seeing a sleep specialist.

Causes

A disruption to your circadian rhythms
Jet lag can occur anytime you cross two or more time zones. Jet lag occurs because crossing multiple time zones puts your internal clock or circadian rhythms, which regulate your sleep-wake cycle, out of sync with the time in your new locale. For instance, you lose six hours on a typical New York to Paris flight. That means that if you leave New York at 4:00 p.m. on Tuesday, you arrive in Paris at 7:00 a.m. Wednesday. According to your internal clock, it's 1:00 in the morning, and you're ready for bed, just as Parisians are waking up. And because it takes a few days for your body to adjust, your sleep-wake cycle, along with most other body functions, such as hunger and bowel habits, remains out of step with the rest of Paris.

The influence of sunlight
A key influence on your internal clock is sunlight. That's because the pineal gland, a part of the brain that influences circadian rhythms, responds to darkness and light. Certain cells in your retina — the tissue at the back of your eye — transmit the signal of light to an area of your hypothalamus, a part of your brain. The signal is then sent to your pineal gland. At night, the pineal gland releases the sleep-promoting hormone melatonin. During the day, melatonin production is very low. So you may be able to ease your adjustment to your new time zone by exposing yourself to daylight in that new time zone.

Airline cabin pressure and atmosphere
Some research shows that the changes in cabin pressure associated with air travel may contribute to some symptoms of jet lag, regardless of travel across time zones. A July 2007 study published in the New England Journal of Medicine showed that simulated air travel at cabin pressures equivalent to 7,000 to 8,000 feet of elevation produced symptoms of altitude-related malaise (a feeling of unwellness), muscular discomfort and fatigue. In addition, most airline cabins circulate very dry air, which can be dehydrating. And mild dehydration can contribute to feelings of malaise, headache, and eye and nasal discomfort.

Risk factors

Factors that increase the likelihood you'll experience jet lag include:

• Number of time zones crossed. The more time zones you cross, the more likely you are to be jet-lagged.
• Flying east. You may find it harder to fly east, when you "lose" time, than to fly west, when you gain it back.
• Being a frequent flyer. Pilots, flight attendants and business travelers are most likely to experience jet lag.
• Being an older adult. Older adults may need more time to recover from jet lag than may younger adults.

Complications
Extreme variations in circadian rhythms have been reported in some instances of heart attacks and strokes, but this is rare.

Treatments and drugs

Jet lag usually doesn't require treatment. However, if you're a frequent traveler continually bothered by jet lag, your doctor may prescribe medications or light therapy.
Medications

• Nonbenzodiazepines, such as zolpidem (Ambien), eszopiclone (Lunesta) and zaleplon (Sonata)
• Benzodiazepines, such as triazolam (Halcion)

These medications may help you sleep during your flight and for several nights afterward. Side effects are uncommon, but may include nausea, vomiting, amnesia, sleepwalking, confusion and morning sleepiness. Although these medications appear to help sleep duration and quality, they may not diminish daytime symptoms of jet lag.

Light therapy
Your body's internal clock or circadian rhythms are influenced by exposure to sunlight, among other factors. When you travel across time zones, your body must adjust to a new daylight schedule and reset, allowing you to fall asleep and be awake at the appropriate times.

Light therapy can help ease that transition. It involves exposing your eyes to an artificial bright light or lamp that simulates sunlight for a specific and regular amount of time during the time when you are meant to be awake. This may be useful, for example, if you are a business traveler and are frequently indoors — away from natural sunlight — during the day in a new time zone. Light therapy comes in a variety of forms including a light box that sits on a table, a desk lamp that may blend in better in an office setting, a light visor that you wear on your head, and a dawn simulator that gradually makes a room brighter — simulating sunrise — which may help you awaken in the morning.

Lifestyle and home remedies

Sunlight
Use sunlight to reset your internal clock. It's the most powerful natural tool for regulating the sleep-wake cycle.
Plan ahead to determine the best times for light exposure on the basis of your origination and destination points and overall sleep habits. An online jet lag calculator may make this task easier.
For example, a poor sleeper traveling from New York to Paris is advised to seek light between 11:20 a.m. and 2:00 p.m. on the first day in France and between 8:20 a.m. and 11:00 a.m. on the second day. By the third or fourth day, the traveler's internal clock should mesh with the local time. The results are even better if light exposure is combined with exercise such as walking or jogging.
Avoiding light at certain times is every bit as important as taking it in at others. The hypothetical New York to Paris traveler should avoid light from 9:00 a.m. to 11:20 a.m. on day one and from 6:00 a.m. to 8:20 a.m. on day two for best results. In the real world, that can be a challenge. At night, draw the blinds or drapes in your hotel room or use a sleep mask. During the day, dark glasses can help block out light.

Caffeine
Using caffeine, such as in the amounts you encounter in beverages like coffee, espresso and soft drinks, may help offset daytime sleepiness. However, it's best to time caffeine use so that it doesn't interfere with planned bedtime, because it may make it even more difficult to fall asleep or sleep well. So, for example, you may not want to consume caffeine within six hours of when you plan to go to bed.

Alternative medicine

Melatonin
As a jet lag remedy and sleep aid, melatonin has been widely studied, and it is now a commonly accepted part of effective jet lag treatment. The latest research seems to show that melatonin does indeed aid sleep during times when you wouldn't normally be resting, making it of particular benefit for people with jet lag.
The hormone is treated as a darkness signal by your body and generally has the opposite effect of bright light. The time at which you take melatonin is important. If you are trying to reset your body clock to an earlier time, you should take melatonin in the evening. If you are trying to reset your body clock to a later time, melatonin should be taken in the morning.

Small doses — as little as 0.5 milligram — seem just as effective as doses of 5 milligrams or higher, although higher doses have been shown by some studies to be more sleep-promoting. If you do use melatonin, take it 20 minutes before you plan to sleep or ask your doctor about the proper timing. Avoid alcohol when taking melatonin. Side effects are uncommon but may include dizziness, headache and loss of appetite, and possibly nausea and disorientation.

Investigate other remedies
Most frequent fliers have a favorite jet lag cure, from aromatherapy or homeopathy to special diets. Many of these diets alternate days of feasting and fasting and high-protein and low-protein meals. Though no anti-jet-lag diets have definitively been shown to work, some people swear by them. If the diets themselves seem too complicated, you can approximate their effects by simply eating more high-protein foods to stay alert and more carbohydrates when you want to sleep. Most alternative jet lag therapies aren't harmful and may be worth a try if nothing else helps.

Prevention

A few basic steps may help prevent jet lag or reduce its effects:

• Arrive early. If you have an important meeting or conference — anything that requires you to be in top form — try to arrive a few days early to give your body a chance to adjust.
• Get plenty of rest before your trip. Starting out sleep-deprived makes jet lag worse.
• Gradually adjust your schedule before you leave. If you're traveling east, try going to bed one hour earlier each night for a few days before your departure. Go to bed one hour later for several nights if you're flying west. If possible, eat meals closer to the time you'll be eating them at your destination.
• Regulate bright light exposure. Because light exposure is one of the prime influences on your body's circadian rhythm, regulating light exposure may help you adjust to your new location. If you have traveled west, wear sunglasses and avoid bright light in the morning, and then allow as much sunlight as possible in the late afternoon for the first days in your new location. If you have traveled east, bright sun exposure in the morning hours will be the most beneficial to helping your body adjust to the local time.
• Stay on your new schedule. Set your watch to the new time before you leave. Once you reach your destination, try not to sleep until the local nighttime, no matter how tired you are.
• Stay hydrated. Drink plenty of water before, during and after your flight to counteract the dehydrating effects of dry cabin air. Dehydration can make jet lag symptoms worse. For the same reason, avoid alcohol and caffeine, both of which dehydrate you further.

Source: Mayo Foundation for Medical Education and Research