What are the treatment options for jet lag?

Jet Lag Treatment

Melatonin (0.5-5mg) taken close to target bedtime (10pm-midnight) at your destination is the most effective treatment for jet lag, particularly when crossing five or more time zones eastward, with a number needed to treat of 2. 1

Primary Pharmacological Treatment

Melatonin is the cornerstone of jet lag management and should be recommended to all adult travelers crossing five or more time zones. 1 The evidence demonstrates:

• Dosing: 0.5-5mg doses are similarly effective, though 5mg helps people fall asleep faster and sleep better than 0.5mg 1
• Timing is critical: Take melatonin close to target bedtime (10pm-midnight) at the destination 1
• Avoid daytime dosing: Taking melatonin early in the day causes sleepiness and delays adaptation to local time 1
• Duration: Slow-release 2mg formulations are less effective than immediate-release, suggesting short-lived higher peak concentrations work better 1
• Efficacy: Nine out of ten trials demonstrated effectiveness, with benefit increasing proportionally to the number of time zones crossed 1

Important Safety Precautions

• Medical supervision required: All pharmacological sleep interventions including melatonin should be overseen by a physician 2
• Contraindications: People with epilepsy should avoid melatonin due to case reports of adverse effects 2
• Drug interactions: Potential interaction with warfarin has been reported and requires investigation 2, 1

Complementary Non-Pharmacological Strategies

Light Exposure Management

Light exposure is the most powerful external regulator of circadian rhythms and should be combined with melatonin for optimal results. 2 The British Journal of Sports Medicine emphasizes this as foundational therapy. 2

• Pre-flight adaptation: Advancing sleep schedule by 1 hour per day for 3 days before eastward travel, combined with morning bright light (>3000 lux) for 3.5 hours after waking, produces 1.5-2.1 hour phase advances 3
• Intermittent bright light: Exposure patterns of 0.5 hours on/0.5 hours off are as effective as continuous bright light 3

Caffeine and Sleep Aids

• Slow-release caffeine or combination caffeine-melatonin may help reduce symptoms 2
• Short-acting hypnotics: For short stopovers (1-2 days) where circadian adaptation is not advised, judicious use of short-acting hypnotics like triazolam (≤12.5mg) combined with strategic naps and caffeine maintains alertness 4, 5

Behavioral Measures

• Hydration: Maintain appropriate hydration while avoiding excessive caffeine or tea during flights 2
• Avoid alcohol: Alcohol alters cognitive function, triggers anxiety, and disrupts sleep 2
• Sleep hygiene: Should always be considered first before pharmacological interventions 2

Duration-Based Treatment Strategy

Short Stopovers (1-2 days)

• Do not attempt circadian adaptation 4
• Use short-term measures: strategic naps, caffeine, and short-acting hypnotics 4

Intermediate Stays (3-5 days)

• Aim for circadian nadir within sleep period, though difficult to achieve 4
• Combine timed light exposure with melatonin 4

Longer Stays (>4-5 days)

• Full adaptation strategies: Timed light exposure/avoidance plus melatonin 4
• Eastward travel requires 5-14 days for complete resynchronization 5
• Westward travel requires 3-7 days for resynchronization 5

Direction-Specific Considerations

Eastward travel is more difficult than westward travel because humans naturally have circadian rhythms of 24-26 hours, making day prolongation (westward) easier to tolerate than day shortening (eastward). 5 Performance decrements may persist up to 72 hours following travel across multiple time zones. 2

Special Population Considerations

• Elderly patients: Already have diminished circadian hormonal rhythms and experience more severe jet lag symptoms with longer recovery times 5
• Cognitive impairment: Adapt medication timing to local time at arrival; jet lag severity is proportional to time zones crossed and cumulative sleep loss 2

Common Pitfalls to Avoid

• Wrong timing of melatonin: Early daytime administration causes sleepiness and delays adaptation 1
• Insufficient dose: While 0.5mg works, 5mg provides better sleep onset and quality 1
• Ignoring pre-flight preparation: Pre-flight circadian adjustment is the most effective strategy but requires time and commitment 4
• Alcohol consumption: Worsens cognitive function and sleep quality during adaptation 2