How to use melatonin to fight jet lag

Jet lag disorder is clinically classified as one of the six circadian rhythm sleep disorders. Circadian rhythm sleep disorders are formally defined as persistent or recurrent patterns of sleep disturbance due to alterations in the circadian timekeeping system or a misalignment between the circadian rhythm and exogenous factors that affect the timing or duration of sleep. In the case of the jet lag type, the “body clock” is disrupted by an exogenous factor, such as when a person travels across different meridians through rapid long haul flights.

A traveler who experiences this disorder has a body clock that still functions in the day-night rhythm set up from the place where he left off. For example, you leave New York at 6am and you arrive London at 5pm, your body then behaves as if its 12 pm. Your sleeping, eating and metabolic processes occur as though it is lunchtime.Depending on unidentified circumstances, the time whereby the body clock resynchronizes with the present time zone varies. Research suggest that the intensity and duration of jet lag disorder may be related to: 1) the number of time zones crossed, 2) the direction of travel, 3) the ability to sleep while traveling, 4) the availability and intensity of local circadian time cues, and 5) individual differences in phase tolerance.

Although jetlag disorder is self-limiting and is a benign disease, symptoms differ in severity as the affected individual notably experiences sleep disturbances, excessive daytime fatigue or somnolence causing reduced functional performance, general malaise and gastrointestinal symptoms. Once you experience a jet lag, the likelihood of recurrence increases when you travel again.

Risk factors

Age and gender

Unfortunately, there are no large systematic studies done to define the role of age and gender as a risk factor for developing jet lag disease. However, some research data suggest that older individuals experience fewer jet lag symptoms compared to younger subjects. However, the quality of data is poor and further studies are necessary to elucidate the role of age in developing this disorder.

Light exposure

It might be more difficult to adapt to local time in the short days of winter when less ambient light is available to resynchronize the one’s body clock. However, no studies have been conducted to address this specifically. Utilizing variable light intensities for 3.5 hours in the morning of the 3 days preceding prospective eastward travel, one simulation study found slower phase advances and more jet lag symptoms in those exposed to dim light versus continuous bright light. Despite these studies, the American Academy of Sleep Medicine meeting review suggests that more studies are necessary to establish the role of sunlight exposure in developing jet lag disorder.

Genetic/ Familial influences

There is no data to support that familial predisposition has a role in developing jet lag disorder.

Melatonin and Jet lag disorder

Ocular light plays a central role in human physiology by transmitting time of day information.Melatonin is a hormone produced in the pineal gland whereby it’s production is controlled by a special structure in the brain called the suprachiasmatic nucleus. The suprachiasmatic nucleus is responsive to retinal exposure to light. During daytime, the production of melatonin is low and during evening hours, it’s production gradually increases. Melatonin functions to regulate the human body clock, wherein increased melatonin levels induce drowsiness or sleepiness. Because of this, it is called the “Dracula of hormones”, since its activity increases at night and declines by daytime. Melatonin production is also affected by indoor light, wherein indoor light decreases its production. Due to this, a lot of people find it difficult to sleep with their lights turned on.

Largely because of its regulatory effects on the circadian system, melatonin has proven to be highly effective for treating the range of symptoms that accompany transmeridian air travel. After each administration, melatonin significantly increased sleep propensity, which is proven by sleep studies. According to research, melatonin can be given 2 hours prior to bedtime or at bedtime. The dose remains to be defined, but immediate release of 0.5 to 5mg appear to be effective. The efficacy of treatment with melatonin can be potentiated by the absence of light exposure since it has been well documented that light directly inhibits melatonin production. Alcohol intake should be avoided when taking melatonin as it poteniates it effect.

Other treatments for Jet Lag disorder

The use of hypnotic agents for jet lag disorder are an accepted treatment and are part of the standard recommendations for short-term insomnia. However, the effect of hypnotics on daytime jetlag symptoms such as daytime somnolence and fatigue have not been studied. Again, do not take alcohol together with hypnotic agents as it potentiates it effect.

The use of coffee to promote daytime alertness can also be done. This option should be discussed carefully with the patients as too much intake of caffeine can also disrupt the normal sleeping pattern.

Diet modification may also help in preventing jet lag disorder. The Argonne diet consists of alternating days of “feasting” with high carbohydrate dinners and “fasting” with small, low calorie meals. This study concluded that there is significant reduction in self-reported jet lag symptoms in those utilizing this diet.

Melatonin and diabetes

It has been established that short sleep duration has been associated with the increasing incidence of diabetes. This may be due to altered food-related behaviors and peripheral metabolic pathways among people who are sleep deprived. More importantly, diabetics should use melatonin with caution because it was found to have metabolic effects related to insulin sensitivity and pancreatic islet cell function.

Sleep deprivation and misalignment of the circadian rhythm can cause serious endocrinologic dysregulation, which directly affects the appetite and satiety centers of the brain. This can further aggravate weight gain and worsen glucose intolerance. In conclusion, it is very important for diabetics to have an adequate amount of sleep and close monitoring with their health care provider.

References:

• Sack MD, RL et al. (2007) Circadian Rhythm Sleep Disorders: Part I, Basic Principles, Shift Work and Jet Lag Disorders: An American Academy of Sleep Medicine Review. SLEEP, Vol. 30, No. 11, 2007
• Herxheimer, A. (2008). Jet lag. BMJ Clinical Evidence, 2008, 2303.
• Tzischinsky, O and Lavie,P. (1994). Melatonin Possesses Time-Dependent Hypnotic Effects.SLEEP, Vol. 17, No.7, 1994
• Skene DJ¹, Arendt J. (2006). Human circadian rhythms: physiological and therapeutic relevance of light and melatonin. Ann ClinBiochem. 2006 Sep;43(Pt 5):344-53.
• Srinivasan V¹, Spence DW, Pandi-Perumal SR, Trakht I, Cardinali DP. (2007).Jet lag: therapeutic use of melatonin and possible application of melatonin analogs. Travel Med Infect Dis. 2008 Jan-Mar;6(1-2):17-28. doi: 10.1016/j.tmaid.2007.12.002.
• Larcher, S, et al. (2015). Sleep and diabetes: Review. Diabetes & Metabolism. 41 (2015) 263–271.
• https://sleepfoundation.org/sleep-topics/melatonin-and-sleep/page/0/2
• http://www.mayoclinic.org/diseases-conditions/jet-lag/basics/alternative-medicine/con-20032662